Intracranial Regulation

The patient has been diagnosed with ethmoid sinusitis. The nurse anticipates the patient to complain of tenderness upon percussion of which area?

Which radiologic finding indicates frontal sinusitis?

The patient presents to the emergency department (ED) with green sputum and severe pain over the top teeth, cheeks, and forehead following a respiratory viral infection. The provider requests the nurse use the transilluminator to assess for sinusitis. Which assessment indicates maxillary sinusitis?

The patient has been prescribed amoxicillin for the treatment of sinusitis. The patient states, “I thought I just had a cold. I don’t want to take antibiotics for a cold.” Which response by the nurse is most appropriate?

The nurse assesses the patient with acute ethmoid sinusitis for which symptom that indicates the patient is experiencing a severe complication of the condition?

The mother of a 1-month-old neonate brings the child to the clinic with concerns that the child’s head seems large. The nurse measures the occipitofrontal circumference (OFC) and notes a 4 cm increase in the OFC since birth. When reporting this information to the provider, the nurse requests which test?

The 76-year-old patient with atrial fibrillation tells the nurse in a slurred voice that the right arm “just isn’t working right.” Which action does the nurse take first?

Which information does the nurse provide to the patient with epilepsy who has been prescribed phenytoin?

A high school wide receiver suffered substantial head trauma during a tackle. The school nurse is concerned about concussion. The nurse provides which information to the adolescent and parents? Select all that apply.

The unit is experiencing increased patient census. Which patients, if suggested for pairing with the 28-year-old patient with epilepsy, does the bedside nurse question? Select all that apply.

The adult child of the patient with dementia who is the patient’s in-home caregiver reports the patient exhibits increased confusion and agitation after 1600 each day. Which statement by the nurse will be most helpful to the caregiver?

The nurse is planning care for the elderly patient with dementia who experiences increased agitation and confusion during the evening hours. Which interventions does the nurse include to decrease evening agitation and confusion? Select all that apply.

The patient with third degree burns to bilateral lower legs is undergoing hydrotherapy to debride eschar tissue from the wounds. Prior to the procedure, the patient received a bolus of intravenous morphine in addition to the continuous infusion for pain control. During the procedure, the patient’s level of consciousness decreases to only rousable by painful stimuli. The patient’s temperature is 36.4°C, respiratory rate is 14 breaths per minute, heart rate is 82 bpm, and oxygen saturation is 93% on room air. The nurse ends the hydrotherapy session and contacts the provider to request which intervention?

The 32-year-old female patient (60 kg) is brought via ambulance to the emergency department following a water drinking competition. The patient has a Glasgow Coma score of 6, oxygen saturation of 94% on room air, heart rate of 62 bpm, and respiratory rate of 16 breaths per minute. The nurse anticipates administering which medication?

The 19-year-old female patient is found unconscious at a party. Bystanders report the individual imbibed a significant amount of grain alcohol and ingested several different pills, including 3,4-methylenedioxymethamphetamine. They observed the patient dancing wildly for several hours; after that, the patient disappeared and was found unconscious an hour later. Vital signs are within defined limits. Which lab result is consistent with the patient’s condition?

The 22-year-old patient is brought to the emergency room with decreased level of consciousness after ingesting 3,4-methylenedioxymethamphetamine. The patient is noted to have a rectal temperature of 40°C. The nurse performs which interventions? Select all that apply.

The nurse most closely monitors the temperature for the patient who underwent which procedure?  

The 62-year-old patient reports erectile dysfunction and states, “I’ve been treating it with herbal remedies prescribed by my naturopathic doctor". Which conditions, if found in the patient’s medical history, prompt the nurse to counsel the patient against these herbal remedies? Select all that apply.  

The nurse is helping to recruit patients for a study about the effectiveness of a new delivery system for somatropin. The nurse filters the records for patients with which conditions? Select all that apply.

The nurse assesses the patient being treated for bipolar disorder for which signs of toxicity?  

The patient being treated for bipolar disorder is found to be lethargic, confused, and obtunded. It is determined that the morning dose of lithium was not taken. Which order does the nurse anticipate first?  

The 24-year-old otherwise healthy patient with bipolar disorder is found unconscious and brought to the emergency department. The patient is mildly febrile, significantly tachycardic, tachypneic, and hypotensive, with poor skin turgor and 5 second capillary refill. The patient’s EKG is notable for inverted T waves and sinus tachycardia. Which orders does the nurse anticipate for this patient? Select all that apply.  

The 11-month-old, previously healthy infant is brought to the emergency department after becoming increasingly lethargic over the past 24 hours. The infant’s vital signs are notable for a temperature of 40.8°C, heart rate 138 bpm, respiratory rate 31, and blood pressure 84/50 mmHg. Upon assessment, the nurse notes sensitivity to light and sound, bulging anterior fontanelle, and significant resistance to turning the head. Place the interventions in the correct order.  

The 5-day-old 38-week-gestation neonate was born to a 25-year-old primigravida woman after a pregnancy and vacuum-assisted delivery complicated by gestational diabetes, large for gestational age fetus, and shoulder dystocia. The neonate required vigorous stimulation and positive pressure ventilation. Apgar scores were 3 and 8 at 1 and 5 minutes of life. At the pediatrician’s appointment after discharge, the neonate is found to have a large bruise at the back of the head that was sustained during birth and eyes glued shut with yellow, mucopurulent discharge. A gram stain of the drainage reveals gram-negative cocci in pairs. The mother states, “No matter what I do, it keeps coming back. I’ve used warm compresses and washed it away.” Additionally, the mother reports the infant is breastfeeding well with 4 wet diapers and 1 stool per day. The nurse informs the provider of the assessment and requests which order first?  

The 75-year-old patient presents to the emergency department complaining of a severe headache that is localized behind the right eye. The patient is nauseous and vomits upon standing. While wearing glasses, the visual acuity is 20/25 in the left eye and 20/110 in the right (records show it is normally also 20/25 corrected). Her left pupil is equal, round, and reactive to light and accommodation; it is measured at 3 mm. Her right pupil reacts only minimally to light and measures at 5 mm; it is round. The provider palpates the eye and reports that it is tense. Her heart rate is 102 bpm and blood pressure is 118/84 mmHg. The nurse anticipates providing which intervention first?  

The 7-year-old child is being evaluated for attention deficit or learning disability. The child’s teachers report a lack of attention to detail and an inability to follow direction. The child’s parents report issues at home, too – not doing what is asked and not remembering what has been said. While being evaluated, the child begins to blink rapidly for 20 seconds. Once the episode ends, the child does not remember what happened or the purpose of the appointment. The nurse prepares education for the parents about which medication? 

The 7-year-old child is being evaluated for attention deficit or learning disability. The child’s teachers report a lack of attention to detail and an inability to follow direction. The child’s parents report issues at home, too – not doing what is asked and not remembering what has been said. While being evaluated, the child begins to blink rapidly for 20 seconds. Once the episode ends, the child does not remember what happened or the purpose of the appointment. The nurse educates the parents about which adverse effects of first line therapy? Select all that apply.  

The patient is brought to the emergency department after sudden onset slurring of the words, confusion, and right-sided weakness that started 3 hours ago. Aspirin was given by emergency response. He has a history of diabetes mellitus, hypertension, and hyperlipidemia for which he is compliant with therapy. He smokes 2 packs of cigarettes per day. Upon assessment, the patient’s temperature is 37.4°C, heart rate is 118 bpm, and blood pressure is 204/118 mmHg.  A stat computed tomography (CT) scan shows an area of hyperechogenicity on the left side of the brain. The nurse prepares to provide which medication?  

The nurse witnesses a 19-year-old collapse while playing soccer. The individual is arousable but confused and irritable. The skin is warm, dry, and flushed. Which actions are most helpful? Select all that apply.  

The patient experiencing an oversecretion of vasopressin presents with a decrease in which laboratory value?