Herzing University NSG 223 Med Surg II Exam 1
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A client with chronic alcoholism and late stage cirrhosis of the liver has
significant damage to Wernicke's area. What data obtained by the nurse
is indicative of this damage?
a. The client is unable to ambulate independently.
b. The client does not comprehend written and spoken language but
speaks.
c. The client has speech impairment, but is able to comprehend
language.
d. The client's left hand is experiencing paralysis. - ANSWER-Answer: b
Cognitive Level: Analyze
Explanation: Damage to Wernicke's area in the brain impairs the client's
ability to comprehend written and spoken language, but the client is still
able to speak.
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A client who sustained head trauma in a motor vehicle crash is
determined to have an increase in intracranial pressure (ICP). What
related complications should the nurse be aware of? Select all that apply.
a. Brain hypoxia
b. Herniation of the brain
c. Brain compression
d. Paralysis of the lower extremities
e. Urinary retention - ANSWER-Answer: a, b, c
Cognitive Level: Apply
Explanation: The skull is a rigid container that contains brain tissue,
CSF, and blood. The volume of these components determines ICP. A
large increase in any of these factors can increase ICP. This can cause
brain hypoxia (oxygen deprivation), herniation of the brain (brain
contents being pushed through an opening), brain compression (the brain
is pushed against the rigid skull), necrosis (death) of brain tissue in a
specific area, or death of the individual.
A client is having a colonoscopy and suddenly the client's heart rate
drops from 72 beats per minute (BPM) to 52 BPM. What cranial nerve
does the nurse determine has been stimulated?
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a. Cranial Nerve I (Olfactory)
b. Cranial Nerve V (Trigeminal)
c. Cranial Nerve IX (Glossopharyngeal)
d. Cranial Nerve X (Vagus) - ANSWER-Answer: d
Cognitive Level: Analyze
What is the Action of Atropine?
blocks the effects of acetylcholine at muscarinic cholinergic receptors
What classification is Atropine?
Anticholinergic
What does atropine treat?
Cardiovascular effects such as bradycardia and syncope
What are the side effects of an overdose of Atropine?
- Decreased secretions
- Increased HR
- Decreased GI and Genitourinary tone
What is the antidote for Atropine?
Physostigmine at a slow rate of 1 mg/min
What are the effects of rapid administration of Atropine?