NCLEX Practice Questions (Pathophysiology Dr. Brown)

NCLEX Practice Questions (Pathophysiology Dr. Brown) Leave the first rating Students also studied Terms in this set (13) Save Epidural and Subdural hematoma 33 terms katherinnsPreview Trauma/SCI/TBI/ICP NCLEX Questio...41 terms carterknw503Preview ACLS Final Exam 50 terms CNPalmer3Preview ICP, he 49 terms alle A client arrives at the ER after slipping on a patch of ice and hitting her head. A CT scan of the head shows a collection of blood between the skull and dura mater.Which type of head injury does this finding suggest?

• Subdural hematoma
• Subarachnoid hemorrhage
• Epidural hematoma
• Contusion

Epidural hematoma An epidural hematoma occurs when blood collects between the skull and the dura mater. An epidural hematoma (EDH) is an extra-axial collection of blood within the potential space between the outer layer of the dura mater and the inner table of the skull. It is confined by the lateral sutures (especially the coronal sutures) where the dura inserts. It is a life-threatening condition, which may require immediate intervention and can be associated with significant morbidity and mortality if left untreated. Rapid diagnosis and evacuation are important for a good outcome.

Option A: In a subdural hematoma, venous blood collects between the dura

mater and the arachnoid mater. A subdural hematoma forms because of an accumulation of blood under the dura mater, one of the protective layers to the brain tissue under the calvarium. The understanding of subdural hematoma relies on the knowledge of neuroanatomical sheets covering the brain.

Option B: In a subarachnoid hemorrhage, blood collects between the pia mater

and arachnoid membrane. Subarachnoid hemorrhage is defined as blood between the arachnoid membrane and the pia membrane. Several factors compromise this syndrome. Most subarachnoid hemorrhages are traumatic in nature. Aneurysmal subarachnoid hemorrhage compromises a small portion of this patient population, but nevertheless is the most worrisome type of subarachnoid hemorrhage.Option D: A contusion is a bruise on the brain’s surface. Contusions can progress and expand, and in many cases, other hemorrhagic contusions are present. Brain contusions have been attributed to bleeding from the continuous flow of injured microvessels during the initial traumatic episode. Hemorrhagic contusions overlie brain parenchyma with loss of function.

Which neurotransmitter is responsible for many of the functions of the frontal lobe?

• Dopamine

B) GABA

• Histamine
• Norepinephrine

Dopamine The frontal lobe primarily functions to regulate thinking, planning, and affect.Dopamine is known to circulate widely throughout this lobe, which is why it’s such an important neurotransmitter in schizophrenia. Dopamine receptors play an essential role in daily life functions. This hormone and its receptors affect movement, emotions and the reward system in the brain.

Option B: Gamma-aminobutyric acid (GABA) is an amino acid that serves as the

primary inhibitory neurotransmitter in the brain and a major inhibitory neurotransmitter in the spinal cord. It exerts its primary function in the synapse between neurons by binding to postsynaptic GABA receptors which modulate ion channels, hyperpolarizing the cell and inhibiting the transmission of an action potential.Option C: Histamine regulates a variety of physiological functions by playing a key role in the inflammatory response of the body. It also has a vital role in various pathomechanisms of inflammatory diseases, which have led to the identification of novel histamine receptors over the years and greater recognition of its functions in the immune system.

Option D: The adrenergic receptors linked to blood vessels have an especially

high affinity for norepinephrine relative to the other amines. Further musculoskeletal actions of catecholamines include enhanced contractility of cardiac muscle (via beta-1 receptors), contraction of the pupillary dilator (via alpha-1 receptors), piloerection (via alpha-1 receptors), and relaxation of smooth muscle in the gastrointestinal tract, urinary tract, and bronchioles (via beta-2 receptors).A client with a C6 spinal injury would most likely have which of the following symptoms?

• Aphasia
• Hemiparesis
• Paraplegia
• Tetraplegia
• Tetraplegia

Tetraplegia occurs as a result of cervical spine injuries. Cervical injuries lead to the same deficits as thoracic injuries and, also, may result in loss of function of the upper extremities leading to tetraplegia. Injuries above C5 may also cause respiratory compromise due to loss of innervation of the diaphragm.

Option A: Aphasia is an impairment to comprehension or formulation of language

caused by damage to the cortical center for language. It can be caused by many different brain diseases and disorders; however, cerebrovascular accident (CVA) is the most common reason for a person to develop aphasia.

Option B: Hemiparesis is weakness or the inability to move on one side of the

body, making it hard to perform everyday activities like eating or dressing. Where the stroke occurred in the brain will determine the location of your weakness.Injury to the left side of the brain, which controls language and speaking, can result in right-sided weakness. Left-sided weakness results from injury to the right side of the brain, which controls nonverbal communication and certain behaviors.Option C: Paraplegia occurs as a result of injury to the thoracic cord and below.Paraplegia is a form of paralysis that mostly affects the movement of the lower body. People with paraplegia may be unable to voluntarily move their legs, feet, and sometimes their abdomen.

While in the Emergency Department, a client with C8 tetraplegia develops a blood pressure of 80/40, pulse 48, and RR of 18. The nurse suspects which of the following conditions?

• Autonomic dysreflexia
• Hemorrhagic shock
• Neurogenic shock
• Pulmonary embolism
• Neurogenic shock

Symptoms of neurogenic shock include hypotension, bradycardia, and warm, dry skin due to the loss of adrenergic stimulation below the level of the lesion.Neurogenic shock is a devastating consequence of spinal cord injury (SCI), also known as vasogenic shock. Injury to the spinal cord results in a sudden loss of sympathetic tone, which leads to the autonomic instability that is manifested in hypotension, bradyarrhythmia, and temperature dysregulation.Option A: Hypertension, bradycardia, flushing, and sweating of the skin are seen with autonomic dysreflexia. Autonomic dysreflexia is a condition that emerges after a spinal cord injury, usually when the injury has occurred above the T6 level.The higher the level of the spinal cord injury, the greater the risk with up to 90% of patients with cervical spinal or high-thoracic spinal cord injury being susceptible.

Option B: Hemorrhagic shock presents with anxiety, tachycardia, and

hypotension; this wouldn’t be suspected without an injury. Hemorrhagic shock is due to the depletion of intravascular volume through blood loss to the point of being unable to match the tissues demand for oxygen. As a result, mitochondria are no longer able to sustain aerobic metabolism for the production of oxygen and switch to the less efficient anaerobic metabolism to meet the cellular demand for adenosine triphosphate.

Option D: Pulmonary embolism presents with chest pain, hypotension,

hypoxemia, tachycardia, and hemoptysis; this may be a later complication of spinal cord injury due to immobility. Pulmonary embolism (PE) occurs when there is a disruption to the flow of blood in the pulmonary artery or its branches by a thrombus that originated somewhere else.Nurse Oliver should expect a client with hypothyroidism to report which health concerns?

• Increased appetite and weight loss
• Puffiness of the face and hands
• Nervousness and tremors
• Thyroid gland swelling

https://nurseslabs.com/quizzes/nclex-endocrine-quiz-1/

• Puffiness of the face and hands

Hypothyroidism (myxedema) causes facial puffiness, extremity edema, and weight gain. Signs and symptoms of hyperthyroidism (Graves’ disease) include an increased appetite, weight loss, nervousness, tremors, and thyroid gland enlargement (goiter). Hypothyroidism results from low levels of thyroid hormone with varied etiology and manifestations. Untreated hypothyroidism increases morbidity and mortality.Option A: Inquire about dry skin, voice changes, hair loss, constipation, fatigue, muscle cramps, cold intolerance, sleep disturbances, menstrual cycle abnormalities, weight gain, and galactorrhea. Also obtain a complete medical, surgical, medication, and family history.Option C: It is important to maintain a high index of suspicion for hypothyroidism since the signs and symptoms can be mild and nonspecific and different symptoms may be present in different patients. Typical features such as cold intolerance, puffiness, decreased sweating and skin changes may not be present always.Option D: Autoimmune thyroiditis causes an increase in the turnover of iodine and impaired organification. Chronic inflammation of the parenchyma leads to predominant T-cell lymphocytic infiltration. If this persists, the initial lymphocytic hyperplasia and vacuoles are replaced by dense fibrosis and atrophic thyroid follicles.

When evaluating an ABG from a client with a subdural hematoma, the nurse notes the PaCO2 is 30 mm Hg.Which of the following responses best describes this result?

• Appropriate; lowering carbon dioxide (CO2) reduces

intracranial pressure (ICP).

• Emergent; the client is poorly oxygenated.
• Normal
• Significant; the client has alveolar hypoventilation.

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• Appropriate; lowering carbon dioxide (CO2) reduces intracranial pressure

(ICP).

A normal PaCO2 value is 35 to 45 mm Hg. CO2 has vasodilating properties; therefore, lowering PaCO2 through hyperventilation will lower ICP caused by dilated cerebral vessels. A subdural hematoma forms because of an accumulation of blood under the dura mater, one of the protective layers to the brain tissue under the calvarium.

Option B: Oxygenation is evaluated through PaO2 and oxygen saturation. The

clinician must begin immediate medical management. These measures include sedation, neuromuscular blockade when appropriate, moderate hyperventilation to a Pc02 (32 to 36), adequate oxygenation to maintain Sp02 greater than 95%, head elevation, and avoidance of hyperthermia.

Option C: Often, the bleeding is undetected initially, discovered as a chronic

subdural hematoma. When there is a sufficient accumulation of blood to occupy a large intracranial space, the brain midline shifts toward the opposite side, encroaching on the brain structures against the inner surface of the calvarium after decreasing the volume of the lateral third and fourth ventricles. As the intracranial space becomes limited, the volumetric forces push the uncal portion of the temporal lobe toward the foramen magnum causing herniation of the brain.

Option D: Alveolar hypoventilation would be reflected in an increased PaCO2.

The infusion of hypertonic saline or mannitol serves to decrease intracranial pressure by promoting osmotic changes in the brain and transiently affecting the rheological properties of the cerebral blood flow, respectively.A female adult client with a history of chronic hyperparathyroidism admits to being non-compliant.Based on initial assessment findings, the nurse formulates the nursing diagnosis of Risk for injury. To complete the nursing diagnosis statement for this client, which "related- to" phrase should the nurse add?

• Related to bone demineralization resulting in

pathologic fractures.

• Related to exhaustion secondary to an accelerated

metabolic rate.

• Related to edema and dry skin secondary to fluid

infiltration into the interstitial spaces.

• Related to tetany secondary to a decreased serum

calcium level.

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• Related to bone demineralization resulting in pathologic fractures.

Poorly controlled hyperparathyroidism may cause an elevated serum calcium. This may diminish calcium stores in the bone, causing bone demineralization and setting the stage for pathologic fractures & risk for injury. Primary hyperparathyroidism preferentially reduces cortical bone density & increases fracture risk at sites where cortical bone predominates, such as the distal forearm, with relative sparing of trabecular bone. Those with hyperparathyroidism should have a dual-energy x-ray absorptiometry that includes the distal third radius, a site composed almost exclusively of cortical bone, in addition to measurements at the spine & hip.

Option B: Hyperparathyroidism doesn’t accelerate the metabolic rate. The

physical exam of a patient with primary hyperparathyroidism is usually normal.Physical exams can be helpful in finding abnormalities that could suggest other etiologies of hypercalcemia.

Option C: A decreased thyroid hormone level, not an increased parathyroid

hormone level, may cause edema & dry skin secondary to fluid infiltration into the interstitial spaces. Patients with primary hyperparathyroidism & other causes of PTH-dependent hypercalcemia often have elevated levels of PTH, while some will have values that fall within the reference range for the general population. A normal PTH in the presence of hypercalcemia is considered inappropriate & still consistent with PTH-dependent hypercalcemia.

Option D: Hyperparathyroidism causes hypercalcemia, therefore, it isn’t

associated with tetany. Parathyroid hormone activates the parathyroid hormone receptor increasing resorption of calcium and phosphorus from bone, enhancing the distal tubular resorption of calcium, and decreasing the renal tubular reabsorption of phosphorus.