Would someone mind helping with a few study guide questions?

MendedHeart · Dec 4, 2013

"ICP" means "intracranial pressure," something everyone has. "Increased ICP" is what we're talking about here. DI is a late sign when things are really bad. What's the mechanism for DI? Why does it occur? What does the urine look like, and why?

Cushings Triad is a late sign, and I could not find any reference to say DI was a late sign, do you have one?

StudentOfHealing · Dec 4, 2013

"ICP" means "intracranial pressure," something everyone has. "Increased ICP" is what we're talking about here. DI is a late sign when things are really bad. What's the mechanism for DI? Why does it occur? What does the urine look like, and why?

Is DI a late sign of Increased Intracranial Pressure because eventually lack of adequate cerebral perfusion and acidosis damages the hypothalamus/posterior pituitary?

OR

Does the body itself seek to inhibit ADH production in hopes of decreasing the cranial pressure, by not allowing the body to retain water (because ADH retains water)?

DI is inadequate ADH.

ADH serves to retain water and also vasoconstrict ...

Patient is really thirty... urinates a lot ... urine is very dilute ?

Pt with DI won't usually look dehydrated though because they'll be drinking so much.

KelRN215, BSN, RN · Dec 5, 2013

I'm just going to address the Neuro questions, because that's my background.

Alright, I've added some of my reasoning for the bolded answers I had previously posted. I also selected by 'best guess' answer for all but the question concerning thrombolytic therapy. I'm pretty clueless on that one.
A rehabilitation nurse is approached by a stroke victim's family and asked why the patient has to do so much for himself when he is obviously struggling. What's the nurses best answer?
A - "We are trying to help your family member be as useful as possible." - implies PT is useless, insulting
B - "The focus on care in a rehabilitation facility is to teach the patient to resume as much self-care as possible." - This is true. Does not set unrealistic expectations.
C - "We aren't here to care for the patient in the way the hospital staff did. We are here to help the patient get better so they can go home." - aggressive in tone, confrontational.
D - "Rehabilitation means helping the patient do what they did before their stroke." - may set unrealistic expectations, possibly right but I don't think so

I don't think D necessarily sets unrealistic expectations. The patient may never get their full function back but the goal is still for them to return to their previous level of functioning and self-care is not the only function of rehab.

A nurse caring for a patient who is discharged home after a stroke is preparing patient/family teaching. What topics would be most important for the nurse to include? (MARK ALL THAT APPLY)
A - Stroke Prevention - Preventing future strokes would be vital
B - The rehabilitation process - Rehab process would be vital for aftercare
C - Causes of stroke - not solid on this answer, knowing causes may prevent future events.
D - Adequate nutrition
E - Exercise

Nutrition and exercise are important for a patient s/p CVA too, are they not? I think all of these answers are correct.

When caring for a patient who has had a stroke a priority is reduction of intracranial pressure. What position is indicated to assist with this goal?
A - Head turned to the right side - non factor, especially since side effected by stroke isn't indicated
B - Elevation of the head of the bed - keeps head upright, above rest of body.. no pressure buildup by blow flowing to head
C - Head turned to the left side - non factor, especially since side effected by stroke isn't indicated
D - Extension of the neck - not sure why, but doesn't seem right

Elevate HOB for patients at risk for increased ICP. If the patient were on stroke precautions, he'd be on strict bedrest with HOB flat.

When assessing a patient, the nurse notes early signs of increasing ICP. What S/S might the nurse have noted?
A - Increased respiratory effort
B - Increased urinary output
C - Decreased heart rate - these two seem most likely because ICP is related to blood flow, blood pressure, etc.
D - Decreased blood pressure

This is a bad question as none of the above are "early" signs of increased ICP. I'm assuming decreased HR is the correct answer but bradycardia/Cushing's triad are LATE signs of increased ICP. Early signs are headache, vision changes, vomiting and lethargy. Blood pressure doesn't decrease with increased ICP- you get a widening pulse pressure with increased systolic and decreased diastolic pressures. Those who are suggesting increased UOP as indicative of DI is the right answer are digging a little to far into this question. DI is a rare disorder, I don't think I've ever seen it from increased ICP. I've seen it from pituitary and hypothalamic tumors and in one case of shaken baby syndrome where the damage was so extensive that she had infarcts that affected her endocrine function.

A patient with a cerebral aneurysm exhibits signs and symptoms of an increase in ICP. What nursing intervention would be most appropriate for this patient?
A - Range of motion exercises to prevent contractures - may increase blood pressure and ICP due to changes in blood flow
B - Encourage independence with ADLs to promote self-esteem - not a priority with ICP
C - Encourage family visitations to decrease anxiety - stimulation may be counterproductive to stated goal
D - Absolute bed rest in a quiet nonstimulating environment - no movement and lack of stimulation keeps PT at rest, keeps BP down, and may help with reducing ICP.

I agree that D is the best answer of those given but I can tell you I've never had a patient on absolute bed rest because of increased ICP. Most of them aren't moving around much because they're so lethargic from the pressure in their heads but if they had other symptoms of increased ICP (such as vomiting), there's no reason why they can't get up to vomit in the toilet if they feel so inclined.

Jenngirl34RN · Dec 5, 2013

Increased ICP leads to decrease in intracranial blood flow. The brain's first response is to seek more blood flow by increasing BP. After that, HR drops. So C is the answer. Look up Cushing's Triad.

Yes, but the OP's question specifically said early signs of ICP, and the HR drop is a late sign...Wouldn't the answer be A? I know hypoventilation can occur in the early stages, especially when sleeping.

MendedHeart · Dec 5, 2013

I'm just going to address the Neuro questions, because that's my background.
I don't think D necessarily sets unrealistic expectations. The patient may never get their full function back but the goal is still for them to return to their previous level of functioning and self-care is not the only function of rehab.
Nutrition and exercise are important for a patient s/p CVA too, are they not? I think all of these answers are correct.
.

They are important, yes, but the question is asking for MOST Important, and It cannot be All ever. IT WILL NEVER BE ALL OF THE ABOVE!

As.a Neuro person, you should be aware that there are certain mandated topics of education required. These are specific, constant, and tailored too the individual.

We just went through our Stoke certification and had a lot of CEs on this stuff.

So again, as I said before(not convinced people truely read all of peoples previos posts) they are looking for most important

Esme12, ASN, BSN, RN · Dec 5, 2013

They are important, yes, but the question is asking for MOST Important, and It cannot be All ever. IT WILL NEVER BE ALL OF THE ABOVE!
As.a Neuro person, you should be aware that there are certain mandated topics of education required. These are specific, constant, and tailored too the individual.
We just went through our Stoke certification and had a lot of CEs on this stuff.
So again, as I said before(not convinced people truly read all of peoples previous posts) they are looking for most important

It is a take home and not necessarily truly NCLEX.

A rehabilitation nurse is approached by a stroke victim's family and asked why the patient has to do so much for himself when he is obviously struggling. What's the nurses best answer?

I agree that this is probably B.... wordy but accurate.

A nurse caring for a patient who is discharged home after a stroke is preparing patient/family teaching. What topics would be most important for the nurse to include? (MARK ALL THAT APPLY)

A - Stroke Prevention

B - The rehabilitation process

C - Causes of stroke

D - Adequate nutrition

E - Exercise

out of all these.....which is the most important to each the patient to help thier future at home.

A - Stroke Prevention

B - The rehabilitation process

D - Adequate nutrition

E - Exercise

while the causes of stroke is important the most important going forward would be to prevent further strokes, know that rehab is important to return function, good/proper nutrition is important to their heath, and exercise is the best way to reduce risks and improve health and function

In genetic and genomic medicine, what do nurses help both individuals and families understand?

hummmmm....I agree C just because one has a genetic predisposition doesn't not mean they will be afflicted with disease....it's about environment, diet, exercise in some cases.

When caring for a patient who has had a stroke a priority is reduction of intracranial pressure. What position is indicated to assist with this goal?

Since the question is about ICP....the best position for an elevated ICP is keep the HOB elevated at least 35 degrees with the head an neck in a NEUTRAL position to facilitate venous outflow.

When assessing a patient, the nurse notes early signs of increasing ICP. What S/S might the nurse have noted?

A - Increased respiratory effort

B - Increased urinary output

C - Decreased heart rate

D - Decreased blood pressure

Well....I don't like the question nor the answers. The early signs of an elevated ICP are...confusion, restlessness, lethargy, and disorientation first to time, then to place, and then to person. Bradycardia is a common early sign that increasing pressure is significant. Increased respiratory effort....is this referring to Cheyne Stokes/hyperventilation type respirations the brain usues in an attempt to decrease the ICP...another late sign...but that is an increased/variable rate not necessarily effort. Increases urinary output? another late sign of an elevated ICP. Most of these patient have increased urinary output due to the use of osmotic diuretics like Mannitol. Decreased B/P is just a plain NO. Cushings triade: widening pulse pressure (with hypertension), bradycardia, and abnormal respiratory patterns...Increased ICP

Given the answers provided...bradycardia for it is probably the first/common thing you will see in head trauma

As a member of the stroke team, you know that the contraindications for thrombolytic therapy include what? MARK ALL THAT APPLY

Another annoying question. There are absolute and relative contraindications in the use of thrombolytics. Absolute:

Previous intracranial bleeding at any time, stroke in less than 6 months, closed head or facial trauma within 3 months, suspected aortic dissection, ischemic stroke within 3 months (except in ischemic stroke within 3 hours time), active bleeding diathesis, uncontrolled high blood pressure (>180 systolic or >100 diastolic), known structural cerebral vascular lesion, arterio-venous malformations, thrombocytopenia, known coagulation disorders, aneurysm, brain tumors, pericardial effusion, septic emboli. Relative: Current anticoagulant use, invasive or surgical procedure in the last 2 weeks, prolonged cardiopulmonary resuscitation (CPR) defined as more than 10 minutes, known bleeding diathesis, pregnancy, hemorrhagic or diabetic retinopathies, active peptic ulcer, controlled severe hypertension.

A - INR above 1.0

B - Recent intracranial pathology

C - Symptom onset greater than 2 hours prior to admission

D - Current anticoagulation therapy

E - Symptom onset greater than 3 hours prior to admission

The present recommendation indicate that inclusion cirteria is within a 3-4.5 hour window...so A B D as the question doesn't indicate whether these are absolute or relative contraindications.

A patient with a cerebral aneurysm exhibits signs and symptoms of an increase in ICP. What nursing intervention would be most appropriate for this patient?

Because this is about aneurysm precautions in which it is specifically appropriate and recommended for a quite environment...

A - Range of motion exercises to prevent contractures

B - Encourage independence with ADLs to promote self-esteem

C - Encourage family visitations to decrease anxiety

D - Absolute bed rest in a quiet nonstimulating environment

D would be the answer here. Aneurysm precautions

MendedHeart · Dec 5, 2013

All nursing school questions are geared toward answering NCLEX...what in the world? Im not telling this person wrong info, so please support not dismiss my advice.

Also, in order to use TPA after 3 hours, there are more ecclusion criteria added because the risk.for a bleed increases

Before the 3 hour window-a person can recieve antithrombolytics if the are on anticoagulants, but their INR must be

After 3 hours, they cannot. Also a few other criteria

Esme12, ASN, BSN, RN · Dec 5, 2013

No one is discrediting your posts...My question is...are these made by the teacher or from a book.

I agreed with you y the way....The answer for contraindication were A B and D.

The Massachusetts General.....

[h=3]Protocol for use of IV tPA in the 3-4.5 hour window[/h] The new guidelines....

Revised: rtPA is recommended in eligible patients in the 3- to 4.5-hour window. Eligibility criteria are similar to those for the 3-hour window except for the exclusion of patients over 80 years old, those on oral anticoagulants, those with a baseline NIHSS score > 25, those with imaging evidence of ischemic damage to more than one third of the middle cerebral artery (MCA) territory, and those with a history of both stroke and diabetes mellitus. Physicians should be prepared to manage potential side effects such as bleeding and angioedema. Streptokinase is not recommended for acute stroke, nor are other fibrinolytic or defibrinogenating agents.

Source medscape....it requires registration but it is free....http://www.medscape.com/viewarticle/779968_8

MendedHeart · Dec 5, 2013

The questions are going to be NCLEX style regardless, why would they ask any other type.

Esme12, ASN, BSN, RN · Dec 5, 2013

The questions are going to be NCLEX style regardless, why would they ask any other type.

I KNOW what you are saying...however the teacher just might be fallible.

IF this teacher is consistent then I agree...I ALSO AGREE that there are no all of the above included in these responses.

nurseprnRN, BSN, RN · Dec 5, 2013

DI is caused when the ICP is so high that the brain smooshes down up against the bottom of the skill, making the pituitary ischemic. You see this all the time in organ donors :) Result: No ADH, lots of water out the renals, clear urine with a specific gravity of 1.000 or close to it, massive intravascular loss.

Absent other reasons for huge water losses through the kidney (lithium poisoning is a good one-- disables the kidneys from recognizing ADH even if there's lots of it around; smaller effects from ordinary alcohol, which is why you pee so much after a few drinks), DI is a late sign.

its_meee · Dec 5, 2013

As a student, it's good to know that real NCLEX questions are never all of the above. However, just yesterday in MedSurg we had a question on a quiz where the answer WAS all of the above. So, it is possible that all of the above is correct on this poster's question.