NUR 432 – midterm questions with accurate answers
At which phase of pancreatitis would amylase and lipase levels be
elevated? Ans✓✓✓ during the acute phase, biochemical changes with
serum amylase or lipase levels are greater than three times the upper
limit of normal
How are complications of hemorrhagic stroke managed? Ans✓✓✓ -
cerebral hypoxia, decreased cerebral blood flow, extension of the area of
injury: oxygenation, hydrate with iv fluids, treat extremes in bp,
observe- seizure activity and treat
- vasospasm: worsening headache or decrease loc, new focal neurologic
deficit such as hemiparesis; surgery to clip aneurysm, medicate with
nimodipine (calcium channel blocker), triple h therapy (hypervolemia,
induced arterial hypertension, hemodilution)
- increased icp management
- hypertension- goal: systolic 140 mmhg, if greater than 220 mmhg then
continuous iv antihypertensive may be administered: nicardipine
(cardene), labetalol (trandate), hydralazine (apresoline)
How can the nurse aide in coping with sensory deprivation for the
patient who has undergone intracranial surgery? Ans✓✓✓ periorbital
edema may cause vision impairment: common consequence
- elevate HOB if allowed
- apply cold compresses over eyes
- notify surgeon if edema increases significantly- may indicate clot
development, increasing ICP, poor venous drainage
- vision may be impaired
,- other factors: bulky head dressing, intubation, effects of increased ICP
How can the nurse manage fluid and electrolyte disturbances in the
patient who has undergone intracranial surgery? Ans✓✓✓ - oral fluid
resumed after 24 hours: check gag, swallow reflexes before starting oral
fluids
- large doses corticosteroids: monitor serum glucose every 4-6 hours
- stress ulcers: Histamone-2 receptor antagonists (H2 Blockers) or
Proton Pump Inhibitors
- diabetes Insipidus and SIADH
How can the nurse monitor for increased ICP and bleeding in the patient
who has undergone intracranial surgery? Ans✓✓✓ - clot suspected:
patient who does not awaken as expected or condition deteriorates
- intracranial hematoma suspected: patient has new postoperative
neurologic deficits (dilated pupil on the operative side)
- monitor for increased ICP
How can the nurse prevent infection in the patient who has undergone
intracranial surgery? Ans✓✓✓ - infection is related to brain exposure,
bone exposure, wound hematomas
- arterial lines, ICP monitoring, drains
- CSF leak- report immediately- sudden drainage of clear fluid from
incision, patient complain of salty taste or postnasal drip
- instructed to avoid coughing or nose blowing- creates pressure on
operative site
,How is bleeding related to hepatic cirrhosis managed? Ans✓✓✓ bleeding
esophageal varices:
- assess and monitor vital signs frequently
- monitor emesis and stool for occult blood
- for rest of esophagus, parenteral nutrition may be used
- monitor gastric suctioning if ordered (NGT)
- maintain quiet environment
- administer blood transfusions
- administer Vitamin K
- pharmacologic agents: Propranolol (Inderal), nadolol (Corgard),
carvedilol are given to decrease portal pressure which will decrease
bleeding
- vasopressin (Pitressin) will cause constriction of the splenic arterial
bed to reduce bleeding
octreotide - (Sandostatin) used to decrease bleeding
How is encephalopathy related to hepatic cirrhosis managed? Ans✓✓✓ -
assess neurologic status frequently
- assess vital signs frequently
- safe environment, frequent surveillance
- assess serum ammonia levels daily
- protein intake of 1.2-1.5 g/kg/day
- enteral feedings if necessary
, - reduce absorption of ammonia from GI tract (NGT suctioning, enemas,
oral antibiotics because the normal bacteria in our gut produce bacteria)
- monitor for fluid balance (hypovolemia) and electrolyte status;
imbalances worsen encephalopathy
- sedatives, tranquilizers, analgesic medications are discontinued
- administer medications as ordered- lactulose (Cephulac)
- pulmonary care: coughing, deep breathing, position changes
How is fluid volume excess related to hepatic cirrhosis managed?
Ans✓✓✓ - assess cardiopulmonary status: risk for pulmonary
hypertension, pulmonary edema (crackles)
- vital signs
- I&O
- measure abdominal girth to see if ascites is increasing or decreasing,
assess for edema
- daily weight
- monitor respiratory status: HOB 30 degrees, encourage coughing/deep
breathing
- serum ammonia, creatinine, electrolyte levels
- low sodium diet
- protein supplements
- fluid restriction
- bedrest if ordered because upright position activates renin-angiotensin-
aldosterone system causing water and sodium retention in the kidneys
(this is a bad thing)
At which phase of pancreatitis would amylase and lipase levels be
elevated? Ans✓✓✓ during the acute phase, biochemical changes with
serum amylase or lipase levels are greater than three times the upper
limit of normal
How are complications of hemorrhagic stroke managed? Ans✓✓✓ -
cerebral hypoxia, decreased cerebral blood flow, extension of the area of
injury: oxygenation, hydrate with iv fluids, treat extremes in bp,
observe- seizure activity and treat
- vasospasm: worsening headache or decrease loc, new focal neurologic
deficit such as hemiparesis; surgery to clip aneurysm, medicate with
nimodipine (calcium channel blocker), triple h therapy (hypervolemia,
induced arterial hypertension, hemodilution)
- increased icp management
- hypertension- goal: systolic 140 mmhg, if greater than 220 mmhg then
continuous iv antihypertensive may be administered: nicardipine
(cardene), labetalol (trandate), hydralazine (apresoline)
How can the nurse aide in coping with sensory deprivation for the
patient who has undergone intracranial surgery? Ans✓✓✓ periorbital
edema may cause vision impairment: common consequence
- elevate HOB if allowed
- apply cold compresses over eyes
- notify surgeon if edema increases significantly- may indicate clot
development, increasing ICP, poor venous drainage
- vision may be impaired
,- other factors: bulky head dressing, intubation, effects of increased ICP
How can the nurse manage fluid and electrolyte disturbances in the
patient who has undergone intracranial surgery? Ans✓✓✓ - oral fluid
resumed after 24 hours: check gag, swallow reflexes before starting oral
fluids
- large doses corticosteroids: monitor serum glucose every 4-6 hours
- stress ulcers: Histamone-2 receptor antagonists (H2 Blockers) or
Proton Pump Inhibitors
- diabetes Insipidus and SIADH
How can the nurse monitor for increased ICP and bleeding in the patient
who has undergone intracranial surgery? Ans✓✓✓ - clot suspected:
patient who does not awaken as expected or condition deteriorates
- intracranial hematoma suspected: patient has new postoperative
neurologic deficits (dilated pupil on the operative side)
- monitor for increased ICP
How can the nurse prevent infection in the patient who has undergone
intracranial surgery? Ans✓✓✓ - infection is related to brain exposure,
bone exposure, wound hematomas
- arterial lines, ICP monitoring, drains
- CSF leak- report immediately- sudden drainage of clear fluid from
incision, patient complain of salty taste or postnasal drip
- instructed to avoid coughing or nose blowing- creates pressure on
operative site
,How is bleeding related to hepatic cirrhosis managed? Ans✓✓✓ bleeding
esophageal varices:
- assess and monitor vital signs frequently
- monitor emesis and stool for occult blood
- for rest of esophagus, parenteral nutrition may be used
- monitor gastric suctioning if ordered (NGT)
- maintain quiet environment
- administer blood transfusions
- administer Vitamin K
- pharmacologic agents: Propranolol (Inderal), nadolol (Corgard),
carvedilol are given to decrease portal pressure which will decrease
bleeding
- vasopressin (Pitressin) will cause constriction of the splenic arterial
bed to reduce bleeding
octreotide - (Sandostatin) used to decrease bleeding
How is encephalopathy related to hepatic cirrhosis managed? Ans✓✓✓ -
assess neurologic status frequently
- assess vital signs frequently
- safe environment, frequent surveillance
- assess serum ammonia levels daily
- protein intake of 1.2-1.5 g/kg/day
- enteral feedings if necessary
, - reduce absorption of ammonia from GI tract (NGT suctioning, enemas,
oral antibiotics because the normal bacteria in our gut produce bacteria)
- monitor for fluid balance (hypovolemia) and electrolyte status;
imbalances worsen encephalopathy
- sedatives, tranquilizers, analgesic medications are discontinued
- administer medications as ordered- lactulose (Cephulac)
- pulmonary care: coughing, deep breathing, position changes
How is fluid volume excess related to hepatic cirrhosis managed?
Ans✓✓✓ - assess cardiopulmonary status: risk for pulmonary
hypertension, pulmonary edema (crackles)
- vital signs
- I&O
- measure abdominal girth to see if ascites is increasing or decreasing,
assess for edema
- daily weight
- monitor respiratory status: HOB 30 degrees, encourage coughing/deep
breathing
- serum ammonia, creatinine, electrolyte levels
- low sodium diet
- protein supplements
- fluid restriction
- bedrest if ordered because upright position activates renin-angiotensin-
aldosterone system causing water and sodium retention in the kidneys
(this is a bad thing)
