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Questions and Answers
What is the primary purpose of the National Licensure Examination (NLE) administered by the Board of Nursing?
What is the primary purpose of the National Licensure Examination (NLE) administered by the Board of Nursing?
Which of the following is NOT a regulatory function of the PRC-Board of Nursing (PRC-BON)?
Which of the following is NOT a regulatory function of the PRC-Board of Nursing (PRC-BON)?
What is the main goal of emphasizing modifiable risk factors to a patient who has had a heart attack?
What is the main goal of emphasizing modifiable risk factors to a patient who has had a heart attack?
Which of the following is a modifiable risk factor that a patient can work on to prevent another heart attack?
Which of the following is a modifiable risk factor that a patient can work on to prevent another heart attack?
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What is the ultimate goal of the National Licensure Examination (NLE) administered by the Board of Nursing?
What is the ultimate goal of the National Licensure Examination (NLE) administered by the Board of Nursing?
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Which of the following is a regulatory function of the Professional Regulation Commission, Board of Nursing (PRC-BON)?
Which of the following is a regulatory function of the Professional Regulation Commission, Board of Nursing (PRC-BON)?
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What is a clinical manifestation of ketoacidosis that represents the body's attempt to decrease acidosis?
What is a clinical manifestation of ketoacidosis that represents the body's attempt to decrease acidosis?
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Which of the following is NOT a clinical manifestation of ketoacidosis?
Which of the following is NOT a clinical manifestation of ketoacidosis?
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What is the likely cause of appendicitis?
What is the likely cause of appendicitis?
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What is the name of the clinical sign of acute appendicitis that is defined as discomfort felt on the slow internal movement of the hip joint?
What is the name of the clinical sign of acute appendicitis that is defined as discomfort felt on the slow internal movement of the hip joint?
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Which of the following is a clinical manifestation of ketoacidosis that is related to mental status?
Which of the following is a clinical manifestation of ketoacidosis that is related to mental status?
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What is the medical condition characterized by inflammation and edema of the appendix due to a kinked or occluded fecalith, tumor, or foreign body?
What is the medical condition characterized by inflammation and edema of the appendix due to a kinked or occluded fecalith, tumor, or foreign body?
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What is the term for pupil size asymmetries, often associated with neurological deterioration in severe traumatic brain injury?
What is the term for pupil size asymmetries, often associated with neurological deterioration in severe traumatic brain injury?
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What is the primary goal of the airway step in the ABCD sequence?
What is the primary goal of the airway step in the ABCD sequence?
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Which of the following is a late sign of increased intracranial pressure in a client with severe traumatic brain injury?
Which of the following is a late sign of increased intracranial pressure in a client with severe traumatic brain injury?
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What is the term for the combination of increasing systolic pressure, increasing respiration rate, and bradycardia in a client with severe traumatic brain injury?
What is the term for the combination of increasing systolic pressure, increasing respiration rate, and bradycardia in a client with severe traumatic brain injury?
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In which scenario would the use of an automatic external defibrillator (AED) be indicated?
In which scenario would the use of an automatic external defibrillator (AED) be indicated?
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Which of the following respiratory signs would indicate increasing intracranial pressure in the brain stem?
Which of the following respiratory signs would indicate increasing intracranial pressure in the brain stem?
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What is the recommended maximum degree of head elevation to prevent increasing ICP?
What is the recommended maximum degree of head elevation to prevent increasing ICP?
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What is a sign of increasing intracranial pressure?
What is a sign of increasing intracranial pressure?
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What is an early indication of deterioration in the neurologic status of a client with severe traumatic brain injury?
What is an early indication of deterioration in the neurologic status of a client with severe traumatic brain injury?
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What is the correlation between abnormalities of pupillary response and neurological outcome in severe traumatic brain injury?
What is the correlation between abnormalities of pupillary response and neurological outcome in severe traumatic brain injury?
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What is the purpose of maintaining a safe CPP of at least 70 mmHg or 80 mmHg in patients with intracranial hypertension?
What is the purpose of maintaining a safe CPP of at least 70 mmHg or 80 mmHg in patients with intracranial hypertension?
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What is the name of the position that would be contraindicated in patients with intracranial hypertension?
What is the name of the position that would be contraindicated in patients with intracranial hypertension?
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What is the primary purpose of awareness in problem determination?
What is the primary purpose of awareness in problem determination?
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What is a barrier to goal setting between the nurse and the family?
What is a barrier to goal setting between the nurse and the family?
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Why might a family refuse to take action despite perceiving a problem?
Why might a family refuse to take action despite perceiving a problem?
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What is the primary effect of a family's failure to perceive a problem?
What is the primary effect of a family's failure to perceive a problem?
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What is the main benefit of preventive potential?
What is the main benefit of preventive potential?
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Why is modifiability of the problem an important consideration?
Why is modifiability of the problem an important consideration?
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Study Notes
Ketoacidosis
- Kussmaul respiration is a clinical manifestation of ketoacidosis, representing the body's attempt to decrease acidosis by counteracting the effect of ketone buildup.
- Lethargy is a possible mental status variation in ketoacidosis.
- Acetone breath odor occurs due to elevated ketone levels.
Appendicitis
- Appendicitis occurs when the appendix becomes inflamed and edematous as a result of becoming kinked or occluded by a fecalith, tumor, or foreign body.
- Rovsing's sign may be elicited by palpating the left lower quadrant, causing pain to be felt in the right lower quadrant.
- Obturator sign is a clinical sign of acute appendicitis, defined as discomfort felt during slow internal movement of the hip joint while the right knee is flexed.
Nursing Practice
- Airway, Breathing, and Circulation (ABC) principles:
- Airway: opening and maintaining an airway.
- Breathing: providing artificial ventilation by rescue breathing if spontaneous respirations are absent or inadequate.
- Circulation: promoting artificial circulation by external cardiac compression when there is no pulse; administering medications (e.g., epinephrine for asystole).
- Defibrillation: using a standard defibrillator or automatic external defibrillator (AED) for ventricular tachycardia and ventricular fibrillation.
Positioning
- Head elevation up to 30 degrees is recommended to help decrease intracranial pressure (ICP), provided a safe cerebral perfusion pressure (CPP) of at least 70 mmHg or even 80 mmHg is maintained.
Intracranial Pressure (ICP)
- Decreasing systolic pressure, increasing body temperature, and unequal pupil size are signs of increasing ICP.
- Pupillary reactivity is an early indicator of increased ICP.
Barriers to Goal Setting
- Failure of the family to perceive the existence of a problem is a barrier to joint goal setting between the nurse and the family.
Modifiable Risk Factors
- Smoking, high blood pressure, high cholesterol, and being overweight are modifiable risk factors that a patient can work on to prevent another heart attack.
Licensure Examination
- The National Licensure Examination (NLE) is administered by the Professional Regulation Commission, Board of Nursing.
- The examination aims to protect the public from incompetent practitioners and demonstrates expected competency standards.
Regulatory Functions
- The PRC-Board of Nursing (PR-BON) has the power to regulate nursing practice in the Philippines, including enforcing and monitoring quality standards of nursing practice.
Respiratory Signs
- Slow, irregular respiration is a respiratory sign that may indicate increasing intracranial pressure in the brain stem.
Neurological Deterioration
- Early indications of deterioration in neurological status include:
- Dilated, fixed pupil.
- Widening of pulse pressure.
- Decrease in the level of consciousness, an early sign of cerebral hypoxia and increased ICP.
- Decrease in pulse rate.
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Description
This quiz assesses the nurse's knowledge of modifiable risk factors to prevent heart attacks. It focuses on the factors that can be controlled by patients to reduce the risk of another heart attack.