CH2 Exam 1

BRAIN GAMES (NEURO)

100

Identify the neurological condition characterized by continuous or rapidly reoccurring seizures, which is considered a medical emergency.

Answer: Status Epilepticus.

Rationale: The source defines Status Epilepticus as continuous or rapidly reoccurring seizures. It is a medical emergency because it causes hypoxemia, brain damage, arrhythmias, and acidosis.

200

Describe the clinical presentation of Cushing’s Triad, specifically the three specific vital sign changes shown in the provided clinical text and imagery.

Answer: Increased Blood Pressure (Widened Pulse Pressure), Bradycardia (Decreased Heart Rate), and Cheyne-Stokes respirations.

• Rationale: These three vital sign changes constitute Cushing's Triad. The source identifies these as compensatory mechanisms that occur when mean arterial pressure drops or ICP increases.

300

What are the primary nursing interventions when a patient begins a seizure to ensure safety and maintain a patent airway?

Answer: Protect from injury, maintain a side-lying position, provide oxygen therapy, and have suction available.

• Rationale: Priority actions during a seizure focus on safety and maintaining a patent airway. Positioning the patient on their side prevents aspiration, while supplemental oxygen and suctioning manage respiratory compromise.

400

Differentiation between brain tumors is critical for prognosis. Is Glioblastoma Multiforme classified as a primary or secondary tumor, and is it benign or malignant?

Answer: It is a Primary brain tumor and is classified as Malignant/Aggressive.

• Rationale: The source explicitly differentiates brain tumors, categorizing Glioblastoma Multiforme as a highly aggressive, malignant primary tumor.

500

Differentiate between a Grade 2 concussion and a Grade 3 concussion based on the duration of symptoms and the presence of loss of consciousness.

Answer: Grade 2: No loss of consciousness, symptoms persist > 15 min. Grade 3: Presence of loss of consciousness, symptoms persist > 15 min.

• Rationale: Concussions are classified by severity. Both grades involve symptoms lasting longer than 15 minutes, but Grade 3 is defined specifically by the presence of a loss of consciousness.

BREATH OF FRESH AIR (RESPIRATORY)

100

What is the name of the protocol bundle used to prevent a specific type of pneumonia that develops within 48 hours of intubation?

Answer: The Ventilator Bundle (to prevent Ventilator-Associated Pneumonia or VAP).

• Rationale: The "Ventilator Bundle" is a set of evidence-based protocols (CRUSH OUT VAP) designed to prevent infections that occur within 48 hours of intubation. The bundle includes: Elevation of HOB (30-45 degrees), Oral care with antimicrobial rinse, Peptic ulcer prophylaxis, Sedation vacations to assess readiness to extubate, Hand hygiene, Subglottic/In-line suctioning, and Transport guidelines.

200

What diagnostic test is the "gold standard" for the STAT evaluation of a suspected Pulmonary Embolism (PE)?

Answer: CT pulmonary angiogram.

• Rationale: For a STAT evaluation of a suspected Pulmonary Embolism, the CT pulmonary angiogram is identified as the clinical gold standard.

300

When a ventilator alarm sounds, what is the priority nursing action and what must be assessed first?

Answer: Assess the patient first, ventilator second. Assess breathing, color, and oxygen saturation.

• Rationale: Nursing management in critical care dictates that clinical assessment of the patient’s physical status (O2 sat, color, breathing) must always precede the evaluation of mechanical ventilator settings.

400

During the "Exudative Phase" of ARDS, what are the early physical assessment findings regarding heart rate and breath sounds?

Answer: Tachycardia and Diffuse Crackles.

• Rationale: The Exudative Phase of ARDS presents with an acute onset of symptoms, including an increased heart rate (tachycardia) and abnormal breath sounds described as diffuse crackles.

500

According to "The Weaning Path," what are the criteria required to move to the "Ready, weaning!" stage, specifically regarding GCS, breathing, the P/F ratio, and stability?

Answer: GCS ≥ 8, Spontaneous breathing, PaO2/FiO2 > 200, Hemodynamic stability, and Reversal of the cause for respiratory failure.

• Rationale: "The Weaning Path" graphic and text identify these criteria as the essential physiological indicators that a patient is physically ready to begin the weaning process.

SPINE & TRAUMA

100

A patient with a cervical spine injury at or above which specific level will require lifelong mechanical ventilation?

Answer: C4 (Injuries above C4).

• Rationale: The source states that cervical injuries above C4 disrupt the innervation required for spontaneous breathing, thereby necessitating lifelong mechanical ventilation.

200

Differentiate between Spinal Shock and Neurogenic Shock based on the three hemodynamic features unique to neurogenic shock.

Answer: Hypotension, Bradycardia, and Poikilothermia.

• Rationale: Unlike spinal shock (a temporary loss of reflexes), Neurogenic Shock is a hemodynamic phenomenon caused by a disruption of the sympathetic nervous system, resulting in these three specific vitals changes.

300

The ABCD assessment tool is used to determine stroke risk after a Transient Ischemic Attack (TIA). Define what each letter in this tool stands for, including specific clinical thresholds.

Answer: Age (≥ 60 years), BP (≥ 140/90 mmHg), Clinical TIA features, and Duration of symptoms.

• Rationale: The ABCD tool is used after a TIA to calculate the risk of a progressing stroke. It requires monitoring specific numeric thresholds for age and blood pressure.

400

Describe the paradoxical chest movement associated with Flail Chest and identify which direction the mediastinum moves during inspiration.

Answer: The mediastinum moves toward the opposite lung (unaffected side).

• Rationale: In Flail Chest, the chest wall is destabilized by rib fractures. During inspiration, the affected area "sucks inward," causing the mediastinum to shift toward the unaffected lung.

500

What are the exclusion criteria for fibrinolytic therapy (tPA) in acute ischemic stroke patients regarding age and blood pressure thresholds?

Answer: Age > 80 years and BP > 185 systolic or 110 diastolic.

• Rationale: The source lists being older than 80 and having blood pressure above 185/110 mmHg as specific exclusion criteria for administering tPA during the extended 4.5-hour window.

SENSES & SUCH (EYES/EARS)

100

What is the hallmark symptom of retinal detachment, often described by the patient as an obstruction in the field of vision?

Answer: Curtain vision.

• Rationale: Patients with retinal detachment often describe a painless decrease in vision that feels like a "curtain" being drawn over their field of vision.

200

In managing a penetrating eye injury with a protruding object, what is the strict "Never" rule for the nurse?

Answer: Never remove the object that is protruding/profounding.

• Rationale: Removing a penetrating object can cause further trauma; a medical provider must evaluate the eye and determine the surgical extraction method.

300

For a patient with Meniere Disease, the nurse should promote a quiet environment and recommend a diet low in which specific substances?

Answer: Sodium, Caffeine, and Monosodium Glutamate (MSG). (Also nicotine and alcohol).

• Rationale: Reducing these substances in the diet helps manage the symptoms of Meniere Disease and aids in preserving the remaining hearing.

400

Following a pneumatic retinopexy, what specific positioning instruction must the patient follow, and why is this position avoided?

Answer: Avoid lying on the back (supine position).

• Rationale: The supine position is avoided because it allows the gas bubble to move to the front of the eye, where it may press against and damage the lens.

500

Before performing an ear irrigation for impacted cerumen, what two conditions strictly contraindicate the procedure?

Answer: Eardrum perforation or Otitis Media.

• Rationale: The source strictly prohibits ear irrigation for impacted cerumen if there is any evidence of an active infection (Otitis Media) or a hole in the tympanic membrane (perforation).

THE 'LAB'ORATORY

100

What is the normal range for Intracranial Pressure (ICP) measured in mm Hg?

Answer: 10-15 mm Hg.

• Rationale: This is the normal clinical range for Intracranial Pressure as listed in the source documentation.

200

Identify the specific acid-base imbalance for these ABG values: pH 7.25, PaCO2 50, HCO3 24.

Answer: Respiratory Acidosis.

• Rationale: The pH 7.25 indicates acidosis. The PaCO2 50 is high, indicating a respiratory cause. Since the HCO3 24 is normal, this is an uncompensated respiratory acidosis.

300

How is the P/F ratio calculated in the context of ARDS, and what specific value indicates a diagnosis?

Answer: It is the ratio of arterial oxygen to the fraction of inspired oxygen (PaO2/FiO2); a value < 200 mmHg indicates ARDS.

• Rationale: The P/F ratio is a key diagnostic assessment value. A ratio under 200 mmHg signals severe hypoxemia characteristic of ARDS.

400

During advanced airway management, what is the goal time for an intubation attempt, and what action is taken if the goal is not met?

Answer: < 30 seconds (preferably < 15 seconds). If attempts last longer than 30 seconds, the nurse must provide oxygen.

• Rationale: Limiting intubation attempts to under 30 seconds is a critical safety priority to prevent hypoxia. Supplemental oxygen must be provided if this window is exceeded to protect the patient.

500

Based on ventilation/perfusion mismatch, how is a "Silent Unit" identified?

Answer: The absence of both ventilation and perfusion.

• Rationale: According to the source, a "Silent Unit" is a specific type of V/Q mismatch where neither ventilation nor perfusion is occurring, which is seen in conditions like Pneumothorax or ARDS.