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NUR 242 MEDICAL SURGICAL FINAL EXAM|2025-
2026|ACTUAL 160 QUESTIONS AND
ANSWERS|ALREADY GRADED A+
Terms in this set (161) Original What are the etiologies of intracranial pressure? Hemorrhage (Fluid Build Up due to stroke or aneurysm) Cerebral Edema Cerebral Spinal Fluid Tumor pushing on tissues What is an overt S/S of cerebral Intracranial Pressure? Emesis - projectile vomiting Dizziness Other manifestations of Increasing Intracranial pressure (IICP) Pressure in the brain Increased Blood Pressure Bradycardia (Decreased Pulse) Cerebral Spinal Fluid Drainage (Ears, Nose)
How would you know that the rhinorrhea or otorrhea drainage is Cerebral Spinal Fluid and not typical drainage? Test for glucose What type of diuretic is given for Increasing Intracranial pressure? Osmotic Diuretic - Mannitol How would you know Mannitol is effective at decreasing Intracranial pressure? Increased urinary output Reduced BP Level of Consciousness Improvement Less headache Do I need to worry about orthostatic hypotension with diuretics like mannitol? No, Osmotic diuretics work differently than other diuretics. Osmotic diuretics continuously pull fluid from the rest of the body into the vascular space. Constantly filling the vascular space.
An evaluation tool used to determine level of consciousness, which assigns point values for eyes, verbal and motor functions. Frontal lobe function Involved in motor function: problem solving, memory, judgment, impulse control parietal lobe function Visual attention. Touch perception. Goal directed voluntary movements. Manipulation of objects. Integration of different senses that allows for understanding a single concept frontal lobe observed problems Loss of simple movement of various body parts (Paralysis). Inability to plan a sequence of complex movements needed to complete multi•stepped tasks, such as making coffee (Sequencing). Loss of spontaneity in interacting with others. Loss of flexibility in thinking. Persistence of a single thought (Perseveration). Inability to focus on a task (Attending).
Mood changes (Emotionally Labile). Changes in social behavior. Changes in personality. Difficulty with problem solving. Inability to express language (Broca's Aphasia or Expressive Aphasia). parietal lobe observed problems Inability to attend to more than one object at a time. Inability to name an object (Anomia). Inability to locate the words for writing (Agraphia). Problems with reading (Alexia). Difficulty with drawing objects. Difficulty in distinguishing left from right. Difficulty with doing mathematics (Dyscalculia). Lack of awareness of certain body parts and/or surrounding space (Apraxia) that leads to difficulties in self.care. Inability to focus visual attention. Difficulties with eye and hand coordination. Occipital lobe observed problems Defects in vision (Visual Field Cuts). Difficulty with locating objects in the environment.
Interference with long-term memory Increased or decreased interest in sexual behavior. Inability to categorize objects (Categorization). Right lobe damage can cause persistent talking. Increased aggressive behavior. brain stem function Breathing Heart Rate Swallowing Reflexes to seeing and hearing (Startle Response). Controls sweating, blood pressure, digestion, temperature (Autonomic Nervous System). Affects level of alertness. Ability to sleep. Sense of balance (Vestibular Function). brain stem observed problems Decreased vital capacity in breathing, important for speech. Swallowing food and water (Dysphagia). Difficulty with organization/perception of the environment. Problems with balance and movement.
Dizziness and nausea (Vertigo). Sleeping difficulties (Insomnia, sleep apnea). Cerebellum function coordination of voluntary movements and balance cerebellum observed problems Loss of ability to coordinate fine movements. Loss of ability to walk. Inability to reach out and grab objects. Tremors. Dizziness (Vertigo). Slurred Speech (Scanning Speech). Inability to make rapid movements. What are the signs and symptoms of a secondary injury? Dyspnea Changes in behavior Sudden Hypoxia (poor gaseous exchange)
Sensation and movement Below the repair site/Distal to the repair What are the two most common causes of autonomic dysreflexia in spinal injury patients? Bladder retention Fecal impaction What are your nursing responsibilities when caring for a patient with a halo vest? Skin assessment at the point where the pins are screwed into the bone Wrench available for emergency Why do I need a wrench? ENsure screws are still tightened. Skin assessment where the vest rubs against the skin What kind of procedure is it to do the daily pin care for halo patients? Asepsis and use sterile saline
What should be included in the patient teaching when the patient with the halo vest goes home? Keep a liner between the vest and patient Keep it dry and intact Turn the patient every two hours Teach them the no's No pressure on the vest Do not twist Do not grab or lift the patient by holding on to the vest What s/s that show up in the first couple of days that lead to basilar fractures Racoon eyes Battle sign Cerebral Spinal Fluid leak Watch for drainage from the nose or ears When someone becomes unconscious, what is one of the first tests we do to find out what's going on?
20 degrees Post-op teaching for someone who has head intracranial surgery Do not blow the nose If you were to teach people things to do to prevent spinal injury, what would you teach them? Good body mechanic Bend with knees Lift with legs Have a broad base of support Hold the item close to your center of gravity Ask for help Don't overextend yourself Push or pull versus picking it up if its heavy What do we do if someone falls and we don't know if they injured the spine Do not move them and call for help Implement C Spine Precautions (Immobile the neck, Keep head stable)
What is the medication that we give when the patient develops diabetes insipidus? Vasopressin What is your intervention for SIDA (hyponatremic and fluid overload)? Loop Diuretic (lasix) Thiazide Diuretics What is the dietary intervention for SIDA? Fluid restricted diet (IV and PO) What is the patient teaching for burn prevention? No cooking alone No burning candles No smoking in the house No loose clothing
Underlying pathophysiology: acute kidney injury caused by hypotension and hypovolemia. Perfusion to the kidney was cut. What electrolyte imbalance is associated with the initial third spacing of the fluids after a burn injury? hyperkalemia/Potassium Why is this electrolyte imbalance so dangerous? Leads to lethal dysrhythmias What are the other manifestations that will lead you to suspect that there were some inhalation injuries? Edema of nasal septum Hoarseness or wheezing Singeing of the nose hairs Soot/Carbon deposits around the mouth Burns to the face Why does the MAP decrease? CVP increases with cardiogenic shock forcing the map to increase
What happens to the RAAS system in cardiogenic shock Its activated Which symptoms would you see because the Sympathetic system is activated? Tachycardia Increased respirations How is Serum BNP affected with cardiogenic shock? Increased What are the expected findings of cardiogenic shock? Mean Arterial Pressure (MAP) - decreases GFR - decreased Tachycardia Increased respirations Altered LOC Which autonomic nervous system is activated in Cardiogenic Shock?
Vasodilators Increases oxygen to the myocardium Causes venous pooling What is happening when the mitral valve regurgitation? Backs up the pulmonary vein into the lungs What manifestations will you see in a patient with mitral valve regurgitation? Exertional dyspnea What is Infective Endocarditis? Vegetative Growth on Valves in the heart How does infective endocarditis affect the heart valve? the vegetation can break off into clots or emboli and cause a stroke The valve can become stenotic Aortic stenosis occurs when the aortic valve narrows and blood cannot flow normally.
Can't open or close correctively What are some signs and symptoms of Arterial Disease? Lack of profusion (Diminished pulses, Cooled skin) Shallow ulcers Paresthesia Paralyze (muscles cannot move if its not innervated) How does chronic arterial disease affect sensation? Causes Paresthesia (numbness and tingling) They can no longer innervate What would be some manifestations of an aortic aneurysm? Diminished pulses below umbilicus Pulsating sideways versus vertical in abdominal wall above and to the left of the umbilicus Pain in the back Pain below the site No perfusion
