Maryville NURS 623 Exam 4 with correct answers

Maryville NURS 623 Exam 4 What is important to note when a patient has traumatic injury - correct answer If taking Blood Thinners Define delirium - correct answer Underlying acute cause, abrupt onset, hours to days, reversible, hallucinations, incoherent speech, confusion Define Dementia - correct answer Various causes, gradual change with mental status, months to years, progressive to irreversible (speech, memory, mood, judgment) An older adult with delirium would present with what type of behaviors? - correct answer Agitation and restlessness At the onset of alzheimers, what category of medications should be initiated? - correct answer Cholinesterase inhibitors what factors contribute to a patient being high risk for falls? - correct answer History of falls medications vision impairment heart rate/rhythm abnormalities footwear issues home environment gait/mobility issues poor reflexes What is the primary reason people have long term effects after a Stroke - correct answer living at home and calling PCP instead of 911 leads to prolonged stroke symptoms and long term effects S/S of an Absense Seizure - correct answer Blank stare (upward rotation of eye) Red Flags of back/neck pain - correct answer Incontinence Fever Cancers Unexplained wt loss Long term steroids Trauma IV drug abuse Intense local pain No comfy Position Diagnosing of Alzheimer's - correct answer Impaired ability to learn new info along with a disturbance in language, function, or perception S/S of Alzheimer's - correct answer *C/O memory problems * ↑ cognitive difficulty * ↑ slow response to cognitive challenge *Word-finding difficulty * ↑ difficulty with simple tasks cardinal features of Parkinson's (TRAP)? - correct answer *T-remor at rest (or pill rolling) *R-igidity *A-kinesia/Bradykinesia *P-ostural Disturbances What disease is "freezing phenomenon" a characteristic of? - correct answer Parkinson's A 62 y/o patient calls and c/o of a headache what statement would cause the most concern? - correct answer It's the worst headache I've ever had the headache from a subdural hematoma is of venous origin, typically resulting from ahead injury that is usually mild and easily forgotten by the patient. - correct answer Temporal arteritis s/s of temporal (giant cell) arteritis - correct answer * unilateral HA (temporal artery, orbital) * jaw claudication (pain with chewing) * temporary blindness (Medical Urgency) Polymyalgia rheumatica (pain/stiff muscles shoulders and hips) What age group is at higher risk for temporal arteritis - correct answer >50 Clinical manifestations of Articular disorders? - correct answer *characterized by deep or diffuse pain, pain or limited ROM on active and passive movement *swelling *crepitus Clinical manifestations of Non-Articular disorders? - correct answer *Tend to be painful on active but not passive (assisted) ROM. *Seldom demonstrate swelling, crepitus, instability, or deformity by itself. What diagnostic assessment is most useful in a patient who presents with lumbar radiculopathy? - correct answer The straight leg raise (assesses L5-S1). pain would indicate most common disc herniation What cranial nerve is affected in Bell's Palsy? - correct answer CN VII S/S of Bell's Palsy - correct answer * Acute onset one-sided Facial paralysis with normal ocular movement and sensation * Affects CN VII (facial)-VII(vestibulocochlear) * Loss of taste (dysgeusia) * Postauricular pain * Sound sensitivity (hyperacusis) * Heavy feeling in face How is Bell's Palsy diagnosed? - correct answer Clinical history and exam What is a serious risk in patients with Bell's Palsey? - correct answer Loss of the ability to blink and close the eyelid subjects the cornea to drying and ulceration Patient teaching for Bell's Palsey - correct answer *reassure it is self-limiting with 3-6 month recovery *prevent corneal ulceration/ use artificial tears *unilateral and tends to have a throbbing or pulsatile (head) *precipitated by aura *nausea *vomiting *photophobia *phonophobia - correct answer S/S of Migraine H/A A patient reports seeing flashes 20 minutes before having a severe H/A what type of H/A is it? - correct answer Classic migraine *unilateral orbital, supraorbital, and/or temporal (headache) *causes lacrimation, rhinorrhea, and nasal congestion) - correct answer S/S of cluster H/A bilateral, non-pulsating, tightening (head) pain that is not aggravated by routine physical activity. It is usually not accompanied by nausea and vomiting or photophobia. - correct answer S/S of tension headache If a patient c/o sudden 'thunder clap' H/A worst in their life what is a diff dx that should be considered? - correct answer Aneurism (subarachnoid hemorrhage) potential complications of steroid use in a patient with impaired integrity of bone structure? - correct answer Increased risk of fracture what maneuver should be used to assess CERVICAL nerve-root compression. - correct answer Spurling Symptoms are related to compression of the median nerve, which results in pain, paresthesia's, numbness and tingling, and associated weakness in the hand and wrist that radiate to the thumb, index finger, middle finger, and radial half of the ring finger - correct answer Carpal Tunnel Syndrome Form of arthritis characterized by painful flare-ups in joints of distal extremities? - correct answer Gout Pain on the inside of elbow, Elbow stiffness, Hand and wrist weakness, Tingling sensation or numbness in the fingers, especially the ring and little fingers, Difficulty moving the elbow - correct answer Medial Epicondylitis (Golfer's Elbow) Can cause neck pain, radiating arm pain, shoulder pain, and numbness or tingling in the arm or hand. The quality and type of pain can vary from dull, aching, and difficult to localize to sharp, burning, and easy to pinpoint, Can cause weakness in arm (s) - correct answer Ruptured Cervical Disc In elderly patients, fracture of WHAT would lead to potentially fatal outcomes or problematic long term issues in elderly patients, - correct answer Hip Fracture What is gold standard test for dx osteoporosis? - correct answer DEXA Bone Density test Was is an important step during examination of an ortho complaint to be able to have a comparative value of both extremities - correct answer always exam the non-effected side and then effected side for comparison What medications cause a patient to be at risk for developing osteoporosis? - correct answer • Glucocorticoids • Excessive thyroxine • Long-term phenytoin What populations are at risk for developing osteoporosis? - correct answer • Age (65+) * medications • Family history • Menopause • Genetics In a patient who is elderly and falls (does not remember the fall), but there is no clear cause of falls, what should your workup center around? - correct answer syncope associated with Cardiac and neurologic causes If a patient is alert and oriented and refuses to give consent for a procedure, how do you move forward as a provider? - correct answer Respec their wishes, Discuss risks of NOT having procedure, abort procedure, document refusal In elderly patients, what factors can contribute to loss of appetite and malnourishment? - correct answer *Diminished taste/smell/vision *dry mouth *poor dentition *chronic illness *meds *pain *depression *loneliness How would you assess for a suspected meniscal tear with a physical exam? - correct answer McMurray circumduction test. Which test assesses the integrity of the anterior cruciate ligament? - correct answer Lachman Which test assesses for De Quervain's Tenosynovitis? - correct answer Finkelstein's Pt education for Carpal Tunnel Syndrome - correct answer * prevent flexion and extension movements of the wrist. * Thumb Spika 24/7 x 3 weeks *ergonomic Modifications Patients who would like to incorporate non-traditional therapies for treatment of pain-how do you respond? - correct answer Educate on efficacy of other treatments but ultimately allow them and support them on their own decision as long as the cessation of pharmacological intervention is not detrimental In terms of physical activity in a patient with Osteoporosis, what would encourage - correct answer *Muscle strengthening activities (Weight Bearing) *Heat followed by ice *Physical therapy In terms of physical activity in a patient with Osteoporosis, what would Discourage - correct answer strenuous activity Patient education for Osteoporosis - correct answer * Home environment Safety * Adequate nutrition (Vit D, calcium, Protein) * Vit D & Calcium Supplements *Weight bearing exercises Nodes on (distal) DIP joints secondary to osteoarthritis - correct answer Heberden's nodes bony nodes at the proximal interphalangeal joints associated with OA - correct answer Bouchard's nodes Inflammation of the tendon sheath, also called "mommy thumb" - correct answer DeQuervains Tenosynovitis Use Finkelstein test (tuck thumb, abduct wrist) Type of fracture secondary to systemic disease - correct answer Pathologic fracture an injury to the bone caused by overuse - correct answer Stress fracture Common cause of posterior knee pain - correct answer Bakers cyst Secondary to other process - osteoarthritis #1 A distressing Unilateral, painful electric shock sensation (cranial nerve V) AKA: tic douloureux (unbearable painful twitch). - correct answer Trigeminal Neuralgia Differentiate between dizziness and vertigo - correct answer *Dizziness - sensation of unsteady, feeling of movement in the head *Vertigo - feeling of spinning when you are not moving involves vestibular system, most common causes are benign positional vertigo, vestibular neuritis, Meniere disease, Imbalance mild to moderate, able to walk, Latency usually 20 minutes - correct answer Peripheral Vertigo result from lesions affecting the brainstem and cerebellum, imbalance severe cant walk, Latency usually 5 minutes - correct answer Central vertigo What is used to treat edema in the labyrinth with Peripheral Vestibular Disease? - correct answer Diamox What antibiotic would not require adjusting in the elderly? - correct answer Tobramycin What is considered a normal age-related lab change - correct answer Increased ESR