NUR114 Final Review

In NC, Hemp oil may be used to treat epilepsy in children.

Which of the following is TRUE about fosphenytoin/phenytoin?

A client with a head injury has signs of increased ICP. Select all medication classes that apply to this patient's care.

What should be included in patient teaching about preventing atherosclerosis? (Select all that apply.)

The nurse should provide simple one step instructions for patients with TBI to promote patient autonomy

The nurse observes a school-age client have an absence seizure. What should be documented in the EHR?

A patient in the ER has calf pain, muscle weakness, & upset stomach. Which patient medication would concern the nurse?

Grapefruit interferes with many medications including Plavix.

What assessment finding would suggest to the nurse that a patient is experiencing a deep venous thrombosis?

Delirium is an acute, temporary condition that usually resolves when the underlying cause is identified and treated.

The nurse recognizes which of the following as a modifiable risk factor for cardiovascular disease:

Milieu therapy aims at helping family members cope with the long-term effects of mental health disorders

The reversal agent for heparin is vitamin K

Seizures are symptoms of epilepsy.

TD, EPS, and NMS are unfortunate side-effects patients must live with when prescribed anti-psychotic medications.

A client with increased ICP caused from a head injury has a GCS score of 6. Which action is the most appropriate?

What actions by the nurse will decrease environmental stimuli for a client with increased intracranial pressure. (SATA)

Elevation of the head of bed and aligning the head and neck help decrease ICP

Tonic-clonic seizures are also known as Petit-Mal seizures.

Symptoms of a seizure depends on it's type, location in the brain, & duration

A patient experiences a fever of 104 and severe neck spasms. The nurse identifies which medical emergency?

A child loses consciousness after being hit in the head. VS: HR 48, BP 148/74 , and RR 28 and irregular. This indicates?

Calculate the dose of cardizem. Order 0.25mg/kg IV over 2 minutes. Available: 25mg/5ml vial. Patient weighs 176 pounds

The number one goal of first aid is to keep the person safe until the seizure ends naturally.

A shuffling gait is a symptom of parkinsonism, a possible side effect of antipsychotic medications

What should the nurse include in the plan of care for a patient with increased ICP related to fluid status?

All the following medications are used to treat status epilepticus EXCEPT

A patient weighing 143 pounds is ordered lovenox 1mg/kg. The nurse would administer how many milligrams?

When administering Dilantin IV, the nurse should use a large vein, a filter, flush w/ normal saline, and monitor for SJS

Patients on Depakote should have their creatine and BUN monitored frequently.

Administering 500mg PO Acetaminophen every 6 hours reduces cerebral metabolism in patients with TBI

Which medication would be better for a patient with CHF on Lasix who continues to have hypokalemia?

Which nursing intervention would help a family whose child experienced a serious head injury from an accident?

Patients are more at risk for dementia following post-operative procedures related to pain medication administration.

A MRI is the most common type of diagnostic test for seizures.

A child on a ketogenic diet for seizures complains of left-sided lower abdominal pain. What complication is suspected?

What is the most appropriate precaution for seizures?

It's ok to repeat the BP in the same arm to verify a reading right after obtaining the initial reading.

Administration of docusate reduces risk for increased ICP by preventing constipation.

The ___ side of the heart is affected when a patient with CHF complains of shortness SOB & a nurse auscultates crackles

A patient post seizure is flaccid w/ upward eye deviation, and frothing at the mouth. What should the nurse do first?

Select the appropriate actions by the nurse before administration of digoxin for an irregular heart rate. (SATA)

Stress effects the central nervous system causing an increase in blood pressure, respiratory rate, and pulse.

IV Diazepam may be given slowly if a patient is experiencing tonic-clonic seizure lasting for more than 10 minutes.

A patient shows the nurse an ulcer that has formed near their ankle, a ruddiness is noted too. This is likely?

The nurse is providing education for the use of coumadin. Which of the following statements is accurate:

A 3yo had a 2 minute tonic-clonic seizure. On assmt the airway is clear, o2 94%RA, no fever, BG 118. What next?

Positive symptoms of schizophrenia include: delusions, paranoia, hallucinations, and echolalia.

Order: labetalol 20mg IV push over 2 minutes. Available: 20 ml vial with the concentration of 5mg/1ml. Calculate dose

Which of the following assessment findings could indicate the patient is experiencing poor perfusion? (SATA)

A 2-year-old had a 2 minute generalized tonic-clonic seizure and is diagnosed with RSV. What likely caused the seizure?

Kidney stones (renal calculi) are a complication of the ketogenic diet.

Elderly patients may present w/ this symptom when experiencing an infection, increased ICP, pulmonary edema, & dementia.

The ___ pulse should be used when patients have an irregular heart rate or when administering medications like digoxin.

The nurse understands most patients are prescribed aspirin in the hospital for which reason?

What can a patient do to help heal after a traumatic brain injury?

Which side effect should the nurse advise the patient to report to the healthcare provider regarding atorvastatin?

A patient has been started on gabapentin, the nurse should include what information in patient teaching? (SATA)

The nurse records the following BP:laying 146/72, sitting 132/65, and standing 112/54. Select priority nursing action?

Patients with chronic conditions like back pain or post concussion syndrome benefit from CAM

In NC, a person has to be seizure free for 6-12 months in order to drive.

Which of the following practices does NOT prevent traumatic brain injuries?

The reversal agent for coumadin is Vitamin K and the reversal for heparin is protamine sulfate.

Which of the following patients should the nurse assess for traumatic brain injury. (Select all that apply)

The nurse understands lisinopril uses which mechanism in the body to lower the patient's blood pressure?

The nurse is planning care for a client with a head injury and increased ICP from a MVC. Select priority intervention.

Using a narrow cuff can result in BP readings that are too high

The lab value for a patient with an DVT is an INR of 2.3. Select the best action by the nurse.

The nurse uses the bell to hear low pitched heart sounds.

The nurse understands which auscultation point is best for hearing a murmur of the pulmonic valve?