Test Blueprint: Exam Blue=Neuro, Brown=Dermatology, Green=Endocrine, Red=Immunology Question 1. tPa administration Nursing Process/NCLEX Category/Cognitive Level Intervention (Pharmacological Therapies) Application. (Same question tPa: 1, 3, 50) (Same topic Stroke: 1, 3, 4, 6, 8, 12, 14, 50) ? 2. Increased ICP interventions Intervention (Physiological Adaptation) Application. (Same topic ICP: 2, 5, 7, 11, 13, 15, 18, 19, 49) 3. tPa administration Intervention (Pharmacological Therapies) Application. (Same question tPa: 1, 3, 50) (Same topic Stroke: 1, 3, 4, 6, 8, 12, 14, 50) 4. Embolic stroke Assessment (Physiological Adaptation) Application. (Same topic Stroke: 1, 3, 4, 6, 8, 12, 14, 50) 5. Reducing ICP Planning (Basic Care & Comfort) Application. (Same topic ICP: 2, 5, 7, 11, 13, 15, 18, 19, 49) 6. Hemorrhagic stroke Analysis/Diagnosis (Physiological Adaptation). Application. (Same topic Stroke: 1, 3, 4, 6, 8, 12, 14, 50) 7. ICP Assessment (Physiological Adaptation) Application. (Same topic ICP: 2, 5, 7, 11, 13, 15, 18, 19, 49) 8. Post stroke assessment & monitoring Assessment (Management of Care) Application. (Same topic Stroke: 1, 3, 4, 6, 8, 12, 14, 50) 9. Autonomic dysreflexia Assessment (Physiological Adaptation) Analysis. (Same topic Spinal Injury: 9, 10, 22, 44) 10. Autonomic dysreflexia Assessment (Physiological Adaptation) Application. (Same topic Spinal Injury: 9, 10, 22, 44) 11. Increased ICP & pituitary issues Assessment (Physiological Adaptation) Application. (Same topic ICP: 2, 5, 7, 11, 13, 15, 18, 19, 49) 12. Dysphagia diet & nutrition Planning (Safety & Infection Control) Analysis. (Same topic Stroke: 1, 3, 4, 6, 8, 12, 14, 50) 13. TBI Planning (Psychosocial Integrity) Application. (Same topic ICP: 2, 5, 7, 11, 13, 15, 18, 19, 49) 14. Right vs. left hemisphere strokes (Same topic Stroke: 1, 3, 4, 6, 8, 12, 14, 50) Planning (Management of Care) Analysis. Left Hemisphere Stroke: Language, Wernicke’s Region (? Understanding written language?) Right Hemisphere Stroke: Visual-Spatial?? Parietal Lobe?? 15. Epidural hematoma Analysis/Diagnosis (Physiological Adaptation) Analysis. (Same topic ICP: 2, 5, 7, 11, 13, 15, 18, 19, 49) 16. Burn injury – fluid resuscitation phase (Parkland formula) 17. Burn injury priority Intervention (Pharmacological Therapies) Application. 18. Maintaining ICP Planning (Management of Care) Application. Assessment (Management of Care) Application. (Same topic ICP: 2, 5, 7, 11, 13, 15, 18, 19, 49) 19. Increased ICP Assessment (Physiological Adaptation) Application. (Same topic ICP: 2, 5, 7, 11, 13, 15, 18, 19, 49) Normal ICP is 10-15 mm Hg. Persistent elevation of ICP minimizes cerebral circulation, resulting in cerebral death if not Tx urgently. Manifestations: -Severe HA -Deteriorating LOC -Restlessness -Irritability -Dilated or Pinpoint pupils -Slowness to react -Alteration in breathing pattern -Deterioration in Motor function -Abnormal posturing 20. Allergic/anaphylactic reaction Analysis/Diagnosis (Management of Care) Application. 21. Burn injury – fluid resuscitation 22. Spinal cord injury – complications Evaluation (Physiological Adaptation) Analysis. Assessment (Management of Care) Application. (Same topic Spinal Injury: 9, 10, 22, 44) 23. Seizure management Intervention (Physiological Adaptation) Analysis. 24. SIADH Intervention (Physiological Adaptation) Application. SI=Soaked Inside Causes often include lung cancer/disease or neuro problems (meningitis, Guillan-Barre syndrome, brain tumors). ADH: posterior pituitary gland (“adds to H2O”). Synthetic ADH (Desmopressin/Vasopressin): decrease urine output, or ‘pressin’ the BP up! HA priority** (s/s of neuro problems, can lead to seizures!) Low Na+ Manifestations: 7 S’ -Stops urination (low output) -Sticky & thick urine -Soaked inside (low blood lab values) -Sodium Low (HA is early sign*) -Seizures (from low sodium; HA and confusion) -Severe high BP -Swelling (edema) Interventions: -Fluid/water restriction -Electrolyte therapy (caution, bc you should Tx excess water before giving more electrolytes) -Surgery -Meds that inhibit ADH effects (diuretics, antiseizure meds, cancer meds, antidepressants, etc). 25. Diabetes insipidus Intervention (Physiological Adaptation) Application. DI=Dry Inside 26. Thyroidectomy Assessment (Management of Care) Application. 27. Cushing’s syndrome – treatment Intervention (Physiological Adaptation) Analysis. Adrenaline (epinephrine): rapidly mobilizes energy stores (sugar/fat) to assist with increased metabolism during stress. Cortisol: a crucial stress hormone (glucocorticoid produced by Adrenal Glands). Acts more slowly but persistently, replenishes energy stores and ensures sustained stress response. -Catabolic function (metabolizes glucose, breaks down proteins/fats/carbs). -Anabolic function (synthesizes NEW fats and glucose), thus the buildup of fat deposits. Hormone Negative Feedback Loop: -Hypothalamus (releases Corticotropin Release Hormone) -Pituitary Gland (releases ACTH) -Adrenal Cortex (releases Cortisol. Also releases Aldosterone, Sex Hormones, other Steroid Hormones via other negative feedback loops). Aldosterone: regulates BP thru Renin-Angiotensin-Aldosterone-System. Retains Sodium, and secretes Potassium. Tx for Cushing’s: -Removal of Pituitary Tumor that’s affecting ACTH release (hypophysectomy) -Removal of Adrenal Tumor (educate pt on steroid/cortisol replacement during recovery)*** -Monitor BG, electrolytes (Na+ and K+), Blood pressure, skin fragility, Infection risk. ***** -Emotional support 28. Prioritization of patient assessment 29. Hypothyroidism Planning (Management of Care) Analysis. 30. DKA Intervention (Pharmacological Therapies) Application. 31. Medication calculation Intervention (Pharmacological Therapies) Application. Analysis/Diagnosis (Physiological Adaptation) Application. 32. HHS Intervention (Physiological Adaptation) Application. 33. CT with contrast Intervention (Reduction of Risk Potential) Application. Indications: to ID tumors and infarctions, detect abnormalities, monitor response to Tx and guide needles for biopsies. Contraindications for Contrast Dye: Iodine Allergies!!!! Trauma/Bleeding/Hemorrhagic Stroke Renal Failure Pregnancy Preprocedural: -NPO for at least 4hrs prior -Assess for allergies to shellfish/iodine*** -Assess BUN/creatinine/Urine output (contrast excreted by kidneys) -No jewelry during procedure! -Head secured, NO movement! Intraprocedural: -Supine, head stabilized -CT is painless, but sedation may be given. Postprocedural: -No follow-up unless sedated or Contrast used (monitor sedated pt until stable; monitor for contrast allergy reaction and renal function). 34. Complications of fractures Assessment (Management of Care) Application. 35. ORIF postop Intervention (Reduction of Risk Potential) Application. 36. ABG analysis Assessment (Reduction of Risk Potential) Analysis. 37. Blood transfusion complications 38. Blood transfusion Analysis/Diagnosis (Pharmacological Therapies) Analysis. 39. Hyperparathyroidism Intervention (Physiological Adaptation) Application. 40. Hypothyroidism Intervention (Pharmacological Therapies) Application. 41. Thyroid disorders assessment 42. Steroid therapy Evaluation (Management of Care) Evaluation. 43. Blood transfusion Intervention (Pharmacological Therapies) Application. 44. Spinal cord injuries priority Intervention (Management of Care) Application. Intervention (Pharmacological Therapies) Application. Evaluation (Pharmacological Therapies) Evaluation). (Same topic Spinal Injury: 9, 10, 22, 44) 45. Transfusion reactions Intervention (Pharmacological Therapies) Analysis. 46. Medication calculation Intervention (Pharmacological Therapies) Comprehension. 47. Disaster preparedness – triage 48. Allergic/anaphylactic reaction 49. Increased ICP neuro assessment Assessment (Safety & Infection Control) Application. Intervention (Management of Care) Application. Assessment (Management of Care) Analysis. (Same topic ICP: 2, 5, 7, 11, 13, 15, 18, 19, 49) 50. tPa safe administration Intervention (Pharmacological Therapies) Analysis. (Same question tPa: 1, 3, 50) (Same topic Stroke: 1, 3, 4, 6, 8, 12, 14, 50) Neuro questions= 22 ******** Endocrine questions= 11 **** Dermatology/Muskuloskeletal= 5 Immunology= 6 **** Other= 6