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Nrsg 105 finals-Questions with complete solutions

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Nrsg 105 finals-Questions with complete solutions

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Nrsg 105 finals-Questions with complete solutions
Cognition (orientation), what part of brain is being tested with orientation questions

Frontal- personality, emotions, and intellectual function

Parietal-primary center for sensation

Occipital-primary visual center

Temporal-Primary auditory reception center,taste,and smell

Wernicke- language

LOC ... levels lethargic, stuporus, obtunded, coma

Lethargic-not fully alert drift off to sleep when not mentally stimulated can be aroused to name

when called but looks drowsy. Slow fuzzy loses train of thought

Stuporous-Spontaneous unconscious response to only vigorous shake or pain, has appropriate

motor response, can groan and mumble

Obtunded- a transitional state between lethargic and stupor, sleep most of the time needs loud

shouts and vigorous state, acts confused when aroused, converse in monosyllables speech is

mumbled and incoherent

Coma-completely unconscious no response to pain or any external or internal stimuli

... increasing intracranial pressure

Pushes the brainstem down, it puts pressure on CN III causing pupil dilation. Cushing reflex

shows signs increasing intracranial pressure, sudden BP elevation with widening pulse pressure,

pulse decrease (slow and bounding).

... changes in neuro status

, LOC

Motor function

Pupils

Vitals

Affect

Observable expression of persons emotions (what you observe). Flat- none, Blunted-reduced

expression, Constricted -limited range, labile- rapid change

Delirium (signs and symptoms)

Disoriented, poor memory, easily distracted, hallucinations, agitation, restlessness, confusion,

fear, euphoria

Vertigo, dizziness, tinnitus

Vertigo- you or objects are spinning

Dizziness- lightheaded or faint

Tinnitus- ringing in the ears

Breast dimpling, retractions, inspection, palpation

Inspection- arms at sides, overhead, hands on hips and leaning

Dimpling- pucked area on skin may resemble an orange peel- tumor on ligament

Retraction- nipple or skin appears pulled inward- tumor in duct

Palpatation- circular motion

Test of confrontation

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