A patient presents to the emergency department (ED) complaining of nausea, vomiting, and the “worst headache he has ever experienced.”. While examining the patient, the nurse notes left leg and arm weakness.
The patient is immediately sent to the radiology department for a CT scan.
The registered nurse (RN) identifies the immediate need for treatment because:
A hemorrhagic brain attack is more common than an ischemic brain attack.
A thrombolytic drug will cause the peripheral and central reflexes to become hyper-reactive.
A hemorrhagic brain attack requires immediate intervention to prevent further damage.
An ischemic brain attack is less severe than a hemorrhagic brain attack.
The Correct Answer is C
Choice A rationale
A hemorrhagic brain attack (stroke) is less common than an ischemic brain attack. Ischemic strokes account for the majority of strokes.
Choice B rationale
Thrombolytic drugs are used to treat ischemic strokes, not hemorrhagic strokes. They do not cause hyper-reactive reflexes.
Choice C rationale
A hemorrhagic brain attack requires immediate intervention to prevent further damage. Hemorrhagic strokes involve bleeding in the brain, which can rapidly worsen and cause severe damage.
Choice D rationale
An ischemic brain attack is not necessarily less severe than a hemorrhagic brain attack. Both types of strokes are serious, but hemorrhagic strokes often require more urgent intervention due to the risk of ongoing bleeding.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is ["A","B","E","F"]
Explanation
Choice A rationale
The tripod position helps to improve breathing by allowing the diaphragm to expand more effectively. This position reduces the work of breathing and helps to increase lung capacity, which is beneficial for patients with emphysema.
Choice B rationale
Pursed lip breathing is a technique that helps to keep the airways open longer, allowing more air to escape and reducing the work of breathing. This method helps to improve ventilation and oxygenation in patients with emphysema.
Choice C rationale
Staying current with yearly vaccinations is important for overall health, but it is not a specific strategy for better breathing in emphysema patients. Vaccinations help prevent respiratory infections, which can exacerbate emphysema symptoms.
Choice D rationale
Taking an antihistamine every day is not a recommended strategy for better breathing in emphysema patients. Antihistamines are typically used to treat allergies and may have side effects that could worsen breathing difficulties.
Choice E rationale
Inhaling slowly and deeply helps to maximize lung expansion and improve oxygenation. This technique can help to reduce shortness of breath and improve overall breathing efficiency in patients with emphysema.
Choice F rationale
Sleeping with 2 pillows to prop oneself up helps to reduce the work of breathing by preventing the diaphragm from being compressed. This position can help to improve breathing and reduce shortness of breath during sleep.
Choice G rationale
Measuring peak flow is a useful tool for monitoring lung function, but it is not a specific strategy for better breathing in emphysema patients. Peak flow measurements can help to track the progression of the disease and adjust treatment plans accordingly.
Choice H rationale
Taking a leukotriene inhibitor every day is not a recommended strategy for better breathing in emphysema patients. Leukotriene inhibitors are typically used to treat asthma and may not be effective for emphysema.
Correct Answer is B
Explanation
Choice A rationale
Hypercalcemia is characterized by increased calcium levels in the blood, often due to increased absorption of calcium from the gut. However, in chronic kidney disease (CKD), the kidneys’ ability to activate vitamin D is impaired, leading to decreased calcium absorption from the gut, not increased. Therefore, hypercalcemia is not a typical sign of CKD1.
Choice B rationale
A positive Chvostek’s sign is indicative of hypocalcemia, which is a common symptom in CKD. The kidneys’ reduced ability to activate vitamin D leads to decreased calcium absorption from the gut, resulting in low calcium levels in the blood. This hypocalcemia can cause neuromuscular irritability, leading to a positive Chvostek’s sign.
Choice C rationale
Tetany is a condition characterized by muscle cramps and spasms, often due to hypocalcemia. In CKD, hypocalcemia occurs due to the kidneys’ inability to activate vitamin D, leading to decreased calcium absorption from the gut. This hypocalcemia can cause hyperexcitability of nerves and muscles, resulting in tetany.
Choice D rationale
Hyperphosphatemia is characterized by high phosphate levels in the blood. In CKD, the kidneys’ ability to excrete phosphate is impaired, leading to its accumulation in the blood. However, this is not directly related to the inability to absorb phosphate from the gut but rather the kidneys’ reduced excretion capacity.
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