NUR 265 TEST 3 || All Accurately Answered.
What causes Autonomic Dysreflexia correct answers Stimulation at level of T6 or above
What are some examples of triggers of autonomic dysreflexia correct answers restrictive
clothing; full bladder/neurogenic bladder; fecal impaction; directive pressure s/a sitting in the
wheel chair
signs and systems of Autonomic Dysreflexia correct answers hypertension, flushed face,
headaches, JVD, bradycardic, diaphoresis, pale ext below the level of T6, nausea, dilated pupils,
blurred vision, restlessness
What is the purpose of fluid resuscitation for a burn victim correct answers maintain vital organ
perfusion, reduce edema, minimize effects of fluid shifts, prevent hypovolemic shock
What IV solution is commonly used to resuscitate a pt with a burn correct answers Lactated
ringers
Chemical burns should be irrigated until correct answers 20 minutes or the burn sensation
continues after the 20 minute marker
what would you use to remove hot tar or asphalt correct answers citrus petroleum jelly ex;
medisol
petroleum jelly
antibiotic ointment
what kind of brain injury would you expect if an adult client is positive for Palmer's infant
reflexes correct answers cortical and premotor cortex damage
,what kind of brain injury would you expect if an adult client is positive for plantar infant reflexes
correct answers upper motor neuron lesion
what kind of brain injury would you expect if an adult client is positive for rooting infant reflex
correct answers frontal lobe damage
what kind of brain injury would you expect if an adult client is positive for sucking infant reflex
correct answers Advance dementia; cortical brain damage
what kind of brain injury would you expect if an adult client is positive for glabella (persistent
blinking) infant reflex correct answers diffuse cortical dysfunction
What is the consensus formula for burns correct answers 2-4 ml X TBSA X KG
What S&S are expected for a burn client who is receiving the first 8 hours of fluid resuscitation
correct answers Restlessness, anxiety, Hypothermia
how much fluid replacement are you going to give the first 8 hours correct answers 1/2 of the
fluid consensus
What do you need to monitor when resuscitating fluids for burn pt to make sure that it is working
correct answers Urine output
Besides a hyperbaric chamber how would you admin o2 to a client with CO poisoning correct
answers 100% O2 with a non-rebreather
How would you treat a circumferential trunk burn that is swelling and why? correct answers
Eschartomies R/T constriction of the chest wall expansion
, what are the classification of shock correct answers Cardiogenic; hypovolemic, neurogenic, and
Disruptive
All shock is caused by correct answers inadequate tissue perfusion
Patho of hypovolemic shock correct answers Inadequate circulating blood volume S/A burns,
hemorrhage, dehydration
Patho for cardiogenic shock correct answers Inadequate pumping action of the heart S/A MI,
CHF, PE
What are the 3 subclasses of Distributive shock correct answers Anaphylactic; Septic;
Neurogenic
Patho for neurogenic shock correct answers interference of the nervous system that controls the
blood vessels
Patho for septic shock correct answers Release of vasoactive substance from the immune system
How much blood loss is required for the patient to be at high risk for hypovolemic shock correct
answers 15-25%, or 1/3 of the body blood, or 5L
clients who experience slow blood loss can correct answers Tolerate the blood loss better then a
client with rapid blood loss
Signs and symptoms of compensatory shock correct answers hypotension, tachycardia,
tachypnea, hypothermia, decrease pulse pressure
What causes Autonomic Dysreflexia correct answers Stimulation at level of T6 or above
What are some examples of triggers of autonomic dysreflexia correct answers restrictive
clothing; full bladder/neurogenic bladder; fecal impaction; directive pressure s/a sitting in the
wheel chair
signs and systems of Autonomic Dysreflexia correct answers hypertension, flushed face,
headaches, JVD, bradycardic, diaphoresis, pale ext below the level of T6, nausea, dilated pupils,
blurred vision, restlessness
What is the purpose of fluid resuscitation for a burn victim correct answers maintain vital organ
perfusion, reduce edema, minimize effects of fluid shifts, prevent hypovolemic shock
What IV solution is commonly used to resuscitate a pt with a burn correct answers Lactated
ringers
Chemical burns should be irrigated until correct answers 20 minutes or the burn sensation
continues after the 20 minute marker
what would you use to remove hot tar or asphalt correct answers citrus petroleum jelly ex;
medisol
petroleum jelly
antibiotic ointment
what kind of brain injury would you expect if an adult client is positive for Palmer's infant
reflexes correct answers cortical and premotor cortex damage
,what kind of brain injury would you expect if an adult client is positive for plantar infant reflexes
correct answers upper motor neuron lesion
what kind of brain injury would you expect if an adult client is positive for rooting infant reflex
correct answers frontal lobe damage
what kind of brain injury would you expect if an adult client is positive for sucking infant reflex
correct answers Advance dementia; cortical brain damage
what kind of brain injury would you expect if an adult client is positive for glabella (persistent
blinking) infant reflex correct answers diffuse cortical dysfunction
What is the consensus formula for burns correct answers 2-4 ml X TBSA X KG
What S&S are expected for a burn client who is receiving the first 8 hours of fluid resuscitation
correct answers Restlessness, anxiety, Hypothermia
how much fluid replacement are you going to give the first 8 hours correct answers 1/2 of the
fluid consensus
What do you need to monitor when resuscitating fluids for burn pt to make sure that it is working
correct answers Urine output
Besides a hyperbaric chamber how would you admin o2 to a client with CO poisoning correct
answers 100% O2 with a non-rebreather
How would you treat a circumferential trunk burn that is swelling and why? correct answers
Eschartomies R/T constriction of the chest wall expansion
, what are the classification of shock correct answers Cardiogenic; hypovolemic, neurogenic, and
Disruptive
All shock is caused by correct answers inadequate tissue perfusion
Patho of hypovolemic shock correct answers Inadequate circulating blood volume S/A burns,
hemorrhage, dehydration
Patho for cardiogenic shock correct answers Inadequate pumping action of the heart S/A MI,
CHF, PE
What are the 3 subclasses of Distributive shock correct answers Anaphylactic; Septic;
Neurogenic
Patho for neurogenic shock correct answers interference of the nervous system that controls the
blood vessels
Patho for septic shock correct answers Release of vasoactive substance from the immune system
How much blood loss is required for the patient to be at high risk for hypovolemic shock correct
answers 15-25%, or 1/3 of the body blood, or 5L
clients who experience slow blood loss can correct answers Tolerate the blood loss better then a
client with rapid blood loss
Signs and symptoms of compensatory shock correct answers hypotension, tachycardia,
tachypnea, hypothermia, decrease pulse pressure
