Question

Goro Oishi

INTRACEREBRAL HEMORRHAGE

Glasgow Coma Scale

•Mr. Oishi's level of consciousness remains impaired with a Glasgow Coma Scale score of 4. No verbal response. Does not open eyes. Pupils unequal and sluggishly responsive to light. No spontaneous movement

•Decerebrate rigidity of extremities to painful stimuli on right side. Unresponsive on left side.

•Shallow respiratory effort. No cough or gag reflex. Clear oral secretions suctioned as needed to keep airway clear. On 2 liters of oxygen by nasal cannula with Spo2 94%.

•Peripheral IV of D5NS with KCL at 100 ml/hr, site without redness or edema. NPO. Family at bedside. Family requests palliative care only.

•Urine output decreased with only 200 ml voided since 0700. Peripheral IV of D5NS with KCL infusing at 100 ml/hr, site without redness or edema

•Physical assessment unchanged. 2 liters flow oxygen by nasal cannula continues. SpO2 decreased to 88% at 1100. Temperature remains elevated at 101.2 F.

•Last dose of Acetaminophen received at 0700. Palliative care continues. Family at bedside.

•Urine output decreased with only 200 ml voided since 0700. Peripheral IV of D5NS with KCL infusing at 100 ml/hr, site without redness or edema.

•Neurological assessment with altered findings at 1130. Left pupil fixed and dilated. Blood pressure increased and SpO2 remains decreased at 88%.

•Oxygen administration increased at 1115 to 4 liters flow by nasal cannula without improvement in oxygen saturation. Increasingly labored respiratory effort. Positive Babinski reflex. No urine output since 1000

•Palliative care continues. Family at bedside.

TREATMENT

•Emergency treatment of intracerebral hemorrhage focuses on controlling the bleeding and reducing pressure in your brain caused by the excess fluid.

•Surgery

•Clipping

•Coiling

•AVM surgery

•Stereotactic radiosurgery

1. Goro Oishi exhibited all the following risk factors for stroke except:

A.    diabetes mellitus.

B.    hyperlipidemia.

C.    hypertension.

D.    heavy alcohol consumption.

2. Which information in Goro Oishi's record would help determine whether his stroke was hemorrhagic or thrombotic?

A.    Increasing difficulty speaking

B.    Numbness and weakness on his left side

C.    History of hypertension

D.    Sudden onset of a severe headache

3. When Goro Oishi arrived in the Emergency Department, he displayed no verbal response, had no eye response to painful stimuli and no movement of the left extremities, and demonstrated abnormal posturing and extension on the right side when exposed to painful stimuli. Based on these data, his Glasgow Coma Scale core would be:

A.    3.

B.    4.

C.    5.

D.    6.

4. In the ED, Goro Oishi's pupils were unequal (L>R), with sluggish reaction to light. This indicates:

A.    damage to the pons.

B.    early pressure on the oculomotor nerve.

C.    irreversible coma.

D.    damage to the trigeminal nerve.

5. Which of the following nursing actions is instituted in response to Goro Oishi's increased ICP?

A.    Maintaining patient in heads-up position

B.    Turning and positioning every 2 hours

6. Which of the following is Goro Oishi at risk for because of continuing increased ICP?

A.    Cerebral edema

B.    Hypothermia

C.    Seizures

D.    Sensory overload

C.    Hydrating adequately with IV fluids

D.    Administering pain medication for headache

7. The nurse arranges for hospice care for Goro Oishi, knowing that this care is indicated in this instance because:

A.    family members are in conflict about what treatments should be provided.

B.    the family is unable to provide home care for Mr. Oishi.

C.    this will provide support while Mr. Oishi is dying.

D.    this will treat Mr. Oishi's pain and suffering

8. Before his hospitalization, Goro Oishi was on a combination of oral amlodipine and benazepril. What was the purpose of this medication?

A.    To manage hypertension

B.    To relieve angina

9. Before his hospitalization, Goro Oishi was on atorvastatin 20 mg. What piece of information from his history would signal possible adverse effects in the of this medication?

A.    Hypertension

B.    Increasing stress levels

C.    Alcohol abuse

D.    66 years of age

C.    To reduce congestive heart failure

D.    To improve heart rhythm

10. The order reads "1.0 g/kg of 25% solution." Goro Oishi weighs 165 lb. How many grams of mannitol are needed?

A.    50 g

B.    75 g

C.    100 g

D.    165 g

11. How was the mannitol administered to Goro Oishi?

A.    Intravenously, through a filter

B.    Intramuscularly, deep in a large muscle

C.    Subcutaneously, with care taken to rotate sites

D.    Route depended on the severity of the patient's condition

12. After mixing the IV nitroprusside drip, the nurse should do which of the following?

A.    Place the IV bag in an opaque wrapper.

B.    Let the solution sit for 10 minutes before administration.

C.    Give the medication immediately.

D.    Allow the solution to turn slightly blue before administration.

13. The order reads "Nitroprusside sodium 50 mg in 250 cc D5W to titrate systolic B/P <140 >110." How many mcg per milliliter of nitroprusside are contained in a 250-cc solution?

A.    0.2 mcg

B.    2 mcg

C.    20 mcg

D.    200 mcg

14. The order reads "Famotidine 20 mg IVPB q12h." The nurse decides to add the solution to the primary IV of 1000 cc of D5NS with 20 mEq KCl set at 100 cc/hr. Which of the following is a true statement concerning the nurse's actions?

A.    This is a bad decision; IV famotidine is incompatible with KCl.

B.    This is a good decision; this will deliver a steady dose of famotidine over a 12-hour period.

C.    This is a bad decision; famotidine should be delivered rapid IV push for best effect.

D.    This is a good decision; this will eliminate an unnecessary IV line

15. The order reads "IV D5NS with 20 mEq KCl @ 100 cc/hr." How many mEq of KCl are being delivered per hour?

•A.    2 mEq

•B.    5 mEq

•C.    10 mEq

•D.    20 mEq

16. An IV of D5NS with 20 mEq KCl was ordered. Nursing interventions include the following except:

A.    assess site for phlebitis and/or infiltration.

B.    measure urinary output.

C.    give KCl by slow IV push.

D.    monitor IV flow rate.

17. Which of the following nursing diagnoses is the lowest priority for Goro Oishi's end-of-life care?

A.    Risk for injury

B.    Risk for aspiration

C.    Self-care deficit: total

D.    Altered nutrition: less than body requirements

18. Which of the following factors in Goro Oishi's history plays an important role in his end-of-life care?

A.    Recent heavy drinking binges

B.    Age of 66

C.    Zen Buddhism religion

D.    His response to nitroprusside

SUBJECT: NURSING

Answer 1

1.The risk factors of stroke are diabetes, hypertension and high cholesterol levels in the blood

Chronic alcohol consumption will affect the liver first and not the brain and hence not causing stroke

Ans: heavy alcohol consumption

2.Difficulty in speaking ,numbness, weakness of arms ,history of hypertension are related to the symptoms of thrombotic and hemorrhagic stroke

Headache is a symptom of thrombotic  stroke . This is correct

Ans: Sudden onset of severe headache

3.No eye response =1

No verbal response=1

Motor response (decerebrate =2

The GCS of the patient is 4

The response when increases gradually it is categorized into score 5 or 6.So this is incorrect.

If patient has no eye response, no motor response and no verbal response ,then the score is 3

Ans:4

4.The pons are not damaged first

Optic nerve are affected first and not the occulomotor nerve

When the trigeminal nerves are affected the reaction to light will be sluggish in the eye .So this is correct

Ans:damage to the trigeminal nerve