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Sunday, September 30, 2007

Nclex Preparation: Fluids And Electrolytes Easy Study For Nurses

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Effects of hyponatremia on respiratory system:
shallow, ineffective respiratory movements as a late manifestation r/t skeletal muscle weakness


Effects of hyponatremia on neuromusclar system:
generalized skeletal muscle weakness that is worse in the extremities


Effects of hyponatremia on cerebral function:
headache, personality changes


Effects of hyponatremia on GI system:
a. Increased motility and hyperactive bowel sounds
b. Nausea
c. Abdominal cramping and diarrhea


If the client is taking lithium for hyponatremia, why should you monitor lithium levels?
Hyponatremia can cause diminished lithium excretion, resulting in toxicity.


What are four conditions that cause decreased sodium excretion can result in hypernatremia?
a. Corticosteroids
b. Cushing's syndrome
c. Renal failure
d. Hyperaldosteronism


Effects of hypernatremia on neuromuscular system:
a. Early: spontaneous muscle twitches; irregular muscle contractions
b. Late: skeletal muscle weakness; deep tendon reflexes diminshed or absent


Effects of hypernatremia on central nervous system:
a. altered cerebral function is the most common manifestation of hypernatremia

Effects of hypokalemia on cardiovascular system:
a. Thready, weak, irregular pulse
b. Peripheral pulses weak
c. Orthostatic hypotension
d. EKG changes: ST depression; shallow, flat or inverted T wave; and prominent U wave


Effects of hypokalemia on respiratory system:
a. Shallow, ineffective respirations that result from profound muscle weakness of the skeletal muscles of respiration
b. Diminished breath sounds


Effects of hypokalemia on neuromuscular system:
a. Anxiety, lethary, confusion, coma
b. Skeletal muscle weakness; eventual flaccid paralysis
c. Loss of tactile discrimination
d. Deep tendon hyporeflexia


Effects of hypokalemia on GI system:
a. Decreased motility, hypoactive to absent bowel sounds
b. Nausea, vomiting, constipation, abdominal distention
c. Paralytic ileus


The maximun recommended infusion rate is ___ mEq/hr, never to exceed ___ mEq/hr under any circumstances.
5-10; 20


Effects of hyperkalemia on cardiovascular system:
a. Slow, weak, irregular HR
b. Decreased BP
c. EKG changes: tall peaked T waves; widened QRS complexes; prolonged PR intervals; and flat P waves


Effects of hyperkalemia on respiratory system:
profound weakness of the skeletal muscles causes respiratory failure


Effects of hyperkalemia on system:
a. Early: muscle twitches, cramps, paresthesias
b. Late: profound weakness, ascending flaccid paralysis in the arms and legs


Effects of hyperkalemia on GI system:
a. Increased motility, hyperactive bowel sounds
b. Diarrhea


If renal function is impaired, prepare to administer ___, cation exchange resin that promotes GI sodium absorption and potassium excretion.
Kayexalate


Effect of hypocalcemia on cardiovascular system:
a. Decreased HR
b. Hypotension
c. Diminished peripheral pulses
d. EKG changes: prolonged ST interval; prolonged QT intervals


Effect of hypocalcemia on neuromuscular system:
a. Irritable skeletal muscles: twitches, cramps, tetany, seizures
b. Parasthesias followed by numbness that may affect the lips, nose, and ears in addition to the limbs
c. Hyperactive deep tendon reflexes


Effect of hypocalcemia on GI system:
a. Increased gastric motility; hyperactive bowel sounds


Effect of hypercalcemia on cardiovascular system:
a. Increased HR in early phase; bradycardia that can lead to cardiac arrest in late phases
b. Increased BP
c. Bounding, full peripheral pulses
d. EKG changes: shortened ST segment; widened T wave


Effect of hypercalcemia on respiratory system:
Ineffective respiratory movement as a result of profound skeletal muscle weakness

Effect of hypercalcemia on neuromuscular system:
a. Profound muscle weakness
b. Diminished or absent deep tendon reflexes
c. Disorientation, lethary, coma

Effect of hypercalcemia on renal system:
a. Increased urinary output leading to dehydration
b. Anorexia, nausea, abdominal distention, constipation


Effect of hypomagnesemia on neuromuscular system:
a. Twitches; paresthesias
b. Positive Trousseau's and Chvostek's signs


hypo-___ frequently accompanies hypomagnesemia.
calcemia


Effects of hypermagnesemia on neuromuscular system:
a. Diminished deep tendon reflexes
b. Skeletal muscle weakness


Effects of hypermagnesemia on central nervous system:
drowsiness and lethargy that progresses to coma


A decrease in the serum phosphorus level is accompanied by an increase in the serum ___ level.
calcium


Effects of hypophospatemia on neuromuscular system:
a. Weakness
b. Decreased deep tendon reflexes
c. Decreased bone density that can cause fractures and alterations in bone shape

An increase in the serum phosphorus level is accompanied by a decrease in the serum ___ level.
calcium


The problems that occur in hyperphosphatemia center on the hypo-___ that results when serum phosphorus levels increase.
calcemia





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Nclex Preparation: OB Newborn Nursing Easy Study For Nurses

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What is Apgar scoring?
Scoring test performed at 1 minute then at 5 minutes. If the score is less than 8, then it is probable that some measure need to be taken
Each of the following gets a score of 0 – 2, giving a total score of 0 – 10:
Heart Rate, Respiratory effort, Muscle tone, Reflex irritability, Color


Describe the newborn sleep cycles.
Defined according to duration, length of cycle dependent on age of the newborn.
First period of reactivity – baby is alert, initiate breast feeding
Period of inactivity / sleep phase – Baby sleeps for a few hours
Second period of reactivity – Baby is bathed within 3rd and 4th hour, sometimes under a heat lamp. The baby may be submerged into water.

The baby sleeps 16 to 20 hours per day for the 1st 2 weeks.


Describe the newborn sleep states.
Sleep states: Deep / Quiet sleep – regular breathing, no movement except sudden body jerks, Active REM – irregular breathing, body twitching, may cry out but not awake, Quiet alert – Infant awake and involved with the surroundings, Awake / crying states


Discuss newborns and temperature.
Temperature regulation – babies lose heat very rapidly. When a baby is cold, there is: An increase of O2 consumption, An increase of utilization of glucose (hypoglycemia) & brown fat, An increase need for calories, An increased risk for metabolic acidosis, A decrease in surfactant production.

They lose heat by: Convection – Body heat lost to cool air flow, Conduction –Body heat lost to blankets, etc., Radiation – Body heat lost to cool temps., Evaporation – Body heat lost due to moisture from skin and lungs., Management – babies are stimulated to breath by drying action post birth.


Discuss the normal newborn vital signs.
Vital signs: Temperature – per axila 36.5 – 37.0 C / 97.9 – 98.0 F ** first temperature is done rectally to check for unperferated anus. Then it is performed at the axillary. If the baby’s temp in < than 97.8, double wrap the baby and check again. Babies cannot shiver to warm their own body.
Pulse / Heart Rate – Apical: 120-140 bpm. Varies with sleep / crying
Respirations – 30 – 60 breaths / minute
Blood Pressure – In arm / thigh. May be higher in thigh. 65-41 mm/hg. It is important for the closing of the vessels.


Discuss the normal newborn weight.
Average weight: 3400 grams or 7 lbs 8 oz. There is usually a 5 to 10 % weight loss in the first few days. It is regained within 10-14 days.


Discuss the normal newborn length.
Average length: 45.2 cm to 55 cm or 17.8 inches to 27.7 inches


Discuss the normal newborn head.
33 –35 cm / about 2 – 3 cm larger than chest. Measure right above the brow. Look at fontanels – anterior and posterior – Bulging? Sunken?
Caput succedaneum – Spongy, collection of fluid (like coneheads). It does cross the suture line, will settle down in 24 hours. – Due to edema. Cephalohematoma – Does not cross the suture line – Due to birth trauma. **Extreme size differences in head may indicate microcephaly, hydrocephaly or ICP.


Discuss the normal newborn eyes, nose, mouth & throat.
Check alignment, symmetry – helix of the ear should be above the eyeline. Check for cleft palate. Check for Birthmarks, Milia – White pinhead size keratin-filled cysts. Will go away on its own. Check for newborn rash.

What are the different types of newborn birthmarks?
Birthmark = hemangioma. Strawberry hemangioma - bright red and sticks out of the skin, so it does look a little bit like a strawberry. Some strawberry hemangiomas go away on their own by the time a kid is about 5 years old. Almost all strawberry hemangiomas go away by themselves by the time a kid is about 9 years old.

Cavernous hemangioma - is beneath the outer layer of skin. This type of birthmark is deep beneath the outer layer of skin. This kind of birthmark is puffier than a strawberry hemangioma. It's bluish-red. Cavernous hemangiomas usually don't go away by themselves.

Port-Wine Stains: This isn't puffy or raised, it's level with the outer layer of skin. A port-wine stain is an area of skin that is either maroon or dark red. Kids who have port-wine stains usually have them on the face and neck.

Moles - any brown, blue, or black spots on your skin since birth. Moles are tiny collections of pigment cells -cells that contain color. Like other birthmarks, moles don't hurt and usually aren't a sign of illness in kids.



Discuss the normal newborn neck and body.
Vernix – waxy substance that protects the baby in utero. More than usual = that the baby is immature. Check for skin folds, if not, baby has a web neck. Lanugo – downy, fine hair that is lost as the baby matures.


Discuss the normal newborn chest.
Circumference 32-33 cm. Evident xiphoid. Chest measured a the nipple line. Breast enlargement – enlarged do to hormones. Witch’s milk. Do not squeeze out this milk. Check for extra nipples. Sternal retractions. Listen for lung sounds. Lung maturation: Lung functions after 26th week gestation. Lung surfactant okay at 35 weeks gestation. Check clavical for breaks – can occur during delivery. Respiratory effort: Within the 1st minute of birth: Loud & lusty cry, No dyspnea, No retractions, Respiratory rate < 60 / min, Diaphragmatic & abdominal muscles used, Nose breather.
Mouth = circumoral cyanosis


Discuss the normal newborn abdomen.
Umbilical cord – 2 arteries and 1 vein – Obtain cord blood sample in delivery room.
When cord cut, check to see the three vessles. Brachial and femoral pulses – measured at the umbilicus.


Discuss the normal newborn back and shoulders.
Spine intact. Check for lanugo. Check for mongolian spots – greenish color, lower portion of the body. Run finger down the spine to assess for abnormalities. Check shoulder for break / dystocia – can occur during delivery.


Discuss the normal newborn gastrointestinal and genitourinary.
Listen for bowel sounds. Patent anus. Passes meconium within 24 hours. Urinate within 24 hours. Stools will transition from meconium to:
Seedy – breast fed. Pasty – formula fed.


Discuss the normal newborn genitalia.
Male: Testes palpable in scrotum. Scrotum pendulous, rugae. Check for no hypo or epispadia. Check for testicle descended. Female: Check that labia & clitoris is edematous.
Pseudomentruation. Hymenal tag. If baby is premature, you may see labia minora, labia majora and clitoris all at once.


Discuss the normal newborn extremities.
Check for syndactly / polydactly – check both upper and lower. Check for webbed extremities. Check ortolani’s maneuver – for hip dislocation.


What are the newborn reflexes?
Blink, Rooting – Aid to breastfeeding - Rub jaw, baby will turn and open mouth. Sucking – should be strong, Palmar and plantar grasp – place finger on palm, baby will grasp. Stepping – simulate walking. Tonic Neck / Fencer – Moro – Startle reflex – baby will move hands close together, Babinski – not present as normal in adults. Will fan toes when stroking bottom of foot. Trunk incurvation – Rub the side of the trunk and the baby will turn to that side.


What is the newborn nutrition?
Breast Milk: Colostrum – in the first 3-4 days after birth. Rich in protein, low in sugar and fat, also has minerals, vitamins and maternal antibodies. Transitional milk – Seen day 2 – 4. Mature milk – by day 10
Fore milk, Hind milk – higher in fat – allows for rapid growth of the newborn.

Metabolic Screning Test (or PKU) – blood from baby done prior to 72 hours.


Discuss the newborn stools.
Meconium – Sticky, tarry, blackish green appearance. Passed within the first 24 hours. Transitional – 2nd or 3rd day of life color and consistency changes to greenish brown loose stools
Breast fed stools – More liquid, seedy, yellow color – breast milk easier to digest.
Bottle fed stools – Formed, pasty, brownish-yellow.






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Friday, September 28, 2007

Nclex Preparation: Easy Study For Nurses

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what is a possible complication when administrating Lasix? Tachycardia

Oxygen applied by mask with be at how many liters? 10 liters.

red man syndrome means the IV is infusing rapidly

naegals rule expected date of delivery subtract 3 months and add 7 days of your last menstrual period

if scheduled for CAT scan, check for iodine sensitivity

if scheduled for MRI, check for metallic implants

peas and beans contain protein

if administering enema to a patient and the patient complains, dont stop the administration. just lower the height of the container to slow down the infusion.

when walking up the stairs with crutches, use the "good leg" first

to check a dark skinned patient with anemia, you best check the hard palate

how many inches should the foley catheter be inserted in a male patient? 7-9 inches

when collecting stool from a patient, collect the center of the stool

there is a fire and you are taking care of a ventilator-dependent patient, you first remove the patient and ambu

heroin intoxication and signs of opiate use constricted pupils

Dilantin given IVP do not administer more than 50mg/minute

which electrolyte must be maintained in a steady state for a patient receiving lithium? sodium. low sodium equals high reabsorption of lithium

normal protrhombin time 12-20 seconds

petal the cast means cover the edges with cast batting

miller -abbot tube used for a patient with partial bowel obstruction. advance the tube 3-4 inches as ordered by doc

a patient with pancreatitis taking pancreatin. his stool will contain less fat and occur with less frequency

how do you prevent a spinal headache from happening after you take spinal anesthesia? increase fluid intake and lay the patient flat on the bed.

bucks traction in a patient is to decrease muscle spasms

best position for a patient with preeclampsia in labor left sims position

dont give a patient with pancreatitis morphine because opiates stimulate the sphincter of oddi.

diaphragm use for women do not leave it in for more than 8 hours and change the size if you have gained or lost 10 pounds.

Following a CT scan with contrast medium, you should force fluids so that the dye is excreted through the kidneys and out as waste.

you refrigerate urine because urea breaks down into ammonia, causing urine to become more alkaline and promoting cellular breakdown

patient with enuresis needs bladder training. the ability to remain continent depends on the sympathetic nervous system

which sign is associated with right sided tension pneumothorax? left-sided tracheal deviation

a lab finding that would confirm sensory disturbance would be increased urine catecholamines

a patient with menieres syndrome needs to limit their dietary intake of salt. salt increases edema which triggers menieres syndrome.

myxedema needs to be in what diet? low sodium diet. because cortisol causes sodium retention.

sarcoma is a bone tumor. adramycin decreases neutrophils making them prone to infection

infants dont crawl until 9-10 months

what lab value will you expect to see in a patient with addisons disease? BUN 22

antidepressants take effect several days to several weeks. or 3-6 months

aldactone is what type of diuretic? potassium saving

what is tetralogy of fallot unknown congenital heart defect.

atropine decreases saliva secretions, use for preop.. do not give if patient has glaucoma

dyspepsia luncheon meats can trigger this




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Food And Drug Interaction

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CONDITION MEDICATION SAMPLE MEDICATION INTERACTION
ALLERGIES, ASTHMA, COLDS* AND COUGHS Antihistamines-Antihistamines are used to relieve or prevent the symptoms of colds and hay fever and other types of allergy. They act to limit or block histamine which is released by the body when we are exposed to substances that cause allergic reactions. Some commonly used antihistamines:



brompheniramine/ Dimetane, Bromphen

chlorpheniramine/ Chlor-Trimeton, Teldrin

diphenhydramine/ Benadryl, Benaphen

Avoid taking with alcoholic beverages because antihistamines combined with alcohol may cause drowsiness and slowed reactions.
Bronchodilators-Bronchodilators are used to treat the symptoms of bronchial asthma, chronic bronchitis and emphysema. These medicines relieve wheezing, shortness of breath and troubled breathing. They work by opening the air passages of the lungs. Some commonly used bronchodilators:



aminophylline/ Phyllocontin, Somophyllin

theophylline/ Slo-Phyllin, Theo-Dur

Avoid eating or drinking large amounts of foods or beverages which contain caffeine because both bronchodilators and caffeine stimulate the central nervous system.







Many over the counter cold remedies contain aspirin in combination with other active ingredients.




ARTHRITIS AND GOUT  Aspirin-Aspirin reduces pain, fever and inflammation. Aspirin is available in many brands.   Because aspirin can cause stomach irritation, avoid alcohol. To avoid stomach upset, take with food. Do not take with fruit juice.
Corticosteroids-Cortisone-like drugs are used to provide relief to inflamed areas of the body. They lessen swelling, redness, itching and allergic reactions. Some commonly used steroids:



betamethasone, dexamethasone,

hydrocortisone, methylprednisolone,

prednisone, triamcinolone
Avoid alcohol because both alcohol and corticosteroids can cause stomach irritation. Also avoid foods high in sodium (salt). Check labels on food packages for sodium. Take with food to prevent stomach upset.
Ibuprofen and Other Anti-Inflammatory Agents-Ibuprofen relieves pain and reduces inflammation and fever Some commonly used anti-inflammatory agents:



ibuprofen/ Advil, Haltran, Medipren, Motrin,

Nuprin, naxproxen/ Naprosyn
These drugs should be taken with food or milk because they can irritate the stomach. Avoid taking the medication with those foods or alcoholic beverages which tend to bother your stomach.
Indomethacin-This medication is used to treat the painful symptoms of certain types of arthritis and gout by reducing inflammation, swelling, stiffness, joint pain and fever A commonly used brand name:



Indocin
This drug should be taken with food because it can irritate the stomach. Avoid taking the medication with the kinds of foods or alcoholic beverages which tend to irritate your stomach.
Piroxicam-This medication is used to treat pain, inflammation, redness, swelling and stiffness caused by certain types of arthritis. A commonly used brand name:



Feldene
This medication should be taken with a light snack because it can cause stomach irritation. Avoid alcohol because it can add to the possibility of stomach upset.
HEART AND CIRCULATORY DISEASES Diuretics-Diuretics increase the elimination of water, sodium and chloride from the body. Some commonly used diuretics:



furosemide/ Lasix

triamterene/ Dyrenium

hydrochlorothiazide (HCTZ)/ Esidrix,

Hydrodiuril
Diuretics vary in their interactions with nutrients. Loss of potassium, calcium, and magnesium occurs with some diuretics. Your doctor may prescribe a potassium supplement. With some diuretics, potassium loss is less significant. Consult with your doctor or pharmacist.
Vasodilators-Vasodilators are used to relax veins and/or arteries to reduce work of the heart. Some commonly used vasodilators:



nitroglycerine/ Nitrogard, Nitrostat
Use of sodium (salt) should be restricted for medication to be effective. Check labels on food packages for sodium.
Anti-Hypertensives-Anti-hypertensives relax blood vessels, increase the supply of blood and oxygen to the heart and lessen its work load. They also regulate heart beat. Some commonly used anti-hypertensives:



atenolol/ Tenormin

captopril/ Capoten

hydralazine/ Apresoline

methyldopa/ Aldomet

metoprolol/ Lopressor
Use of sodium (salt) should be restricted for medication to be effective. Check labels on food packages for sodium.
Anticoagulants-Anticoagulants are used to reduce clotting of the blood A commonly used anticoagulant:



warfarin/ Coumadin, Panwarfin
Moderation in consumption of foods high in vitamin K is recommended because vitamin K produces blood-clotting substances. Such foods include spinach, cauliflower, brussel sprouts, potatoes, vegetable oil and egg yolk.
INFECTIONS Erythromycin-Erythromycin is an antibiotic used to treat a wide variety of infections, including those of the throat, ears and skin. Some commonly used erythromycin prods.:



erythromycin/E-Mycin

erythromycin estolate/Ilosone

erythromycin ethylsuccinate? E.E. S.,

E-Mycin E
Erythromycins vary in their reactions with food; consult your doctor or pharmacist for instructions.
Methenamine-Methenamine is used to treat urinary tract infections Some commonly used brand names;



Mandelamine, Urex
Cranberries, plums, prunes and their juices help the action of this drug. Avoid citrus fruits and citrus juices. Eat foods with protein, but avoid dairy products.
Metronidazole-This agent is an anti-infective which is used to treat intestinal and genital infections due to bacteria and parasites. Commonly used brand name:



Flagyl
Do not take alcohol while using this drug, because it may cause stomach pain, nausea, vomiting, headache, flushing or redness of the face.
Penicillins-Penicillins are antibiotics used for treatment of a wide variety of infections. Some commonly used penicillins:



amoxicillin, ampicillin, bacampicillin,

penicillin G and penicillin V
Amoxicillin and bacampicillin may be taken with food; however, absorption of other types of penicillins is reduced when taken with food.
Sulfa Drugs-Sulfa drugs are anti-infectives which are used to treat stomach and urinary infections. Some commonly used sulfa drugs:



co-trimoxazole/ Bactrim, Septa

sulfisoxazole/ Gantrisin
Avoid alcohol, as the combination may cause nausea.
Tetracyclines-Tetracyclines are antibiotics that are used to treat a wide variety of infections. Some commonly used brand names:



tetracycline hydrochloride/ Achromycin,

Sumycin, Panmycin
These drugs should not be taken within two hours of eating dairy products such as milk, yogurt or cheese, or taking calcium or iron supplements.
PAIN Aspirin-(See aspirin under Arthritis and Gout)    
Codeine-Codeine is a narcotic that is contained in many cough and pain relief medicines. Codeine suppresses coughs and relieves pain, and is often combined with aspirin or acetaminophen in medications. Some commonly used brand names:



Aspirin with Codeine, Tylenol with Codeine.
Do not drink alcohol with this medication because it could increase sedative effect of medication. Take with meals, small snacks or milk because this medication may cause stomach upset.
Other Narcotic Analgesics-Narcotics are used for the relief of pain. Some commonly used narcotic analgesics;



meperidine, morphine, oxycodone,

pentazocine, propoxyphene
Do not drink alcohol because it increases sedative effect of the medications. Take these medications with food, because they can upset the stomach.
Ibuprofen and Other Anti-Inflammatory Agents-(See Ibuprofen under Arthritis and Gout)    
PSYCHIATRIC OR EMOTIONAL PROBLEMS  Most medications for psychiatric or emotional disturbances interact with alcohol in a dangerous manner.   Follow the dietary and fluid intake instructions of your physician to avoid very serious toxic reactions.
  Lithium Carbonate-Lithium regulates changes in hormone levels in the brain, balancing excitement and depression.    
  MAO Inhibitors -MAO Inhibitors are used primarily to treat depression Some commonly used MAO Inhibitors:



isocarboxazid/ Marplan

phenelzine/ Nardil

tranylcypromine/ Parnate
A very dangerous, potentially fatal interaction can occur with foods containing tyramine, a chemical in alcoholic beverages, particularly wine, and in many foods such as hard cheeses, chocolate, beef or chicken livers. Be sure to follow physician's instructions.
SLEEP DISTURBANCES     Do not use alcohol with any sleep medications.
STOMACH AND INTESTINAL PROBLEMS Cimetidine, Famotidine, Ranitidine-These medications are prescribe to treat ulcers. They work by reducing the amount of acid in the stomach. Some commonly used brand names:



cimetidine/ Tagamet

famotidine/ Pepcid

ranitidine/ Zantac
Follow the diet your doctor orders.
Laxatives-Some laxatives stimulate the action of muscles lining the large intestine. Other types of laxatives soften the stool, or add bulk or fluid to help food pass through the system.   Most laxatives are available without prescriptions. Excessive use of laxatives can cause loss of essential vitamins and minerals and may require replenishment of potassium, sodium and other nutrients through diet. Mineral oil can cause poor absorption of some vitamins. Discuss the use of laxatives with your doctor or pharmacist.




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Thursday, September 27, 2007

Fundamentals Of The Nervous System And Nervous Tissue

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FUNDAMENTALS OF THE NERVOUS SYSTEM AND NERVOUS TISSUE

Characteristics & Functions
Rapid control and communication
Functions:
Sensory—monitors change through receptors that detect stimuli
Integration—analyses sensory information decides what should be done.
Motor—initiates response by activating effectors (muscles, glands or
organs that respond)
Organization of the Nervous System
There are two branches or principle divisions:
Central Nervous System (CNS)
Composed of the brain and spinal cord
It's function is integration and command.
Peripheral Nervous System (PNS)
Composed of:
Cranial nerves—brain
Spinal nerves—spinal cord
It's function is that it provides the network
Body parts are connected to the CNS by the PNS


LEVELS OF ORGANIZATION IN THE NERVOUS SYSTEM:

Peripheral nervous system: is divided into two divisions
Sensory or Afferent (towards) division—function is to carry messages
from receptors to the CNS.
Motor or Efferent (away from) division—function is to carry messages
from the CNS to effectors. It is divided into two systems:
Autonomic Nervous System (Involuntary)—It controls the heart rate,
digestion rate, breathing rate, hormone production, etc. It is
composed of two divisions:
Sympathetic division—your fight or flight division—prepares you for
emergency response.
Parasympathetic division—rest and digest division—conserves energy,
promotes non-emergency functions.
Somatic Nervous System (Neuromuscular junction)—It controls body
parts that are voluntary such as skeletal muscle.


TISSUES OF THE NERVOUS SYSTEM

Nervous tissue is composed of two types of cells:
Neurons (nerve cells) that transmit the electrical messages or
impulses.
Supporting cells or neuroglia or glial cells (nerve glue) that
supports and protects the nervous system.
Types of supporting cells
Cells in the CNS
Astrocytes:
Star shaped and very abundant.
There function is to form barriers between the blood and the neurons.
The blood brain barrier slows the movement of unwanted materials from
the blood into the brain.
Microglia:
Their function is to engulf and destroy microbes and dead or foreign
materials.

Ependymal cells:
They line the cavities in the brain and spinal cord.
Their function is that they posses cilia that circulate cerebro
spinal fluid (CSF)
Oligodendrocytes form a protective coating around the nerve fibers.
They wrap cell extensions around the nerve fiber.
Their function is to produce a myelin sheath. Myelin sheath is a
fatty layer for electrical insulation.
Cells in the PNS
Schwann cells
The whole cell wraps around the nerve fibers.
Their function is also to form a myelin sheath.
Satellite cells:
Their function is they may play a role in controlling the chemical
environment.


NEURONS

General Characteristics
They are specialized to receive and transmit nerve messages
They live a long time
They do not divide
They need oxygen and glucose constantly
The cell body contains the nucleus, cytoplasm and organelles (Peri
Karyon {area around nucleus} and Soma)
Nissi bodies—the rough ER
Neurofibrils—filaments for intracellular transport
Gray Matter—refers to the clusters of cell bodies
Nuclei—clusters in the CNS
Ganglia—clusters in the PNS
Cell processes (extensions)—long, thin bundles going to and from the
cell
Dendrites
Receive impulses from other neurons
Their numbers are a lot
Axons
Initiate and carry impulses away from the cell
There is only one per cell but it may branch. NOTE: A neuron is
excited by other neurons when their axons release neurotransmitters.
Axon hillock—region of the cell body where the axon leaves.
Axon terminals—synptic knobs—at the end of the axon, stores
neurotransmitters.
Synaptic cleft—gap between the cells
Myelinated fibers—axons covered with a myelin sheath.


MOST NERVE FIBERS ARE MYELINATED

In PNS Schwann cells wrap tightly around the fiber to form the
sheath. This pushes the nucleus and the cytoplasm to the outside.

Neurilemma—the external portion of the Schwann cell containing
the

Nucleus and cytoplasm.

Myelin—inner layer that has a high fat content.

Myelin = white matter

In CNS Ogligodendrocyte the whole cell does NOT wrap around the axon.

NOTE: These lack a neurilemma. The neurilemma is important for
regrowth of injured cells. Injury to CNS fibers has o regeneration.

White matter—is from the axon

Gray matter—cell bodies


STRUCTURAL CLASSIFICATIONS OF NEURONS:

Multipolar
Most common type
Major neurons of the CNS, they are found in the brain and spinal cord
Functions as motor neurons in the CNS and to transmit messages to
effectors
Composed of many dendrites and one axon.
Bipolar
Rare—found in the retina and the nose
Composed of one dendrite and one axon
Unipolar
One short process that acts as both a dendrite and an axon
Composed of two branches:
1 functions as a dendrite
The other functions as an axon
Major function is sensory


FUNCTIONAL CLASSIFICATIONS OF NEURONS:

Sensory—afferent—function is to transmit nerve impulses from
receptors to the CNS.
Motor—efferent—function is to transmit nerve impulses from the CNS to
effectors
Interneurons—association—function is to relay between the sensory and
the motor neurons.
NOTE: 99% of all neurons are interneurons.

Example: They make up the brain and spinal cord.


NEUROPHYSIOLOGY

Basic physiological properties of neurons:
Irritability—ability to respond to stimuli and convert the stimulus
to a nerve impulse.
Conductivity—ability to transmit the impulse to another cell.
Note: when a neuron is stimulated by a threshold stimulus, an
electrical impulse is conducted down the length of the cell.

Relative distribution of ions (mEq/L) in the intracellular fluid
(ICF) and the extracellular fluid (ECF)
NA+ (sodium) higher concentration outside

K+ (potassium) and A- (other anions) are higher inside

Anions are negative and cations are positive

Resting membrane potential
Resting neuron—a neuron that is not transmitting a nerve impulse.
Physiology of a resting neuron
Polarization (polarized)—electrical charge or difference across the
cell membrane
Cytoplasm—is negative
Fluid just outside the membrane—is positive
Resting membrane potential
Voltage (of the charge) across the membrane is measured in
millivolts.
Measured with microelectrodes.
Negative resting potential—inside is negative compared with outside.
NOTE: this is approximately 70 millivolts (mV) of negative charge.

What creates the resting membrane potential?
There are many large molecules inside the cell which are too big to
diffuse out, these are large Big Fate Anions = A-
The sodium – potassium pump
Active transport mechanism
Pumps
3 NA+ out of the cell
2 K+ in to the cell
NOTE: more + charged ions on the outside

K+ is in higher concentration inside the cell than outside the cell
therefore K+ has a tendency to diffuse out.
NOTE: when these K+ migrate or move out through the membrane, the
negatively charge ions cannot move through the membrane and line up
along the inside

THIS CREATES THE RESTING MEMBRANE POTENTIAL.

Action potential—electrical membrane that is transmitted along a
membrane.
General terminology
Stimulus – causes a nerve signal to be generated
Examples: touch, temperature, light, sound & chemicals

Stimulation – changes the permeability of the plasma membrane by
causing sodium gates to open
Note:

Na+ ions rapidly diffuse into the neuron, increases the number of
positive ions on the inside.
This causes depolarization.
Depolarization – inside the cell membrane becomes less negative and
the outside becomes less positive (depolarized sending the message)
This results in a change in the membrane potential from negative 70
to negative 50.
If this change reaches approximately -50 mV, the membrane potential
has reached threshold.
The stimulus must be strong enough to reach threshold in order for
the message to be sent.
Action potential, nerve impulse, is generated if depolarization
reaches threshold.
NOTE:

If a stimulus is below threshold, depolarization does not reach -50.
NO ACTION POTENTIAL is generated, only local depolarization.
Repolarization
A return to the resting potential occurs as soon as the action
potential has been reached which is positive 30.
Sodium gates close
Potassium gates open, K+ rapidly diffuses out of the neuron
Outside quickly becomes positive again and is repolarized
Hyperpolarization – recovery is so quick that there is a momentary
excess of K+ outside the membrane (temporary overshoot) – inside is
more negative than negative 70.
NOTE: after hyperpolarization, sodium – potassium pump returns ions
to their original place.

Refractory period – a neuron cannot be stimulated again until the
resting potential is restored.
All or none response
Action potential – once generated is self-propagating, spreads down
the entire cell.
All or none means if a stimulus is of threshold strength, the action
potential (nerve impulse) is never partially transmitted.
NOTE:

If stimulus is below threshold no message is sent
Strong stimulus causes nerve impulse to be generated more frequently
Speed of impulse conduction along the neuron
Myelinated fibers – transmit the impulse faster due to the impulse
jumping the nodes.
Salutatory conduction – the impulse jumps from node to node
Multiple sclerosis – when the sheath is destroyed so the impulse is
not sent.
Unmyelinated fibers transmit the impulse slower because the impulse
is transmitted down the entire length with no skipping.
Warm fibers conduct impulses faster than the cooler ones.
NOTE: cold partially blocks pain messages

Large diameter fibers conduct impulses faster than small diameter
fibers because there is less resistance.
Substances/drugs that affect the action potential, many substances
affect nerve transmission by influencing permeability.
Calcium
Acts as "Guard" for sodium channels, required to close Na+ channels
Deficient in Ca+ = Na+ ions may diffuse in repeatedly causing
impulses to be generated again and again and could lead to cramps.
Procaine, cocaine, novacaine
Decrease membrane permeability to sodium
Prevents nerve impulses from being sent
Uses as a local anesthetic
What is their mode of action?

They prevent the sodium gates from opening so a message cannot be
sent.


THE SYNAPSE

Introduction
A nerve impulse is an electrical signal
To be effective, the impulse must be transmitted along the axon and
to another cell.
Cells or structures that may receive the message include:
Muscles
Organs and glands
Other nerve cells
Synapse – the junction between a nerve cell and another cell.
Example: 2 neurons.
Presynaptic neuron – sending neuron, its axon sends impulse to
another cell.
Postsynaptic neuron – receiving neuron, its dendrites transmit
impulse from a cell.
Types of synapses
Electrical
Cytoplasm of adjacent neurons are connected, there is no gap
Ions travel from one cell to the other without a neurotransmitter.
Example: some regions of the brain for stereotyped movements.
Chemical
Release of chemicals relays the message
Most synapses are this type
Transmission depends on chemical neurotransmitters
Structures of the chemical synapse:
Synaptic cleft – narrow gap between the cells
Synaptic vesicles – store the neurotransmitter in the axons.
NOTE: a nerve impulse traveling down the axon causes the vesicles to
release the neurotransmitter when calcium enters.


NEUROTRANSMITTERS – GENERAL INFORMATION

Affects of neurotransmitters vary: some are excitatory and some are
inhibitory

Excitatory neurotransmitters – open Na+ gates, increase the chance of
post-synaptic cell being depolarized
NOTE: causes hypopolarizationn = hyperexcitable – makes it easier for
the nerve to send a message.

Inhibitory neurotransmitters
Open K+ gates, allows K+ to leave the cell
The exiting of K+ decreases the positive ions on the inside
Resting membrane potential becomes more negative
NOTE: causes hyperpolarization = hypoexcitable makes it harder for
the nerve to send messages

Postsynaptic potentials:
excitatory postsynaptic potentials (EPSPs)
caused by excitatory neurotransmitters, cause hypopolarization
excitatory neurotransmitters cause these messages to be sent more
easily
inhibitory postsynaptic potentials (IPSPs)
caused by inhibitory neurotransmitters
inhibitory neurotransmitters cause these messages to be sent more
slowly
NOTE:

a receiving neuron may get input from hundreds of other neurons; some
sending EPSPs and some IPSPs
the sum of all their effects determines what the receiving cell will
do.
Termination of neurotransmitters
Neurotransmitters act only briefly and then they must be terminated

Types of termination mechanisms=

Neurotransmitter is destroyed by enzymes
Neurotransmitter is transported back to the axon
Neurotransmitter diffuses into the receiving neuron
Types of neurotransmitters:
Acetylcholine (Ach)
Best known and studied
Only neurotransmitter at neuromuscular junction causes skeletal
muscles to contract.
Found in many areas of the brain
ACh examples/comments:
Curare – (South American poison arrow frog) – it blocks ACh receptors
on skeletal muscles causing paralysis
Insect poisons – inhibit AChase – can cause seizures or spasms, may
play a roll in Alzheimer's disease.
Alzheimer's disease – some groups of neurons in the brain that
produce ACh may be destroyed
Biogenic amines
Catecholamines: epinephrine (epi = E), norepinephrine (NE), dopamine
(DA)
Dopamine – widely distributed in the brain and affects muscle
activity and good feelings
NOTE: dopamine plays an important role in inhibiting muscle
contraction.

Parkinson's disease – not enough DA

Muscle tremors and rigid muscles are associated with this disease
Certain DA producing neurons degenerate
Schizophrenia too much DA

Epinephrine (E) and norepinephrine (NE) – prepare the body to respond
to stress
NOTE:

NE affects mood and causes good feelings
Drugs that block NE secretion cause depression
Indolamine: serotonin (S) – affects moods and sleep patterns.
NOTE:

Too little could cause anxiety attacks and depression.
Treatment, Prozac.
Antidepressant drugs prolong effects of some neurotransmitters.

Tricyclic block transport of NE & S and remove them from the synapse.
Example: Elavil and Cocaine

MAO (monoamine oxidase) inhibitors inhibit NE
Amino acids are found in the CNS

Glycine and GABA are inhibitory
Tranquilizers bind to GABA receptors and mimic it's effects

Example: Valium

Glutamate – excitatory
NOTE: There are high levels of this in stroke victims.

Peptides

Endorphins and enkephalins reduce the perception of pain (natural
pain killers)
Examples:

Enkephalins increase during labor and delivery.

Endorphins produce a runners second wind.

Narcotics produce euphoria by attaching to the same receptors as our
natural pain killers.
Examples: Morphine, Heroin

Substance P, the neurotransmitter for sending pain signals


THE CENTRAL NERVOUS SYSTEM

Brain
Characteristics:
Pinkish-gray, wrinkled
Texture of cold oatmeal
3 – 3.5 pounds in a typical adult
Intelligence
NOTE:

Size is not related to intelligence
Connections between neurons determines intelligence
100 billion neurons in the brain and each can be connected to as many
as 1000 others.


REGIONS OF THE BRAIN (4)

Ventricles
Cerebral hemispheres (cerebrum)
Diencephalon:
Thalamus
Hypothalamus
Epithalamus
Brain stem:
Midbrain
Pons
Medulla oblongata
Cerebellum


VENTRICLES

Introduction
NOTE: the brain is not solid
Ventricles are hollow chambers within the brain connected to each
other and the spinal cord canal.
Cerebrospinal fluid (CSF) fills these chambers.
Anatomy of the ventricles
Lateral ventricles, each hemisphere has:
One lateral ventricle
Interventricular foramen which is a small opening in each lateral
ventricle that leads to the third ventricle.
Third ventricle is a slit in the diencephalon
NOTE: the third ventricle is connected to the:

Lateral ventricle via the interventricular foramen
Fourth ventricle via the cerebral aqueduct
Fourth ventricle
Between the brain stem and the cerebellum
Openings in its walls lead to:
Central canal of the spinal cord
Subarachnoid space which is a fluid filled space sorrounding the
brain.


CEREBROSPINAL FLUID

Characteristics:
Liquid cushion in and around the brain and spinal cord
Function is to absorb shocks, float the brain and help nourish the
brain
Composition is 99% water
Source: choroid plexus which is a clust of capillaries in each
ventricle that continuously makes CSF.
Circulation of CSF
Ependymal cells are ciliated to create a current to circulate the
fluid.
Route of CSF is from the ventricles, in and around the spinal cord
and around the brain.
Obstructions would cause the fluid to build up
Hydrocephalus – water on the brain (p. 467)


CEREBRAL HEMISPHERES

Cerebrum – divided into 2 halves

External anatomy:
Gyri (singular is gyrus) are the outward folds
Grooves:
Sulci are shallow grooves
Examples:

Central sulcus which divides the frontal lobe from the porietal lobe.
Lateral sulcus which outlines the temporal lobe
Parieto-occipital sulcus (not visible externally)outlines the
occipital bone or suture.
Fissures are deep grooves
Example – longitudinal fissure seperates the two hemispheres.

Lobes – named after bones they're beneath:
Frontal
Parietal
Occipital
Temporal
Internal anatomy or regions
Composed of 3 general regions:
Cerebral cortex – thin outer layer of gray matter
White matter is on the inside and connects the two hemispheres.
Basal nuclei – island clusters of gray matter scattered throughout
the white matter.
Cerebral cortex
Produces our most distinctive human skills
Examples:

Speech
Emotions
Intelligence
Brodmann (1906) mapped functional areas of the cerebral cortex
3 types of functional areas
Motor – control of voluntary movement
Sensory – receives messges
Association – interpretation, analysis of information
Motor areas
Primary motor area – sends commands to the skeletal muscles
NOTE: The right hemisphere controls the left side of the body

Precentral gyrus (4){Brodman's numbering} contains the primary motor
area
Motor homunculus – little man drawn on gyrus – to represent the body
region controlled by that area of the brain
Broca's area – planning speech and speaking
Overlaps Brodmanns area 44 & 45, present in only one hemisphere,
usually left
Sensory areas
3 neurons minimum:
Receptors to spinal cord
Spinal cord to thalamus
Thalamus to the cortex
Primary somatosensory cortex
Receives signals from body receptors for touch, pain, temperature and
pressure – spatial discrimination.
Postcentral gyrus (1 – 3) behind the central sulcus and contains the
primary somatosensory cortex
Somatosensory homunculus – amount of cortex dedicated to an area is
related to how sensitive the area is.
Somatosensory association area (5 – 7) – interprets the incoming
sensory information.
NOTE: It works on prior knowledge.

Primary visual cortex – receives information (impulses) from eyes
Visual association area, interprets what we see
Occipital lobe
Primary auditory area – hearing
Temporal lobe
Olfactory cortex – smell
Medial part of temporal lobe
Gustatory cortex – taste
Parietal lobe
Wernick's area
Speech area
Sounding unfamiliar words
Probably not the complex language comprehension center
Association area – makes sense of the incoming information

NOTE:

Sites of higher mental activities "thinking" and understanding
abstract ideas
Use the various inputs to make judgements, evaluate consequences,
planning
Necessary for reasoning & concerns
Especially important – prefrontal cortex – sets humans apart because
it gives us intelligence.
Lateralization – each hemisphere has its own unique properties
The 2 cerebral hemispheres differ in structure and function
Their primary motor and sensory areas dominate different sides of the
body
Left and right association areas function differently
Left hemisphere is in charge of language, math, logic, science,
analyzing, reasoning and memorizing.
Right hemisphere has greater control over music, art, poetry and
creative design.
Cerebral white matter—for communication between the cerebral
hemispheres and other CNS centers
Corpus callosum—thick band of nerve fibers that connects the
hemispheres and allows them to function as a whole.

Basal nuclei
Islands of gray metter in the white matter
Important in motor coordination; like starting and stopping.
Parkinson's disease—could result from problems with the basal nuclei.


DIENCEPHALON: THALAMUS, HYPOTHALAMUS, EPITHALMUS

Thalamus
Forms the side walls of the third ventricle
Two masses of gray matter joined by a bridge of gray matter called
the gray commissure
Function—relays all sensory information (except smell) to the
cerebral cortex.
NOTE: 3 neurons:

Receptor --- spinal cord --- thalamus --- primary somatosensory
cortex

Hypothalamus
Forms the floor of the third ventricle
Small but important
Function helps regulate homeostasis
Controls hormone secretion by the pituitary gland
Regulates organ systems to maintain homeostasis
Influences eating, drinking, sleeping and body temperature
Helps us experience emotions, pleasure, fear, anger
NOTE: connects the nervouse and the endocrine systems

Epithalamus
Forms the roof of the third ventricle
Contains pineal gland and associated with
Melatonin
Chemical that regulates our biological clock


BRAIN STEM: MIDBRAIN, PONS, MEDULLA OBLONGATA

NOTE: houses all the sensory and motor neurons between spinal cord
and upper brain regions.

Midbrain—top of the brain stem
Cerebral peduncles (paired & ventral)—contain motor nerves going down
to the spinal cord.
Corpora quadrigemina (4 & dorsal)
Visual reflex centers –moving eyes and head when you visually follow
a moving object or if you reflexively turn to look at something.
Auditory reflex centers—moving head towards sound
Pons—the enlarged region of the brainstem
NOTE:

Mainly fibers that connect the various parts of the brain to the
spinal cord
Respiratory centers: help control breathing
Medulla oblongata
Lowest part of brainstem, blends into the spinal cord
Pyramids—2 ridges that contain motor nerve tracts that cross to
opposite sides of the brain.
Decussation of pyramids:

Point where most of these fibers cross
Each hemisphere controls the opposite side of the body
Three vital reflex centers:
Cardiac center—controls the heart
Vasomotor center—regulates blood pressure by controlling the diameter
of the blood vessels
Respiratory center—affects breathing
Non-vital reflexes—vomiting, hiccuping, coughing and sneezing.
NOTE: a blow to the medulla can be fatal


CEREBELLUM

Anatomy of the cerebellum
Two hemispheres—have fine parallel gyri
Vermis—worm like connection between the two hemispheres
Cerebellar cortex—the outer layer of the cerebellum
Arbor vitae—when cut, inside surface looks like a branching tree
Functions—planning center for subconscious events
Makes movements that are complex & smooth. EX: driving a car, riding
a bicycle, typing and skating.
Helps maintain posture
Maintains balance and equilibrium (information from inner ear)
Receives information about muscle tension


FUNCTIONAL BRAIN SYSTEMS

Work together but are not localized in a specific region

Limbic system
Location—structures in cerebrum and diencephalon that encircle the
upper brain stem
Function—responsible for emotion and memory
NOTE:

Origin in primitive smell are of the brain
Smells cause emotions and memories
Reticular system
Location—extends throughout the brain stem, connections to all areas
of the brain.
Function—regulates the reticular activating system (RAS)
Sends impulses to cerebral cortex which keeps it alert and conscious
Inhibited by sleep centers, alcohol and tranquilizers
Damge can produce unconsciousness or coma


PROTECTION OF THE BRAIN

Protective structures or fluids
Bones of the skull
Meninges which are membranes wrapped around the brain
Cerebrospinal fluid
Blood-brain barrier
Meninges—3 layers of membranes
Dura mater—"tough mother"
Outer layer (membrane)—double layered
Lines cranial cavity and is attached to the skull
Inward folds—to anchor the brain
Subdural space—containing serous fluid
Arachnoid mater—arachnoid is "spider web"
Thin net like covering
Subarachnoid space—filled with CSF
Pia mater—"gentle mother"
Delicate
Adheres to the surface of the brain
Meningitis
Inflammation of meninges
Caused by viruses or bacteria
May spread to the brain
Swelling around brain—a stiff neck, fever and headache
Encephalitis—inflammation of the brain
Blood-brain barrier
Brain capillaries (tiny blood vessels) differ from others in the body
How? Less permiable

Capillaries allow nutrients (glucose) in but keep others out
Excludes non-essential chemicals: drugs
Fat-soluble material can diffuse through. EX: anesthetics, nicatine
and alcohol.


TRAUMATIC INJURIES TO THE BRAIN

Can cause damage

Concussion—slight injury with mild symptoms but no permanent damage.
Contusion—marked tissue destruction with variety of symptoms
including a coma


DEGENERATIVE DISEASES

Cerebrovascular accident (CVA) "stroke"—occurs when a local region of
the brain has neuron death from ischemia
Ischemia—a lack of blood

Alzheimer's disease—it could result from a gene that causes neurons
to die
SPINAL CORD

Characteristics:
Located within the vertebrae
Continuous with the medulla oblongata
Extends from foramen magnum to bottom of 1st lumbar vertebra (17
inches long; thumb width wide)
Functions:
Transmits messages to and from the brain
Forms reflexes
Protection—bone, CSF & meninges
Meninges:

Dura mater forms sheath around the spinal cord
Epidural space between the dura mater and the bone
NOTE:

The epidural space is filled with fat and blood vessels
"saddle block" is given to block pain messages in this space
Arachnoid
Subarachnoid space
Filled with CSF
Below L3, is site for spinal taps (lumbar punctures)
Pia mater—the inner layer
Anatomy of the spinal cord and associated structures
4 general regions—cervical, thoracic, lumbar and sacral
Specific regions posterior to the lumbar region:
Conus medullaris—the cone shaped bottom of the spinal cord
Cauda equina—the horse tail, nerve fibers below the spinal cord
Filum terminale—the fibrous anchors for the spinal cord
Spinal nerves – their exit from the spinal cord
31 pair of spinal nerves exit via intervertebral foramina – go to the
body parts.
cervical enlargement goes to the arms
lumbar enlargement goes to the legs
cauda equina
spinal nerves below L1 angle down before exiting the foramina.
Collection of nerves at the bottom
cross-section anatomy – the spinal cord is a flat oval
two grooves divide the spinal cord into a right and a left half
anterior median fissure which is deep
posterior median sulcus which is shallow
gray matter and spinal roots
gray matter: H-shaped – butterfly shape
gray commissure – is the median cross bar
posterior (dorsal) horns are cell bodies of sensory neurons coming in
anterior (ventral) horns are cell bodies of motor neurons going out
to muscles
later horns are cell bodies of motor-neurons going out to organs
ventral root is where axons of all motor neurons leave
dorsal root is where sensory neurons enter
dorsal root ganglion – enlargement containing cell bodies of sensory
nerves

NOTE: dorsal and ventral roots are short and fuse to form the spinal
nerve at the ganglion.

white matter is mostly myelinated nerve fibers
funiculi – columns of white matter on each side of the spinal cord
examples – posterior, anterior, lateral

NOTE: each column contains several fiber tracts which are axons with
similar destinations.

ascending tracts conduct sensory messages up
descending tracts deliver motor impulses down.
THE PERIPHERAL NERVOUS SYSTEM

PNS overview – links the central nervous system to the various parts
of the body.
NOTE: consists of nerves running to and from the CNS

Nerve – cord like bundle of axons
Connective tissue associated with nerves: (see diagram below)
endoneurium – connective tissue around each axon
fascicles – a bundle of axons

perineurium – connective tissue around each fascicle
epineurium – connective tissue around all the fascicles
Functional divisions of nerves:
sensory – carry messages to the CNS
motor – carry messages away
*Most nerves are mixed, have both sensory and motor

CRANIAL NERVES

Function and Location:
connect the brain with receptors, muscles and glands
mainly in the head, face and neck
12 pairs – viewed from ventral (under) side of the brain
names of the cranial nerves
NOTE: Roman numerals indicate their order anterior to posterior

I – olfactory

II – optic

III – oculomotor

IV – trochlear

V – trigeminal

VI – abducens

VII – facial

VIII – vestibulocochlear (auditory)

IX – glossopharyngeal

X – vagus

XI – accessory (spinal accessory)

XII – hypoglossal

Mnemonics: "Oh Oh Oh, To Touch And Feel A Girl's Vagina Ahh Heaven"

functions of the cranial nerves:

I – olfactory (sensory) transmits sensory (smell) impulses from the
nasal cavity through the cribriform plate of the ethmoid bone.

II – optic (sensory)

transmits sensory impulses for vision
lead from retina through optic foramen into cranial cavity
some fibers cross over to the other side at the X shaped optic
chiasma
NOTE: damage to the optic nerve would result in blindness

III – oculomotor (motor)

control most of the muscles that help move "focus" the eye.
Internal muscles that move the eyeball in its orbit
Ptosis – upper eyelid droops because the nerve is damaged
IV – trochlear (motor) pulley

only ones to emerge from dorsal side
control eye muscles
V – trigeminal (both) the largest nerve with three branches

- motor portions to muscles involved in chewing

- sensory the major sensory nerve of the face

- 3 divisions

(1) opthalmic – transmit sensory impulses from the scalp,

The eye and nose.

Testing – corneal reflex – is that anything
touching

Cornea will cause blinking and tearing.

maxillary – transmit sensory impulses from the middle of the face.
Mandibular – transmit sensory impulses from the bottom of the face
NOTE: inflammation – trigeminal neuralgia – tic douloureux –
excruciating pain of unknown cause

VI – abducens (both) supply nerves to muscles which cause
lateral eye

Movements

VII – facial (both)

sensory from the taste buds on the front of the tongue
motor main motor nerve of the face – control facial expressions and
glands
5 branches:

(1) temporal

(2) zygomatic

(3) buccal

(4) mandibular

(5) cervical

NOTE: inflammation – Bell's palsy paralysis of facial
muscles on 1 side

Results in drooping eye lids, sagging mouth and dripping
tears

VIII – vestibulocochlear (sensory) – sensory nerves from
the inner ear

vestibular branch for balance
cochlear branch sound
IX – glossopharyngeal (both)

motor – controls swallowing
sensory – transmits taste & sensation from the back of the mouth
X – vagus (both)

NOTE: only cranial nerve that goes down to chest and abdomen,

Called the wanderer.

motor fibers
go to the throat and larynx (swallowing & speech) – if it is damaged
you would have problems swallowing or speaking
regulate – breathing, heart rate and digestion
sensory portion – transmits sensory impulses from the same organs
NOTE: damage – you would die; heart could not beat and you could not
breath.

XI – accessory (motor)

motor fibers to throat & to muscles involved in turning the
head and shrugging the shoulders

XII – hypoglossal (both)

motor fibers to the tongue
SPINAL NERVES

Distribution of spinal nerves

31 pairs – all mixed – both motor and sensory
Categories:
cervical nerves – 8 pairs – exit above each vertebrae
thoracic nerves – 12 pairs – exit below
lumbar nerves – 5 pairs
sacral nerves – 5 pairs
coccygeal nerves – 1 pair
Nerve roots – emerge from the spinal cord
ventral root – contains motor fibers
dorsal root – contains sensory fibers
NOTE:

these 2 roots fuse to form a spinal nerve
the spinal nerve exits the vertebral column through the foramina
once outside the intervertebral foramen each spinal nerve branches to
form rami
rami:
dorsal ramus – is small and serves the back
ventral ramus – serves rest of the body
meningeal ramus – reenters vertebral canal to innervate the meninges
Innervation of the Anterolateral Thorax and Abdominal Wall
Intercostal nerve is a branch of the thoracic nerve

NOTE: the ventral rami of all other spinal nerves except thoracic
intertwine and criss-cross to form a plexus

Plexuses Serving the Neck and Limbs
cervical plexus – neck
located deep in neck under sternocleidomastoid
phrenic nerve – motor fibers to the diaphragm
NOTE:

irritation causes hiccups – no cure
both phrenic nerves destroyed – you cannot breath on your own.
brachial plexus – arms
location – in shoulder between the neck and arm pit
supplies – most of the nerves of the arm
major nerves:
axillary – is in the arm pits
musculocutaneous – muscles that flex the forearm
median – muscles that pronate the forearm and flex the wrist and
fingers
ulnar – behind medial epicondyle of the humerus
radial
triceps brachii
compression would result in the inability to extend the hand at the
wrist
lumbar plexus – is in the small of the back
serves most nerves of the thigh
femoral nerve serves the quadriceps
NOTE: if slipped disc compresses lumbar plexus you could have trouble
walking

sacral plexus above the sacrum
nerves that serve the buttocks and legs
sciatic nerve – the thickest, longest nerve in the body
its branches supply all the muscles of the leg
injury
impairs the lower limbs
severed you could be paralyzed
sciatica – stinging pain in you leg
Innervation of the Skin, Dermatomes and Referred Pain
general statements
cranial nerves send branches to the skin of the face and scalp.
all spinal nerves except C1 send branches to the skin of the rest of
the body
dermatomes area of skin served by a spinal nerve
referred pain
nerves serving certain internal organs and dermatomes to the same
region of the spinal cord

NOTE: it is not understood why, but the brain may
interpret pain

as coming from a dermatome or skin area

example – heart pain – is felt as pain in the left arm


REFLEX ACTIVITY

Spinal cord has 2 main functions:
carry information to and from the brain
form reflexes
reflexes – rapid, predictable, involuntary responses to stimuli
types of reflexes:
autonomic reflexes – not conscious of these – they control visceral
activities (digestion, urine, eggs, hormones, sperm, etc.)
somatic reflexes
involves stimulation of somatic sensory receptors
aware of these
example to touch a hot stove
reflex arcs – the neural pathways that reflexes travel
components:
receptors – is the site of the stimulus
sensory neuron transmits the impulse to the spinal cord
integration center within the spinal cord relays the information to
the motor neuron
motor neuron transmits the impulse from the integration to the
effector
effector – the muscle, gland or organ that responds
types of reflexes:
monosynaptic – only one synapse
simplest type
sensory neuron synapses directly with motor neuron in spinal cord
patellar reflex or knee jerk is an example
NOTE: most reflexes are more complicated and include one or more
inter-neurons in the spinal cord.


THE AUTONOMIC NERVOUS SYSTEM

Characteristics:

- Division of PNS

- Involuntary – regulates activities, not under our conscious
control

- Composed of motor neurons serving smooth and cardia muscle

- Important in maintaining homeostasis by regulating activity
of organs

Examples: heart rate, breathing, digestion, blood
pressure

- Functions of reflexes and may be effected by stress

- Composed of 2 sets of neurons with opposite effects

Parasympathetic division – most active under calm
conditions

Examples: lower heart rate and breathing

Sympathetic division "fight or flight" – active during
emergencies

Examples: speeds up heart rate and breathing

NOTE: these are opposite extremes; most organs receive both
parasympathetic and sympathetic signals which adjust the activities
to a suitable level


- Comparison of efferent pathways of the somatic and autonomic
nervous

System

Preganglionic – cell body lies in the brain or spinal
cord and its axon

Synapses with another neuron.

Parasympathetic = lonfiltered= short

Postganglionic – cell body lies in a ganglion outside the
CNS and

Its axon synapses with the effector

Parasympathetic = short sympathetic = long

Diagram & summary/comparison of somatic and autonomic nervous

Systems (see page 534)

PARASYMPATHETIC DIVISION (CRANIOSACRAL)

Neurotransmitter of the parasympathetic division is ACh

Note: both pre and postganglionic neurons release ACh

Cranial outflow = cranial nerves with parasympathetic function:

- Cranial nerve III innervates the eye muscles

- Cranial nerve VII innervates major glands of the face

Examples: the salivary glands

- Cranial nerves IX innervates the parotid salivary glands

- Cranial nerve X sends branches to several plexuses and
innervates many

Organs

Examples:

Cardiac plexuses – will go to the heart

Pulmonary plexuses – will go to the lungs

Esophageal plexuses – will go to the esophagus

Sacral outflow – sacral spinal nerves with parasympathetic function:

Where? S2 – S4 – innervate several visceral organs: to control
digestion

Examples: send preganglionic fibers to innervate several
visceral

Organs of the intestines, the bladder and the genitals.

SYMPATHETIC DIVISION (THORACOLUMBAR)

Neurotransmitters:

- Preganglionic fibers release ACh

- Postganglionic fibers release E and NE

- Norepinephrine (NE) = noradrenalin – the
neurotransmitter released

By the adrenal gland

- Epinephrine is released from the adrenal gland

NOTE: percentage of E:NE = 80:20

Sympathetic Complexity

NOTE: the sympathetic division of the autonomic nervous system
is much

More complex than the parasympathetic

Examples of structures under sympathetic control:
blood vessels,

Sweat glands, arrector pili muscles, heart, the lungs and digestive
organs

Origin, function & ganglia associated with sympathetic fibers

- Preganglionic neurons are found in spinal cord segments T1
through L2

- Sympathetic fibers from these neurons emerge from the
thoracic and

Lumbar regions of the spinal cord to form ganglia

- Chain ganglia – line each side of the vertebral column

- Collateral ganglia – are located in front of the
vertebral column

Chain ganglia fibers supply:

Examples: the salivary glands and the thoracic
glands

- Collateral ganglia and the organs their fibers supply:

Superior mesentric

The upper abdominal
organs:

Liver, gallbladder,
stomach, spleen

Celiac

Inferior mesenteric

The lower digestive
and reproductive

Organs: small
intestine, kidneys,

bladder, ovaries

Hypogastric

RECEPTORS OF THE AUTONOMIC NERVOUS SYSTEM

Cholinergic Receptors (parasympathetic) – receptors are responsive to
ACh

Types:

- Nicotinic – when nicotine binds to these, it produces
same effect

As ACh

ACh stimulates nicotine receptors

Types of nicotinic receptors (examples):

N1 – are found at all post ganglionic sites

N2 – are found at the neuromuscular junctions

- Muscarinic – these bind a poison (muscarine) from
mushrooms

Respond to ACh and produce similar effects

NOTE:

Usually excitatory but can be
inhibitory

Examples: digestive and sweat glands – E

Heart rate and blood pressure – I

Adrenergic "adrenal gland" (sympathetic) Receptors

Two types:

Alpha – is mainly stimulatory

Types:

Alpha 1

Alpha 2

Beta – is usually inhibitory

Types:

B1

B2

NOTE: knowing the location of cholinergic and adrenergic receptors
and their subtypes is useful.

Example: important clinical breakthrough was the discovery of
adrenergic blockers that attach beta blockers; are used to reduce
heart rate and prevent irregular heart beat.

SOURCE:Good Nurse's Club


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Wednesday, September 26, 2007

Nursing Practice Test V

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Situation: The nurse is interviewing a handsome man. He is intelligent and very charming. When asked about his family, he states he has been married four times. He says three of those marriages were "shotgun" weddings. He states he never really loved any of his wives. He doesn't know much about his three children. "I've lost track," he states.

1. If a patient is very resistant in taking responsibility of his action and asks, "Can you just give me some medication?" the best response is:

a. "The medication has too many side effects."
b. You don't want to take medication, do you?"
c. Medication is given only as a East resort."
d. "There is no medication specific for your condition."

2. The patient asks the nurse, "What is this therapy for anyway. I just don't understand it." the best reply is:

a. "It keeps you from being put on medications."
b. "It helps you to change others in the family."
c. "The purpose of therapy is to help you change."
d. "No one but professionals can really understand

3. For patient in group therapy, the goal is:

a. Exchanging information and ideas
b. Developing insight by relating to others
c. Learning that everyone has problems
d. All of the above

4. In planning care for the patient with a personality disorder, the nurse realizes that this patient will most likely:

a. Not need long-term therapy
b. Not require medication
c. Require anti-anxiety medication
d. Resist any change in behavior

5. The person with an antisocial personality is participating in therapy while a patient at a psychiatric hospital. The nurse’s expectations are that he will:

a. Make a complete recovery
b. Make significant changes
c. Begin the slow process of change
d. Make few changes, if any

6. One of the reasons that persons with antisocial personalities may marry repeatedly or get into trouble with legal authorities is:

a. They usually just don't care
b. They are borderline mentally retarded
c. They are too psychotic to see what’s going on
d. They do not learn from past mistakes

7. The nurse recognizes that these are traits of:

a. Bipolar disorder
b. Alcoholic personality
c. Antisocial personality
d. Borderline personality

Situation: The patient with bipolar disorder is pacing continuously and is skipping meals.

8. Blood levels are drawn on the patient who has been taking Lithium for about six months. The present level is 2.1 meq/L. The nurse evaluates this level as:

a. Therapeutic
b. Below therapeutic
c. Potentially dangerous
d. Fatally toxic

9. The priority in working with patient a thought disorder is:

a. Get him to understand what you're saying
b. Get him to do his ADLs
c. Reorient him to reality
d. Administer antipsychotic medications

10. The most recent Lithium level on bipolar patient indicates a drop non-therapeutic level. What associated behavior does the nurse assess?

a. Ataxia
b. Confusion
c. Hyperactivity
d. Lethargy

11. Adequate fluid intake for a patient on Lithium is:

a. 1,000 ml per day
b. 1,500 ml per day
c. 2,000 ml per day
d. 3,600 ml per day

12. The physician orders Lithium carbonate for the bipolar patient. The nurse is aware that:

a. The patient should be put on a special diet
b. The medication should be given only at night
c. A salt-free should be provided for the patient
d. The drug level should be monitored regularly

13. The nursing plan should emphasize:

a. Offering him finger foods
b. Telling him he must sit down and eat
c. Serving food in his room and staying with him
d. Telling him to order fast food of he wants to eat

Situation: Anna, 25 years old was raped six months ago states, "I just can't seem to get over this. My husband and I don't even have sex anymore. What can I do?"

14. Supportive therapy to the rape victim is directed at overwhelming feeling that the victim experiences just after the rape has occurred?

a. Guilt
b. Rage
c. Damaged
d. Despair

15. Anna asks, "Why do I need to have pelvic exam?" The nurse explains:

a. "To make sure you're not pregnant."
b. "To see if you got an infection."
c. "To make sure you were really raped."
d. "To gather legal evidence that is required."

16. In providing support therapy, the nurse explains that rape has nothing to do with sexual desires or heeds. The two most common elements in rape are:

a. Guilt and shame
b. Shame and jealousy
c. Embarrassment and envy
d. Power and anger

17. The rape victim will not talk, is withdrawn and depressed. The defensive mechanism being used is:

a. Rationalization
b. Denial
c. Repression
d. Regression

18. The composite picture of rape victim reveals that most victimized women are:

a. Secretaries
b. Elderly
c. Students
d. Professionals

19. The best intervention is:

a. Tell her it just takes a long time
b. Ask her if her husband is angry
c. Refer her and her husband to sex therapy
d. Tell her she is suffering PTSD

Situation: Obsessions are recurring thoughts that become prevalent in the consciousness and may be considered as senseless or repulsive white compulsion are the repetitive acts that follow obsessive thoughts.

20. To understand the meaning of the cleaning rituals, the nurse must realize:

a. The patient cannot help herself
b. The patient cannot change
c. Rituals relieve intense anxiety
d. Medications cannot help

21. Upon admission to the hospital the patient increases the ritual behavior at bedtime. She cannot sleep. The treatment plan should include:

a. Recommending a sedative medication
b. Modifying the routine to diminish her bedtime anxiety
c. Reminding her to perform rituals early in the evening
d. Limit the amount of time she spends washing her hands

22. A patient has been diagnosed with a personality disorder with .compulsive traits. Of the following behavior's, which one would you expect the patient to exhibit?

a. Inability to make decisions
b. Spontaneous playfulness
c. Inability to alter plans
d. Insistence that things be done his way

23. The patient will not be able to stop her compulsive washing routines until she:

a. Acquires more superego
b. Recognizes the behavior is unrealistic
c. No longer needs them to manage her feelings of anxiety
d. Regains contact with reality

24. A 48-year-old female patient is brought to the hospital by her husband because her behavior is blocking her ability to meet her family's needs. She has uncontrollable and constant desire to scrub her hands, the walls, floors and sofa. She keeps repeating," Everything is dirty." This is an example of:

a. Compulsion
b. Obsession
c. Delusion
d. Hallucination

25. The female patient is preoccupied with rules and regulations. She becomes upset if others do not follow her lead and adhere to the rules exactly. This is a characteristic of which of the following personality?

a. Compulsive
b. Borderline
c. Antisocial
d. Schizoid

26. In planning care focused on decreasing the patient's anxiety, what plan should the nurse have in regards to the rituals?

a. Encourage the routines
b. Ignore rituals
c. Work with her to develop limits of behavior
d. Restrain her from the rituals

27. After the patient entered the hospital she began to increase her ritualistic hand washing at bedtime and could; not sleep. The nurse plans care around the fact that this patient needs:

a. A substitute activity to relieve anxiety
b. Medication for sleeping
c. Anti-anxiety medication such as Xanax
d. More scheduled activities during the day

28. The patient states, "I know all this scrubbing is silly but I can’t help it:'', this statement indicates that the patient does not recognize:

a. What she is doing
b. Why she is cleaning
c. Her level of anxiety
d. Need for medication

Situation: Substance, abuse is a common, growing health problem in this country.

29. The nurse is monitoring a drug abuser who states he was given cocaine and heroine that war cut with cornstarch or some other kind of powder. He states, "It was really bad stuff." Which complication is most threatening to this patient?

a. Endocarditis
b. Gangrene
c. Pulmonary abscess
d. Pulmonary embolism

30. The chronic drug abuser is suffering lymphedema in all extremities, but particularly in the arm where the drug was obviously injected. There is severe obstruction of veins and lymphatics. The nurse suspects the patient used:

a. A dull, contaminated needle
b. A needle contaminated with AIDS
c. Contaminated drugs
d. Cocaine mixed with uncut heroin

31. The nurse is assessing a heroin user who injected the drug into an artery instead of a vein. Which complication is the nurse most likely to expect?

a. Infection
b. Cardiac dysrhythmias
c. Gangrene
d. Thrombophlebitis

32. The nurse is assessing a 16-year-old patient for drug abuse. The patient is incoherent. Because she notes irritation of eyes, nose and mouth, she suspects inhalants. Which sign is most indicative of inhalant abuse?

a. Vomiting
b. Bad breath
c. Bad trip
d. Sudden fear

33. An impaired nurse has been admitted for treatment of Demerol addiction. She asks, "When will the withdrawal begin?" the best response is:

a. "It varies, with each individual."
b. "There is no way to tell."
c. "Withdrawal begins soon after the last dose."
d. "It depends upon how well the Demerol works."

34. The patient has a blood pressure of 180/100, heart rate of 120, associated with extreme restlessness. He is very suspicious of the hospital environment and actions of healthcare workers. The nurse should confront this patient on abuse of;

a. Marijuana
b. Cocaine
c. Barbiturates
d. Tranquilizers

35. The nursing interventions most effective in working with substance dependent patients are:

a. Firm and directive
b. Instillation of values
c. Helpful and advisory
d Subjective and non-judgmental

36. An adolescent patient has bloodshot eyes, a voracious appetite (especially for junk foods), and a dry mouth. Which drug of abuse would the nurse most likely suspect?

a. Marijuana
b. Amphetamines
c. Barbiturates
d. Anxiolytics

Situation: Defense mechanisms are unconscious intrapsychic process implemented to cope with anxiety. The use of some of these mechanisms is healthy, while she use of others is unhealthy.

37. A patient cries and curls in a fetal position refusing to move or talk. This is an example of:

a. Regression
b. Suppression
c. Conversion
d. Sublimation

38. A person who expands sexual energy in a nonsexual, socially accepted way is using the coping mechanism of.

a. Projection
b. Conversion
c. Sublimation
d. Compensation

39. "The reason I did not do well on the exam is that I was tired." This is an example of:

a. Rationalization
b. Projection
c. Compensation
d. Substitution

40. An unattractive girl becomes a very good student. This is an example of:

a. displacement
b. Regression
c. Compensation
d. Projection

41. A patient has been sharing a painful experience of sexual abuse during his childhood. Suddenly he stops and says, “l can't remember any more." The nurse assesses his behavior as:

a. Stubbornness
b. Forgetfulness
c. Blocking
d. Transference

42. The patient has a phobia about walking down in dark halls. The nurse recognizes that the coping mechanism usually associated with phobia is:

a. Compensation
b. Denial
c. Conversion
d. Displacement

43. The patient is denying that he is an alcoholic He states that his wife is an alcoholic. The defense mechanism he is utilizing is: v

a. Sublimation
b. Projection
c. Suppression
d. Displacement

Situation: Ms. Dwane, 17 years old, is admitted with anorexia nervosa. You have been assigned to sit with her while she eats her dinner. Ms. Dwane says "My primary nurse trusts me. I don't see why you don't."

44. Which observation of the client with anorexia nervosa indicates the client is improving?

a. The client eats meats in the dining room
b. The client gains one pound per week
c. The client attends group therapy sessions
d. The client has a more realistic self-concept

45. The nurse is caring for a client with anorexia nervosa who is to be placed on behavioral modification. Which is appropriate to include in (he nursing care plan?

a. Remind the client frequently to eat all the food served on the tray
b. Increased phone calls allowed for client by one per day for each pound gained
c. Include the family of the client in therapy sessions two times per week
d. Weigh the client each day at 6:00 am in hospital gown and slippers after she voids

46. A nursing intervention based on the behavior modification model of treatment for anorexia nervosa would be:

a. Role playing the client's interaction with her parents
b. Encouraging the client to vent her feelings through exercise
c. Providing a high-calorie, high protein diet with between meals snacks
d. Restricting the client's privileges until she gains three pounds

47. While admitting Ms. Dwane, the nurse discovers a bottle of pills that Ms. Dwane calls antacids. She takes them because her stomach hurts. The nurse's best initial response is:

a. Tell me more about your stomach pain
b. These do not look like antacids. I need to get an order for you to have them
c. Tell me more about you drug use
d. Some girls take pills to help them lose weight

48. The primary objective in the treatment of the hospitalized anorexic client is to:

a. Decrease the client's anxiety
b. Increase the insight into the disorder
c. Help the mother to gain control
d. Get the client to ea and gain weight

49. Your best response for Ms. Dwane is:

a. I do trust you, but I was assigned to be with you
b. It sounds as if you are manipulating me
c. Ok, when I return, you should have eaten everything
d. Who is your primary nurse?

Situation: The nurse suspects a client is denying his feelings of anxiety

50. The nurse is monitoring a patient who is experiencing increasing anxiety related to recent accident. She notes an increase in vital signs from 130/70 to 160/30, pulse rate of 120, respiration 36. He is having difficulty communicating. His level of anxiety is:

a. Mild
b. Moderate
c. Severe
d. Panic

51. The patient who suffers panic attacks is prescribed a medication for short-term therapy. The nurse prepares to administer.

a. Elavil
b. Librium
c. Xanax
d. Mellaril

52. In attempting to control a patient who is suffering panic attack, the nursing priority is:

a. Provide safely
b. Hold the patient
c. Describe crisis in detail
d. Demonstrate ADLs frequently

53. Which assessment would the nurse most likely find in a person who is suffering increased anxiety?

a. Increasing BP, increasing heart rate and respirations
b. Decreasing BP, heart rate and respirations
c. Increased BP and decreased respirations
d. Increased respirations and decreased heart rate

54. A patient who suffers an acute anxiety disorder approaches the nurse and while clutching at his shirt states "I think I'm having a heart attack." The priority nursing action is:

a. Reassure him he is OK
b. Take vital signs stat
c. Administer Valium IM
d. Administer Xanax PO

55. In teaching stress management, the goal of therapy is to:

a. Get rid of the major stressor
b. Change lifestyle completely
c. Modify responses to stress
d. Learn new ways of thinking

56. Another client walks in to the mental health outpatient center and States, "I've had it. I can't go on any longer. You've got to help me. "The nurse asks the client to be seated in a private interview room. Which action should the nurse take next?

a. Reassure the client that someone will help him soon
b. Assess the client's insurance coverage
c. Find out more about what is happening to the client
d. Call the client's family to come and provide support

57. Mr. Juan is admitted for panic attack. He frequently experiences shortness of breath, palpitations, nausea, diaphoresis, and terror. What should the nurse include in the care plan for Mr. Juan? When he is shaving a panic attack?

a. Calm reassurance, deep breathing and medications as ordered
b. Teach Mr. Juan problem solving in relation to his anxiety
c. Explain the physiologic responses of anxiety
d. Explore alternate methods for dealing with the cause of his anxiety

58. Ms. Wendy is pacing about the unit and wringing his hands. She is breathing rapidly and complains of palpitations and nausea, and she has difficulty focusing on what the nurse is saying. She says she is having a heart attack but refuses to rest. The nurse would interpret her level of anxiety as:

a. Mild
b. Moderate
c. Severe
d. Panic

59. When assessing this client, the nurse must be particularly alert to:

a. Restlessness
b. Tapping of the feet
c. Wringing of the hands
d. His or her own anxiety level

Situation: Raul aged 70 was recently admitted to a nursing home because of confusion, disorientation, and negativistic behavior. Her family states that Raul is in good health. Raul asks you, "Where am I?"

60. Another patient, Mr. Pat, has been brought to the psychiatric unit and is pacing up and down the hall. The nurse is to admit him to the hospital. To establish a nurse-client relationship, which approach should the nurse try first?

a. Assign someone to watch Mr. Pat until he is calm
b. Ask Mr. Pat to sit down and orient him to the nurse's name and the need for information
c. Check Mr. Pat's vital signs, ask him about allergies, and call the physician for sedation
d. Explain the importance of accurate assessment data to Mr. Pat .

61. If Raul will say "I'm so afraid! Where I am? Where is my family'?" How should the nurse respond?

a. "You are in the hospital and you're safe here. Your family will return at 10 o'clock, which is one hour from now"
b. "You know were you are. You were admitted here 2 weeks ago. Don’t worry your family will be back soon."
c. "I just told you that you're in the hospital and your family will be here soon."
d. "The name of the hospital is on the sigh over the door. Let's go read it again."

62. Raul has had difficulty sleeping since admission. Which of the following would be the best intervention?

a. Provide him with glass of warm milk
b. Ask the physician for a mild sedative
c. Do not allow Raul to take naps during the day
d. Ask him family what they prefer

63. Which activity would you engage in Raul at the nursing home?

a. Reminiscence groups
b. Sing-along
d. Discussion groups
c. Exercise class

64. Which of the following would be an appropriate strategy in reorienting a confused client to where her room is?

a. Place pictures of her family on the bedside stand
b. Put her name in large letters on her forehead
c. Remind the client where her room is
d. Let the other residents know where the client’s room is

65. The best response for the nurse to make is:

a. Don't worry, Raul. You're safe here
b. Where do you think you are?
c. What did your family tell you?
d. You're at the community nursing home

Situation: The police bring a patient to the emergency department. He has been locked in his apartment for the past 3 days, making frequent calls to the police and emergency services and stating that people are trying to kill him.

66. A client on an inpatient psychiatric unit refuses to eat and states that the staff is poisoning her food. Which action should the nurse include in the client's care plan?

a. Explain to the client that the staff can be trusted
b. Show the client that others eat the food without harm
c. Offer the client factory-sealed foods and beverages
d. Institute behavioral modification with privileges dependent on intake

67. The client tells the nurse that he can't eat because his food has been poisoned. This statement is an indication of which of the following?

a. Paranoia
b. Delusion of persecution
c. Hallucination
d. Illusion

68. The client on antipsychotic drugs begins to exhibit signs and symptoms of which disorder?

a. Akinesia
b. Pseudoparkinsonism
c. Tardive dyskinesia
d. Oculogyric crisis

69. During a patient history, a patient state that she used to believe she was God. But she knows this isn't true. Which of the following would be your best response?"

a. "Does it bother you that you used to believe that about yourself?"
b. "Your thoughts are now more appropriate"
c. "Many people have these delusions."
d. "What caused you to think you were God?"

70. The nurse is caring for a client who is experiencing auditory hallucination. What would be most crucial for the nurse to assess?

a. Possible hearing impairment
b. Family history of psychosis
c. Content of the hallucination
d. Otitis media

71. A patient with schizophrenia reports that the newscaster on the radio has a divine message especially for her. You would interpret this as indicating.

a. Loose of associations
b. Delusion of reference
c. Paranoid speech
d. Flight of ideas

72. What type of delusions is the patient experiencing?

a. Persecutory
b. Grandiose
c. Jealous
d. Somatic

Situation: Helen, with a diagnosis of disorganized schizophrenia is creating a disturbance in the day room. She is yelling and pointing at another patient, accusing him to stealing her purse. Several patients are in the day room when this incident starts.

73. The nurse is preparing to care for a client diagnosed with catatonic schizophrenia. In anticipation of this client's arrival, what should the nurse do?

a. Notify security
b. Prepare a magnesium sulfate drip
c. Place a specialty mattress overlay on the bed
d. Communicable the client's nothing-by-mouth status to the dietary department

74. The nurse is caring for a client whom she suspects is paranoid. How would the nurse confirm this assessment?

a. indirect questioning
b. Direct questioning
c. Les-ad-in-sentences
d. Open-ended sentences

75. Which of the following is an example of a negative symptom of schizophrenia?

a. Delusions
b. Disorganized speech
c. Flat affect
d. Catatonic behavior

76. The patient tells you that a "voice" keeps laughing at him and tells him he must crawl on his hands and knees like a dog. Which of the following would be the most appropriate response?

a. "They are imaginary voices and we're here to make them go, away."
b. "If it makes you feel better, do what the voices tell you."
c. "The voices can't hurt you here in the hospital"
d. "Even though I don't hear the voices, I understand that you do."

77. A 23-year-old patient is receiving antipsychotic medication to treat his schizophrenia. He's experiencing some motor abnormalities called extrapyramidal effects. Which of the following extrapyramidal effects occurs most frequently in younger make patients?

a. Akathisia
b. Akinesia
c. Dystonia
d. Pseudoparkinsonism

78. Which of the following should you do next?

a. Firmly redirect the patient to her room to discuss the incident
b. Call the assistance and place the patient in locked seclusion
c. Help the patient look for her purse
d. Don't intervene - the patients need a little bit of room in which to work out differences

Situation: John is admitted with a diagnosis of paranoid schizophrenia.

79. You're reaching a community group about schizophrenia disorders. You explain the different types of schizophrenia and delusional disorders. You also explain that, unlike schizophrenia, delusional disorders:

a. Tend to begin in early childhood
b. Affect more men than women
c. Affect more women than men
d. May be related to certain medical conditionsa

80. A patient with schizophrenia (catatonic type) is mute and can't perform activities of daily living. The patient stares out the window for hours. What is your first priority in this situation?

a. Assist the patient with feeding
b. Assist the patient with showering and tasks for hygiene
c. Reassure the patient about safely, and try to orient him to his surroundings
d. Encourage, socialization with peers, and provide a stimulating environment

81. Which of the following would you suspect in a patient receiving Chlorpromazine (Thorazine) who complains of a sore throat and has a fever?

a. An allergic reaction
b. Jaundice
c. Dyskinesia
d. Agranulocytosis

82. While providing information for the family of a patient with schizophrenia, you should be sure to inform them about which of the following characteristics of the disorder?

a. Relapse can be prevented if the patient takes medication
b. Support is available to help family members meet their own needs
c. Improvement should occur if the patient's environment is carefully maintained
d. Stressful situations in the family in the family can precipitate a relapse in the patient

83. While caring for John, the nurse knows that John may have trouble with:

a. Staff who are cheerful
b. Simple direct sentences
c. Multiple commands
d. Violent behaviors

84 Which nursing diagnosis is most likely to be associated with a person who has a medical diagnosis of schizophrenia, paranoid type?

a. Fear of being along
b. Perceptual disturbance related to delusion of persecution
c. Social isolation related to impaired ability to trust
d. Impaired social skills related to inadequate developed superego

85. Which of the following behaviors can the nurse anticipate with this client?

a. Negative cognitive distortions
b. Impaired psychomotor development
c. Delusions of grandeur and hyperactivity
d. Alteration of appetite and sleep pattern

Situation: A client is admitted to the hospital. During the assessment the nurse notes that the client has not slept for a week. The client is talking rapidly, and throwing his arms around randomly.

86. When writing an assessment of a client with mood disorder, the nurse should specify:

a. How flat the client's affect
b. How suicidal the client is
c. How grandiose the client is
d. How the client is behaving

87. It is an apprehensive anticipation of an unknown danger:

a. Fear
b. Anxiety
c. Antisocial
d. Schizoid

88. It is an, emotional response to a consciously recognized threat.

a. Fear
b. Anxiety
c. Antisocial
d. Schizoid

89. All but one is an example of situational crisis:

a. Menstruation
b. Role changes
c. Rape
d. Divorce

90. What would be the highest priority in formulating a nursing care plan for this client?

a. Isolate the client until he or she adjusts to 'the hospital
b. Provide nutritious food and a quite place to rest
c. Protect the client and others from harm
d. Create a structured environment

Situation: Wendell, 24 year-old student with a primary sleep disorder, is unable to initiate maintenance of sleep. Primary sleep disorders may be categorized as dyssomnias or parasomnias.

91. The nurse is caring for a client who complains; of fat?gue, inability to concentrate, and palpitations. The client stales that she has been experiencing these symptoms for the past 6 months. Which factor in the client’s history has most likely contributed to.these symptoms?

a. History of recent fever
b. Shift work
c. Hyperthyroidism
d. Fear

92. If Wendell complains of experiencing an overwhelming urge to sleep and states that he's been falling asleep while studying and reports that these episodes occur about 5 times daily Wendell is most likely experiencing which sleep disorder?

a. Breathing-related sleep disorder
b. Narcolepsy
c. Primary hypersomnia
d. Circadian rhythm disorder

93. The nurse is preparing a teaching plan for a client diagnosed with primary insomnia. Which of the following teaching topics should be included in the plan?

a. Eating unlimited spicy foods, and limiting caffeine and alcohol
b. Exercising 1 hour before bedtime to promote sleep
c. Importance of steeping whenever the client tires
d. Drinking warm milk before bed to induce sleep

94. Examples of dyssomnia includes:

a. Insomnia, hypersomnia, narcolepsy
b. Sleepwalking, nightmare
c. Snoring while sleeping
d. Non-rapid eye movement

Situation: The following questions refer to therapeutic communication.

95. When preparing to conduct group therapy, the nurse keeps in mind that the optimal number of clients in a group would be:

a. 6 to 8
b. 10 to 12
c. 3 to 5
d. Unlimited

96. What occurs during the working phase of the-nurse-client relationship?

a. The nurse assesses the client's needs and develops a plan of care
b. The nurse and client together evaluate and modify the goals of the relationship
c. The nurse and client discuss their feelings about terminating the relationship
d. The nurse and client explore each other's expectations of-the relationship

97. A 42 year-old homemaker arrives at the emergency department with uncomfortable crying and anxiety. Her husband of 17 years has recently asked her for a divorce. The patient is sitting in a chair, rocking back and forth. Which is the best response for the nurse to make?

a. "You must stop crying so that we can discuss your feelings about the divorce."
b. "Once you find a job, you will feel much better and more secure."
c. "I can see how upset you are. Let's sit in the office so that we can talk about how you're feeling."
d. "Once you have a lawyer looking out for your interests, you will feel better."

98. A client on the unit tells the nurse that his wife's nagging really gets on his nerves. He asks the nurse if she will talk with his wife about nagging during their family session tomorrow afternoon. Which of the following would be most therapeutic response to client?

a. "Tell me more specifically about her complaints"
b. "Can you think why she might nag you so much?"
c. "I'll help you think about how to bring this up yourself tomorrow."
d. "Why do you want me to initiate this discussion in tomorrow's session rather than you?"

99. The nurse is working with a client who has just stimulated her anger by using a condescending tone of voice. Which of the following responses by the nurse would be the most therapeutic?

a. "I feel angry when I hear that tone of voice"
b. "You make me so angry when you talked to me that way."
c. "Are you trying to make me angry?"
d. "Why do you use that condescending tone of voice with me?"

100. A 35 year-old client tells the nurse that he never disagrees with anyone and that he has loved everyone he's ever known. What would be the nurse's best response to this client?

a. "How do you manage to do that?"
b. "That's hard to believe. Most people couldn't to that."
c. "What do you do with your feelings of dissatisfaction or anger?"
d. "How did you come to adopt such a way of life?"



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