ATI Care of the Patient with a Cerebral or Cerebrovascular Disorder: Chapter 10: Perrin: Understanding the Essentials of Critical Care Nursing: Chamberlain College of Nursing NR 341 (A Graded) Latest Questions and Complete Solutions Perrin: Understanding the Essentials of Critical Care Nursing Chapter 10: Care of the Patient with a Cerebral or Cerebrovascular Disorder MULTIPLE CHOICE. Choose the one alternative that best completes the statement or answers the questions 1) A patient is recovering from transphenoidal surgery for partial resection of a pituitary adenoma. The nurse should caution the patient NOT to do which of the following? A) Blow his nose or sneeze B) Deep breathe C) Drink more than 2 liters of fluid a day D) Sit up in bed higher than 30 degrees Answer: A Explanation: A) These activities may cause the patch to dislodge which could result in a cerebrospinal fluid leak (CSF) and increase the risk of infection. #2 is incorrect. Deep breathing is a post- operative activity that all po-sotp patients should perform to prevent atelectasis. Coughing would be contraindicated in this patient as is would raise intracranial pressure. #3 is incorrect. Drinking 2 liters of fluid per day is- ao poasctivity that helps the body metabolize anesthesia, maintains hydration and liquefies pulmonary secretions. #4 is incorrect. The head of the beds needs to be elevated at least 30 degree higher to reduce po-sot p edema. This also allows for better lung expansion to prevent atelectasis. Nursing Process: Intervention Cognitive Level: Application Category of Need: Physiological Integrity–Reduction of Risk Potential B) These activities may cause the patch to dislodge which could result in a cerebrospinal fluid leak (CSF) and increase the risk of infection. #2 is incorrect. Deep breathing is a postoperative activity that all po-sotp patients should perform to prevent atelectasis. Coughing would be contraindicated in this patient as is would raise intracranial pressure. #3 is incorrect. Drinking 2 liters of fluid per day is- ao poasctivity that helps the body metabolize anesthesia, maintains hydration and liquefies pulmonary secretions. #4 is incorrect. The head of the beds needs to be elevated at least 30 degree higher to reduce po-sot p edema. This also allows for better lung expansion to prevent atelectasis. Nursing Process: Intervention Cognitive Level: Application Category of Need: Physiological Integrity–Reduction of Risk Potential C) These activities may cause the patch to dislodge which could result in a cerebrospinal fluid leak (CSF) and increase the risk of infection. #2 is incorrect. Deep breathing is a postoperative activity that all po-sotp patients should perform to prevent atelectasis. Coughing would be contraindicated in this patient as is would raise intracranial pressure. #3 is incorrect. Drinking 2 liters of fluid per day is- ao poasctivity that helps the body metabolize anesthesia, maintains hydration and liquefies pulmonary secretions. #4 is incorrect. The head of the beds needs to be elevated at least 30 degree higher to reduce po-sot p edema. This also allows for better lung expansion to prevent atelectasis. Nursing Process: Intervention Cognitive Level: Application Category of Need: Physiological Integrity–Reduction of Risk Potential D) These activities may cause the patch to dislodge which could result in a cerebrospinal fluid leak (CSF) and increase the risk of infection. #2 is incorrect. Deep breathing is a postoperative activity that all po-sotp patients should perform to prevent atelectasis. Coughing would be contraindicated in this patient as is would raise intracranial pressure. #3 is incorrect. Drinking 2 liters of fluid per day is- ao poasctivity that helps the body metabolize anesthesia, maintains hydration and liquefies pulmonary secretions. #4 is incorrect. The head of the beds needs to be elevated at least 30 degree higher to reduce po-sot p edema. This also allows for better lung expansion to prevent atelectasis. Nursing Process: Intervention Cognitive Level: Application Category of Need: Physiological Integrity–Reduction of Risk Potential 2) A patient is diagnosed with a grade II astrocytoma. The nurse realizes that this patient's prognosis is: A) Excellent. B) Good as long as the tumor is treated soon. C) Good because the tumor is well defined. D) Poor because the tumor cells are irregularly shaped. Answer: B Explanation: A) Astrocytomas are the most common types of primary brain tumor, and are graded from I to IV according to tissue histology. Grade I and grade II tumors are considered to be low- grade tumors and have the most favorable survival rates and respond favorably to early treatment. #3 is incorrect. Grade I tumor cells are well defined and almost normall shaped. They have a low incidence of brain infiltration. Grade II tumor cells are less well defined and there is the possibility that a grade II tumor will transform to a higher grade #4 is not correct. Highegrade (III and IV) tumor cells are abnormally shaped and have a pronounced ability to infiltrate normal brain tissue, therefore the prognosis is poor. #1 is not correct. Excellent prognosis is not associated with this type of brain tumor Cognitive Level: Analysis Nursing Process: Assessment Category of Need: Physiological Integrity–Reduction of Risk Potential B) Astrocytomas are the most common types of primary brain tumor, and are graded from I to IV according to tissue histology. Grade I and grade II tumors are considered to be low- grade tumors and have the most favorable survival rates and respond favorably to early treatment. #3 is incorrect. Grade I tumor cells are well defined and almost normall shaped. They have a low incidence of brain infiltration. Grade II tumor cells are less well defined and there is the possibility that a grade II tumor will transform to a higher grade #4 is not correct. High- egrade (III and IV) tumor cells are abnormally shaped and have a pronounced ability to infiltrate normal brain tissue, therefore the prognosis is poor. #1 is not correct. Excellent prognosis is not associated with this type of brain tumor Cognitive Level: Analysis Nursing Process: Assessment Category of Need: Physiological Integrity–Reduction of Risk Potential