Nursing 130 Exam 5 2024-2025 Questions And Answers
What is the most important nursing task to reduce pressure points on a pt? - ANS - Rotate pt every 2 hours
What is the Braden scale used for? - ANS - assess pressure ulcer risk
Which measurements are in the Braden scale? - ANS - - Sensory perception (1-4 pts)
- Moisture (1-4 pts)
- Activity (1-4 pts)
- Mobility (1-4 pts)
- Nutrition (1-4 pts)
- Friction & Shear (1-3 pts_
(total of 23 points. The lower the points the bigger the risk for pressure ulcer)
Which conditions does a brain scan pick up? - ANS - - vascular lesions
- neoplasms
- abscesses
- areas of cerebrovascular ischemia
What does a neuro chair do? - ANS - help to transfer pt's in and out of bed and serve as a comfortable place
for the pt to rest when out of bed.
If a pt. with autonomic dysreflexia gets sudden hypertension, they are at risk for______? - ANS - Death.
What can a brain abscess lead to? - ANS - Meningitis
What are the 2 signs for meningeal irritation? - ANS - - Brudzinski (stiff neck)
- Kernig (stiffness of hamstrings)
How do you test for Brudzinski (stiff neck)? - ANS - Severe neck stiffness causes a patient's hips and knees to
flex when the neck is flexed
How do you test for Kernig (stiffness of hamstrings)? - ANS - inability to straighten the leg when the hip is
flexed to 90 degrees.
What should a nurse never do to a pt with increased intracranial pressure? - ANS - never move the head up or
down without specific orders from healthcare provider.
Which part of the brain is involved with long term memory? - ANS - Hippocampus
Stimulating the vagus nerve does what? - ANS - decreased heart rate
why do we dextrostix fluid seeping from eyes, ears, or nose in head injury pt's? - ANS - to determine if glucose
is present
What does it indicate if you find glucose with the dextrostix in fluid seeping from eyes, ears, or nose in head
injury pt's? - ANS - That they fluid is CSF (cerebrospinal fluid)
What are the functions of the medulla oblongata in the brain? - ANS - - respiratory center (controls muscles of
respiratory response)
- cardiac center (helps regulate HR and force of heart beat)
- vasomotor center (regulates contraction of smooth muscle in blood vessel walls and controls flow and BP)
, Nursing 130 Exam 5 2024-2025 Questions And Answers
What are the functions of the reticular formation (RAS) in the brain? - ANS - - sends impulses to the cerebral
cortex to keep us awake and attentive
- screens out unnecessary sensory input
What are the functions of the cerebellum? - ANS - - movement
- posture
- balance
Major function of the parietal lobe? - ANS - -sense of touch
- knowing where things are in space
Major function of the temporal lobe? - ANS - - hearing
- auditory processing
Major function of the occipital lobe? - ANS - - vision
- visual processing
Major function of frontal lobe? - ANS - - movement
- thinking
- cognition
What is the basic anatomy of a sensory neuron? - ANS - Sensory cells carry afferent impulses to a central
interneuron, which makes contact with a motor neuron
What kinds of thing does a sensory neuron transmit? - ANS - - touch
- pressure
- pain
- taste
- smell
What kind of wounds can you put a wound vac on? - ANS - - deep wounds
- stage III & IV pressure ulcers
- mastectomy wounds
Why does a wound vac help? - ANS - - reduces swelling
- removes excess fluid
- stimulates growth of healthy cells
- increases blood flow
How do you irrigate a wound? - ANS - - draw up sterile NS in syringe (usually 20cc)
- spray directly into the wound
- repeat until it runs clear
- pad dry with sterile gauze
What is the best dressing to prevent skin breakdown by friction? - ANS - Transparent
Describe stage ! pressure ulcer? - ANS - - intact skin
- may include changes in (one or more): temperature (warm/cool), tissue consistency (firm/boggy/mushy),
induration (swelling), sensation (pain/itching).
- defined area of persistent redness
Describe stage II pressure ulcer? - ANS - - skin broken
- loss of epidermis with extension into dermis
What is the most important nursing task to reduce pressure points on a pt? - ANS - Rotate pt every 2 hours
What is the Braden scale used for? - ANS - assess pressure ulcer risk
Which measurements are in the Braden scale? - ANS - - Sensory perception (1-4 pts)
- Moisture (1-4 pts)
- Activity (1-4 pts)
- Mobility (1-4 pts)
- Nutrition (1-4 pts)
- Friction & Shear (1-3 pts_
(total of 23 points. The lower the points the bigger the risk for pressure ulcer)
Which conditions does a brain scan pick up? - ANS - - vascular lesions
- neoplasms
- abscesses
- areas of cerebrovascular ischemia
What does a neuro chair do? - ANS - help to transfer pt's in and out of bed and serve as a comfortable place
for the pt to rest when out of bed.
If a pt. with autonomic dysreflexia gets sudden hypertension, they are at risk for______? - ANS - Death.
What can a brain abscess lead to? - ANS - Meningitis
What are the 2 signs for meningeal irritation? - ANS - - Brudzinski (stiff neck)
- Kernig (stiffness of hamstrings)
How do you test for Brudzinski (stiff neck)? - ANS - Severe neck stiffness causes a patient's hips and knees to
flex when the neck is flexed
How do you test for Kernig (stiffness of hamstrings)? - ANS - inability to straighten the leg when the hip is
flexed to 90 degrees.
What should a nurse never do to a pt with increased intracranial pressure? - ANS - never move the head up or
down without specific orders from healthcare provider.
Which part of the brain is involved with long term memory? - ANS - Hippocampus
Stimulating the vagus nerve does what? - ANS - decreased heart rate
why do we dextrostix fluid seeping from eyes, ears, or nose in head injury pt's? - ANS - to determine if glucose
is present
What does it indicate if you find glucose with the dextrostix in fluid seeping from eyes, ears, or nose in head
injury pt's? - ANS - That they fluid is CSF (cerebrospinal fluid)
What are the functions of the medulla oblongata in the brain? - ANS - - respiratory center (controls muscles of
respiratory response)
- cardiac center (helps regulate HR and force of heart beat)
- vasomotor center (regulates contraction of smooth muscle in blood vessel walls and controls flow and BP)
, Nursing 130 Exam 5 2024-2025 Questions And Answers
What are the functions of the reticular formation (RAS) in the brain? - ANS - - sends impulses to the cerebral
cortex to keep us awake and attentive
- screens out unnecessary sensory input
What are the functions of the cerebellum? - ANS - - movement
- posture
- balance
Major function of the parietal lobe? - ANS - -sense of touch
- knowing where things are in space
Major function of the temporal lobe? - ANS - - hearing
- auditory processing
Major function of the occipital lobe? - ANS - - vision
- visual processing
Major function of frontal lobe? - ANS - - movement
- thinking
- cognition
What is the basic anatomy of a sensory neuron? - ANS - Sensory cells carry afferent impulses to a central
interneuron, which makes contact with a motor neuron
What kinds of thing does a sensory neuron transmit? - ANS - - touch
- pressure
- pain
- taste
- smell
What kind of wounds can you put a wound vac on? - ANS - - deep wounds
- stage III & IV pressure ulcers
- mastectomy wounds
Why does a wound vac help? - ANS - - reduces swelling
- removes excess fluid
- stimulates growth of healthy cells
- increases blood flow
How do you irrigate a wound? - ANS - - draw up sterile NS in syringe (usually 20cc)
- spray directly into the wound
- repeat until it runs clear
- pad dry with sterile gauze
What is the best dressing to prevent skin breakdown by friction? - ANS - Transparent
Describe stage ! pressure ulcer? - ANS - - intact skin
- may include changes in (one or more): temperature (warm/cool), tissue consistency (firm/boggy/mushy),
induration (swelling), sensation (pain/itching).
- defined area of persistent redness
Describe stage II pressure ulcer? - ANS - - skin broken
- loss of epidermis with extension into dermis
