Would someone mind helping with a few study guide questions?

StudentOfHealing · Dec 4, 2013

You need to answer them and tell the fine people here at AN why you think they're right.

Nobody will do your homework...!

HappyWife77, BSN, RN · Dec 4, 2013

You need to answer them and tell the fine people here at AN why you think they're right.
Nobody will do your homework...!

Yes.....what do you think?

aaabbbccc · Dec 4, 2013

I just read that in the rules above!

I'll do some editing to show my reasoning.

aaabbbccc · Dec 4, 2013

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

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

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

A - How genetic and psychological factors influence weekly rituals – the rituals parts makes this answer worse than others.

B - How genomic and physical factors influence longevity – other factors than longevity would be important.

C - How genetic and environmental factors influence health and disease – most likely candidate in my opinion focuses on the effects of genetic influence.. the environmental section does put me off a little.

D - How physical factors influence genetics and wellness – it seems the priorities are swapped in this answer

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

While a nurse is taking a patient's history, the patient tells the nurse that she is trying to get pregnant and is very fearful she will have another miscarriage. She states she has lost two pregnancies and she shares with the nurse that she does not know why she lost the babies. Based on this PT's history, what recommendation should the nurse make at the present time?

A - Instruct her to continue to try to get pregnant. – dismissed issue at hand

B - Let the patient know that her loss may not occur again – while technically correct in ‘may not’ fails to address concern

C - Instruct her on chromosome testing studies – may indicate genetic issue causing miscarriages, doesn’t directly address problem but indicates a possible resource.

D - Tell her to have an amniocentesis with the next pregnancy – amniocentesis RAISES risk of miscarriage

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

A family history that is obtained as a nursing assessment is the first step in what?

A - Establishing the patten of inheritance

B - Establishing a pedigree - pedigree allows visual representation of inherited traits and health status

C - Answering the patient's genetic questions - family history is generally first genetic test done. would seem logical this may be an answer.

D - Answering families' relationship questions

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

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

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.

Jenngirl34RN · Dec 4, 2013

For the second one I would have chosen A, D, and E, as he is newly discharged and his rehab, diet, and exercise will be very important and would be included in the instructions to the patient and family. For number seven I would say A, but B could be right too. A family history is not really a genetic test and a patient's genetic questions could not be answered by the info gathered in a history. For number 6 I would say A...I think that with increasing ICP the blood pressure would actually be expected to increase not decrease, and decreased heart rate is a later sign.

StudentOfHealing · Dec 4, 2013

For the second one I would have chosen A D, and E, as he is newly discharged and his rehab, diet, and exercise will be very important and would be included in the instructions to the patient and family. For number seven I would say A, but B could be right too. A family history is not really a genetic test and a patient's genetic questions could not be answered by the info gathered in a history. For number 6 I would say AI think that with increasing ICP the blood pressure would actually be expected to increase not decrease, and decreased heart rate is a later sign.[/quote']
ICP question is tricky, as decreased HR is part of Cushings Triad.
Does the blood pressure initially increase or decrease in response to increased ICP? I would assume initially BP would increase ... because this will bring more blood flow to the brain, right? (body trying to do what it thinks is good).
Neuro mystified me back when I did my Neuro ICU rotations ... it still baffles me. I love it though!

MendedHeart · Dec 4, 2013

For the second one I would have chosen A, D, and E, as he is newly discharged and his rehab, diet, and exercise will be very important and would be included in the instructions to the patient and family.
For number seven I would say A, but B could be right too. A family history is not really a genetic test and a patient's genetic questions could not be answered by the info gathered in a history. For number 6 I would say AI think that with increasing ICP the blood pressure would actually be expected to increase not decrease, and decreased heart rate is a later sign.

CAUSES

RISK FACTORS

MEDICATION

RESOURCES FOR SUPPORT

TREATMENTS

DISCHARGE INSTRUCTIONS-All of these mandated education by Joint Commission and CMS to be Stroke certified and Reimbursed:

I would go with A,C,D (maybe B)because these are MOST IMPORTANT at this particular time. I do think the other two are important but if you had to pick the most crucial and consequential, those are the ones Id pick.

Thoughts?

Try getting in the habit of picking out these keys phrases when answering NCLEX style questions. Like: "..whats the PRIORITY, what would the nurse do FIRST, What is MOST IMPORTANT, ETC....

MendedHeart · Dec 4, 2013

ICP question is tricky, as decreased HR is part of Cushings Triad.
Does the blood pressure initially increase or decrease in response to increased ICP? I would assume initially BP would increase ... because this will bring more blood flow to the brain, right? (body trying to do what it thinks is good).
Neuro mystified me back when I did my Neuro ICU rotations ... it still baffles me. I love it though!

PULSE PRESSURE WIDENS (USUALLY SYSTOLIC HIGH, DIASTOLIC LOW )and a decreased Pulse are LAte SIGNS

BP stays stable until later then increases with that wide PP

Respiratory compromise is usually late as well

My first thought was Increased Urinary Output because Diabetes Insipidus can occur with ICP

nurseprnRN, BSN, RN · Dec 4, 2013

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

B is a pretty good answer, but incomplete. D is better, because rehab is aimed at more than self-care.

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

All of the above. Just because it's stroke doesn't mean he doesn't get the best patient teaching you can give, and you almost always want to be sure about nutrition (can he cook? eat? shop? normally?) and exercise (to maintain functional gains)

In genetic and genomic medicine, what do nurses help both individuals and families understand?
A - How genetic and psychological factors influence weekly rituals – the rituals parts makes this answer worse than others.
B - How genomic and physical factors influence longevity – other factors than longevity would be important.
C - How genetic and environmental factors influence health and disease – most likely candidate in my opinion focuses on the effects of genetic influence.. the environmental section does put me off a little.
D - How physical factors influence genetics and wellness – it seems the priorities are swapped in this answer

C is correct. Current research indicates they go hand in hand in many 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?
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

It's not "no pressure buildup by blood (you did mean that, right? :) ) flowing to head," it's increased venous drainage, no obstruction to venous outflow.

While a nurse is taking a patient's history, the patient tells the nurse that she is trying to get pregnant and is very fearful she will have another miscarriage. She states she has lost two pregnancies and she shares with the nurse that she does not know why she lost the babies. Based on this PT's history, what recommendation should the nurse make at the present time?
A - Instruct her to continue to try to get pregnant. – dismissed issue at hand
B - Let the patient know that her loss may not occur again – while technically correct in ‘may not’ fails to address concern
C - Instruct her on chromosome testing studies – may indicate genetic issue causing miscarriages, doesn’t directly address problem but indicates a possible resource.
D - Tell her to have an amniocentesis with the next pregnancy – amniocentesis RAISES risk of miscarriage

This is a problem question, but not for the reasons you might think. None of these answers are within the scope of nursing practice.

A: If you told her to keep trying to conceive, and she conceived another defective fetus, you could be liable for causing distress because you gave medical, not nursing, advice.

B: See A, and also you can have no idea whatsoever if this is the case.

C: It is not within scope to "instruct" her on chromosome testing studies. Although this is probably a nursing school question, and they probably mean this to be the correct answer (it's marginally better than the others), but it would have been more appropriate to say something like, "What do you know about chromosomal studies? Have you discussed chromosomal testing with your physician?"

D: Also out of your scope of practice. "Have you discussed ....?"

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

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.

A family history that is obtained as a nursing assessment is the first step in what?
A - Establishing the patten of inheritance
B - Establishing a pedigree - pedigree allows visual representation of inherited traits and health status
C - Answering the patient's genetic questions - family history is generally first genetic test done. would seem logical this may be an answer.
D - Answering families' relationship questions

You can't do a pedigree without the assessment, and you would always get info on health status generally, not just the genetic disease (which you might not even know about yet, or might not have a medical diagnosis for), to construct that visual. So B it is. C is outside of your scope of practice.

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

What's thrombolysis? There is only one answer here, and that's E. Why is that? Whose guidelines say so?

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.

Perfect. PT means "physical therapy," though. "Patient" is usually abbreviated as "pt."

Thanks for giving your thoughts and letting us know you actually put some work into this.

nurseprnRN, BSN, RN · Dec 4, 2013

My first thought was Increased Urinary Output because Diabetes Insipidus can occur with ICP

"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?

MendedHeart · Dec 4, 2013

B is a pretty good answer, but incomplete. D is better, because rehab is aimed at more than self-care.
All of the above. Just because it's stroke doesn't mean he doesn't get the best patient teaching you can give, and you almost always want to be sure about nutrition (can he cook? eat? shop? normally?) and exercise (to maintain functional gains).

It will NEVER be ALL THE ABOVE. Select all that apply questions are NEVER just one and NEVER all of the above, there must be at leat 2 correct and no more than 4. This is basic NCLEX question answering skills