...out idiopathic normal pressure hydrocephalus, by definition) 2 - Age under 40 (idiopathic normal pressure hydrocephalus unlikely) 2 - Asymmetrical or transient symptoms - Cortical deficits, e.g., aphasia, apraxia, or paresis - Lack of progression of symptoms (a controversial point, as authors differ on the period of time in which symptoms should be seen to progress) - Progressive dementia without gait disturbance (even if the ventricles are enlarged) • Laboratory o The differential diagnosis of gait disturbances includes: - Deficiencies of vitamin 86 and 812 o It is often not possible to distinguish normal pressure hydrocephalus from other causes of subcortical dementia by the clinical and radiological findings alone • Imaging o Imaging studies of the brain reveal ventriculomegaly without any marked degree of cortical atrophy 20 o Computerized tomography 13 - Typical Findings of normal pressure hydrocephalus include disproportionate widening of the ventricles in comparison to the cerebral sulci - A coronal section at the level of the posterior commissure reveals a narrow subarachnoid space surrounding the outer surface of the brain (a "tight convexity") and narrow medial cisterns - The third ventricle is usually enlarged as well, while the fourth ventricle may or may not be enlarged 14 - Thus, a Fourth ventricle of normal size in the presence of enlarged lateral and third ventricles need not indicate aqueductal stenosis and is a finding consistent with normal pressure hydrocephalus...
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...subarachnoid hemorrhage, intraparenchymal hemorrhage, brain tumor, meningitis and hydrocephalus. Increasing ICP causes decrease CPP, impaired autoregulation, hypotension, hypoxemia, cerebral ischemia, hypercarbia, hyperthermia and hypo/hyperglycemia. The goal of care is to prevent the secondary brain injury that results from increased ICP. An EVD (external ventricular drain) may be indicated in these cases. It is considered the most accurate ICP monitor while allowing for drainage of CSF. The procedure to place drain may be performed at the bedside under sterile conditions or in the OR. Nursing Considerations * Obtain pre procedure assessment to provide baseline data including vital signs, LOC, sensation and motor function, cranial nerve function and mental status. * Obtain history of recent asprin and anticoagulation therapy. * Obtain history of prior craniotomies, aneurysm clips, embolic materials, permanent balloon occlusions, detachable clips or ventriculoperitoneal shunt. Evaluate labs for coagulopathy studies and radiology and angiography results. Report findings to MD. * ------------------------------------------------- Assess for allergies: EVD...
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...NCSBN ON-LINE REVIEW 1.A client has been hospitalized after an automobile accident. A full leg cast was applied in the emergency room. reason for the nurse to elevate the casted leg is to A) Promote the client's comfort B) Reduce the drying time C) Decrease irritation to the skin D) Improve venous return The most important D: Improve venous return. Elevating the leg both improves venous return and reduces swelling. Client comfort will be improved as well. 2. The nurse is reviewing with a client how to collect a clean catch urine specimen. What is the appropriate sequence to teach the client? A) B) C) D) Clean the meatus, begin voiding, then catch urine stream Void a little, clean the meatus, then collect specimen Clean the meatus, then urinate into container Void continuously and catch some of the urine A: Clean the meatus, begin voiding, then catch urine stream. A clean catch urine is difficult to obtain and requires clear directions. Instructing the client to carefully clean the meatus, then void naturally with a steady stream prevents surface bacteria from contaminating the urine specimen. As starting and stopping flow can be difficult, once the client begins voiding it’s best to just slip the container into the stream. Other responses do not reflect correct technique 3. Following change-of-shift report on an orthopedic unit, which client should the nurse see first? A) B) C) D) 16 year-old who had an open reduction of a fractured wrist 10 hours ago 20 year-old...
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...publisher. No patent liability is assumed with respect to the use of the information contained herein. Although every precaution has been taken in the preparation of this book, the publisher and author assume no responsibility for errors or omissions. Nor is any liability assumed for damages resulting from the use of the information contained herein. ISBN-13:978-0-7897-2706-9 ISBN-10: 0-7897-3706-x Library of Congress Cataloging-in-Publication Data Rinehart, Wilda. NCLEX-PN exam cram / Wilda Rinehart, Diann Sloan, Clara Hurd. -- 2nd ed. p. cm. ISBN 978-0-7897-3706-9 (pbk. w/cd) 1. Practical nursing--Examinations, questions, etc. 2. Nursing--Examinations, questions, etc. 3. National Council Licensure Examination for Practical/Vocational Nurses--Study guides. I. Sloan, Diann. II. Hurd, Clara. III. Title. RT62.R55 2008 610.73'076--dc22 2008000133 Printed in the United States of America First Printing: February 2008 Trademarks All terms mentioned in this book that are known to be trademarks or service marks have been appropriately capitalized. Pearson Education cannot attest to the accuracy of this information. Use of a term in this book should not be regarded as affecting the validity of any trademark or service mark. Warning and Disclaimer Every effort has been made to make this book as complete and as accurate as possible, but no warranty or fitness is implied. The information provided is on an “as is” basis. The...
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...Practice Examination One Part One You will have two hours and 30 minutes to complete Part One. 1. The nurse is instructing an unlicensed assistant on how to collect a urine specimen from an indwelling catheter. Which of the following statements indicates that the assistant understands the instructions? A. "I will empty the catheter drainage bag, have the client drink some water, and an hour later collect the urine that drains into the bag. " B. "I will get a sterile syringe and remove urine from the catheter through the collection port to place in the specimen container. " C. "I should collect urine from the catheter drainage bag at the end of the shift and place it in the specimen container. " D. "I will disconnect the drainage tube from the catheter and let urine run from the catheter into the specimen container. " 2. Linda is a 19-year-old primipara who delivered a viable male neonate 2 hours ago. She has decided to breast-feed. Her 22-year-old husband supports her decision. She tells the nurse, "My mother breast-fed all of her children, but I'm going to need lots of help with breastfeeding. I'm worried that I won't be able to do this. " Which of the following should the nurse include when assessing the client? A. Determine the client's level of motivation to breast-feed. B. Perform a complete physical examination to determine her need for help. C. Assess her body-to-fat ratio and nutritional status before beginning...
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