ICP
During the assessment of a patient with increased ICP, you note that the patient’s arms are extended straight out with hyperpronation of the forearms and toes pointed downward. You will document this as:
DECEREBRATE POSTURING
You witness a seizure what interventions are key state 4
Stay with the client
Time the seizure
Ensure safety
Oxygen
Have suction ready
A client comes to the ED with mild hypothermia, what is the best nursing intervention
Administer warmed iv fluids
CBC
CMP
BUN and Creat
A client refuses to go to the grocery store as they may see an ex girlfriend
Avoidant personality
___________is a neurologic emergency that includes systolic HTN, Bradycardia and altered respirations.
What is Cushings Triad
A client is experiencing a tonic clonic seizure what medication is given
Lorazepam IV
Nursing interventions for heat stroke
Cooling blankets
Check electrolytes
Fluid replacement
What assessment findings is expected with a patient with bulimia
Tooth decay
Abnormal labs
BMI at or above normal
A patient stole a car as they thought it was rightfully theirs
What is narcissistic
Posturing above the spinal cord
What is decorticate posturing
A patient experiencing status epileptics what is the primary nursing intervention
Administer Diazepam IV
What nursing intervention should be avoided in a patient with frostbite
Massage the area
What character trait is often seen in a patient with anorexia
Rigid rules and regulations
When caring for this person it is important to open meds in front of them and not whisper
What is paranoid personality disorder
Late sign of IICP
Bradycardia
A patient who has increased ICP is at a risk for seizures. Which of the following interventions will the nurse institute? (select all that apply):
Low stimuli
Suction at the bedside
Avoid passive ROM
What is tachypnea, flushed skin, dramatic increase in body temperature, cola colored urine, sweating, dysrhythmias, hypotension, confusion, muscle pain and rigidity?
What is malignant hyperthermia
A client with an eating disorder is started on an SSRI what education should the nurse give the client
Don't stop abruptly
Allow 4-6 weeks to be effective
Side effects include GI upset, insomnia, sexual dysfunction
This client admits to actively using tinder, goes on multiple dates and seems to be acting bizarre
What is histrionic personality disorder
What drug is given for cerebral edema
Mannitol
When should you assess a patient with seizures?
Before during and after
Name this heat illness based on its symptoms: weak rapid pulse, low BP, headache, nausea, dizziness, goosebumps
What is heat exhaustion
A therapy that aims to help clients counteract harmful behaviors and stop dysfunctional thoughts. Often used for eating disorders
What is CBT
What is cluster B personality disorders
Histrionic, narcissistic, antisocial, and borderline personality disorders make up this cluster