ADVANCED MED-SURG PRINCIPLES
JERSEY COLLEGE EXAM 1 QUESTIONS
WITH CORRECT ANSWERS ALREADY
GRADED A+
A decrease incerebral perfusion pressure could trigger.... ...ANS:
vasodilation and result in an increase in ICP and lower prefusion
pressures
A dural tear puts a pt at risk for.... ...ANS: meningitis
A hematoma following intracranial surgery should be suspected if?
...ANS: the pt doesn't waken or the condition worsens (dilated pupil
or Cushing's triad)
Acetazolamide (Diamox) has diuretic effects and contains sulfa,
what would you monitor for and/or avoid? ...ANS: - monitor
electrolytes
- avoid it with a sulfa allergy
After ear surgery to reduce complicationsthe patient
should? ...ANS: - not blow nose
- not get water in the operative ear for 2-3 wks
- keeping the mouth open when sneezing/coughing
- not lift > 10lbs, bend or strain when lifting
- promptly report excessive purulent ear drainage
After ear surgery what is normal? ...ANS: temporary hearing loss
in the middle ear
,After ear surgery what should the pt report? ...ANS: crackling and
popping sounds in the ear
An excessive increase in ADH (vassopression) will result
in.... ...ANS: a decrease in serum sodium levels (hyponatremia)
At what level should cerebral perfusion pressure be maintained
above? ...ANS: 50 mm Hg (ideally it should be maintained
between 70 - 80 mm Hg)
Brain tumors can contribute to what? ...ANS: - cerebral edema
- increase in ICP
- hydrocephalus
- seizures
- changes in pituitary function
Cerebral cells are unable to store significant amounts of glucose or
oxygen so.... ...ANS: a constant supply of oxygen and glucose is
needed
Clinical signs of respiratory failure with or without acidosis
indicates a need for what? ...ANS: mechanical ventilation
Conditions that increase ICP can also impair what? ...ANS:
respirations
Damage to the upper motor neurons can result in..... ...ANS:
spasticity (stiff muscles)
Disorders such as ALS and MG affect the bulbar muscle function
result in..... ...ANS: - dysphagia
- difficulty speaking
- increased risk for aspiration
,During mechanical ventilation with altered LOC or tube feedings
(unless contraidicated) you would elevate the HOB.... ...ANS: 30-
45 degrees to prevent aspiration
During spinal shock reflex acitivity stops (bladder and bowel
function stop).... ...ANS: below the level of the injury and the
muscles innervated by the nerve become flaccid and paralyzed
Facial nerve injury is a rare complication of what type of
surgery? ...ANS: mastoid surgery ; and you should assess cranial
nerve VII
Following a carotid endarectomy (CEA), what would suggest hyper-
perfusion in the pt? ...ANS: unilateral headache that improves
upon sitting or standing
Following a CEA (carotid endarterectomy) you should monitor
what? ...ANS: monitor BP closely, since hypotension could cause
cerebral ischemia and HTN could result in cerebral hemorrhage
Following a CEA edema and hematoma could result in
what? ...ANS: airway obstruction
Following a tranphenodial surgery you should check what? ...ANS:
nasal packing for blood or CSF
Following an infratentorial incision you should..... ...ANS: - keep
the HOB flat
- provide one firm pillow
- position onto the side
- maintain the neck in a neutral position
, For supratentoiral incisions you should.... ...ANS: elevate the HOB
to 30 degrees and use one pillow
High cervical injuries (above C4) that injure the phrenic nerve are
the leading cause of what? ...ANS: death from acute respiratory
failure
How and why do most hemorrhagic strokes occur? ...ANS: most
result from spontaneous rupture of a small vessel and are due to
uncontrolled HTN
How can you determine the area of the brain where a seizure
originates from? ...ANS: by assessing the initial seizure activity
How do assess cranial nerve IX? ...ANS: instruct the pt to swallow
How do NSAID's preimarily produce pain relief? ...ANS: by
preventing prostaglandin formation
How do referrals to occupational therapists help a stroke
pt? ...ANS: identify devices to maintain self-care independence
How do referrals to physical therapists help a stroke pt? ...ANS:
help to promote safe transfers and ambulation while reducing pain
How do we administer around the clock pain relief for post-op and
chronic pain? ...ANS: provide analgesics, never wait for chronic
pain to reoccur
How do you administer meds? ...ANS: starting with the lowest
dose and titrating up slowly
How do you asses hearing loss with the Rinne test? ...ANS: a
tunning fork is placed on the mastoid bone and then in front of the
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