NLE Review Questions [NP 3 - Medical-Surgical]

B! Flat on bed for infratentorial surgery to prevent herniation; having a small pillow is adequate to promote venous drainage from the head thus limiting further increase in ICP

B! Cataract

• Glaucoma – this blurred vision or halos around lights, loss of peripheral vision is often accompanied with some pain like aching or discomfort around the eyes and headache (Brunner and Sudarth, 2004, p. 1758)
• retinal detachment – no pain; patients report the sensation of a shade or curtain coming across the vision of one eye, cobwebs, bright flashing lights, or the sudden onset of a great number of floaters (Suddart and Brunner, p. 1767)
• diabetic retinopathy – deterioration of the small blood vessels that nourish the retina; may cause distorted vision; pls note that other ocular complications such as cataract and glaucoma may develop in diabetes (Suddarth and Brunner, p. 1189)

A! These are common risk factors for glaucoma; other risk factors include diabetes, cardiovascular disease, migraine syndromes, nearsightedness (myopia), eye trauma, and prolonged use of topical or systemic corticosteroids (Suddart and Brunner, p. 1757)
• Re specific age group, in Suddart and Brunner, it merely states “older age” and does not specify the age; however, glaucoma is more prevalent among people older than 40 and the incidence increases with age
• Not D because “sudden physical exertion” is not a risk factor but may exacerbate the increase intraocular pressure

B! Eye pain is present with open & narrow angle glaucoma but not with a detached retinal

C! The client should blow the nose gently one side at a time to prevent pressure changes in the ear

D! Tinnitus is a classic sign of Aspirin overdosage, either from too much ingestion or limited excretion

C! Cardiovascular function ; smoking is an important risk factor but since the patient has stopped smoking for 10 years, his risk drops to the same level as a non-smoker.

B! Patient remains conscious despite the lost or diminished of reflexes

B! Digitalis exerts a direct and beneficial effect on myocardial contraction in the failing heart. It increases ventricular contractility, increases ventricular emptying and the capacity of the heart to work thereby improving stroke volume and cardiac output. Because of improved contractility, there will be an indirect effect on slowing the HR but not to bradycardic level.
 Prior to administering digitalis (or digoxin in the Philippines which is more commonly used with brand name of Lanoxin), take a full-minute HR to assess for slowing of HR since an adverse effect is development of heart block. The problem with this drug is that there is a very narrow margin between the therapeutic dose and the toxic dose. Thus, we need to monitor the HR which indicates toxicity that is dose-related.