Midterm Test Drill No.

Name: Shekinah C. de Fiesta, BSN 4

Answer the following questions: (50 points)

1. A patient with GI bleeding requires fluid rescucitation and 4 units of PRBC. Which
electrolyte imbalance should you watch for following the transfusion of the packed RBC?
Support your answer.
- Hypocalcemia (Calcium level in the blood) due to the complex of citrate with serum
calcium.
2. Why are elderly patients at increased risk for hypocalcemia?
- Elderly patients are at particular risk because of decreased skin synthetic capacity,
undernutrition, and lack of sun exposure. In fact, most people with deficiency have
both decreased skin synthesis and dietary deficiency.
3. A patient is admitted with a history of hypothyroidism and has not complied with his
thyroid medication, what electrolyte imbalance should a nurse expect to find? Why?
- First is the Calcium level. Total calcium levels in serum were found to be significantly
lowered in hypothyroid patients when compared to controls. Thyroxine normally
regulates blood calcium levels by releasing calcium from the cells. In hypothyroidism,
there is less thyroxine in the bloodstream; thus less thyroxine enters the cells and
less calcium is released.
- Second is the Sodium level. Which is Euvolemic hyponatremia (decrease in total
body water) it occurs in people with hypothyroidism, adrenal gland disorder, and
disorders that increase the release of the antidiuretic hormone (ADH), such as
tuberculosis, pneumonia, and brain trauma.
- Third is the Iodine level. Since hypothyroidism connects with the iodine level in the
body.
4. How does hypovolemia progress to hypovolemic shock?
- Hypovolemia is a state of decreased blood volume specifically decreased blood
volume of plasma. It characterized by salt (sodium) depletion. Tachycardia,
decreased BP and delayed capillary refill were some of the signs of hypovolemia.
And it progresses to hypovolemic shock if hypovolemia was uncontrolled or if not
treated. The "Tennis" staging of hypovolemic shock as the stages of blood loss are
under 15% of volume for the stage 1, 15-30% of volume the stage 2, 30-40% of
volume stage 3 and stage 4 above 40% of volume. Where in the stage 4 survival is
extremely unlikely.
5. Is respiratory acidosis caused by hypoventilation or hyperventilation? Support your
answer.
- Respiratory acidosis results from alveolar hypoventilation caused by the bodys
inability to rid itself of carbon dioxide. An increased respiratory rate with a shallow
depth is a sign of alveolar hypoventilation.
6. Why were seizure precautions instituted for patient with metabolic alkalosis?
- Metabolic alkalosis results in neuromuscular excitibility, causing muscle twitching,
weakness and tetaniy. The patient may experience hyperactive reflexes and
numbness and tingling of the fingers, toes, and mouth. Apathy and confusion may
occur and progress to seizures, stupor, and coma. Causes of metabolic alkalosis

include excessive acid loss from the GI tract, diuretic therapy, and Cushings
disease.
7. What is these?
A. Ashmans phenomenon
- an aberrant ventricular conduction due to a change in QRS cycle length.
B. Wellens syndrome
- efers to these specific electrocardiographic (ECG) abnormalities in the precordial Twave segment, which are associated with critical stenosis of the proximal left anterior
descending (LAD) coronary artery.
- Wellens syndrome is also referred to as LAD coronary T-wave syndrome.
C. Restenosis
- a narrowing of a blood vessel, leading to restricted blood flow.
- It usually pertains to an artery or other large blood vessel that has become narrowed,
received treatment to clear the blockage and subsequently become renarrowed.
D. Raynauds phenomenon
- smaller arteries that supply blood to your skin narrow, limiting blood circulation to
affected areas (vasospasm).
- causes some areas of our body such as fingers and toes to feel numb and cold
in response to cold temperatures or stress.
E. Lou Gehrigs disease
- a rapidly progressive, neuromuscular disease.
- It attacks the motor neurons that transmit electrical impulses from the brain to the
voluntary muscles in the body.
- When they fail to receive messages, the muscles lose strength, atrophy and die.
8. Whats the difference between hypertensive urgency and a hypertensive emergency or
crisis.
- Hypertensive urgency is a severe elevation in blood pressure without progressive
target organ dysfunction while hypertensive emergency or crisis is characterized by a
severe elevation in blood pressure (> 180/120 mm Hg) complicated by evidence of
impending or progressive target organ dysfunction. Examples of target organ
dysfunction include coronary ischemia, disordered cerebral function, cerebrovascular
events, pulmonary edema, and renal failure.

9. A patient is at risk for arterial occlusive disease. What signs and symptoms should a
nurse will look for?
- The signs and symptoms that a nurse should look for are the following:
1. Severe pain, coldness, and numbness in a limb.
2. Sores on your toes, heels, or lower legs.
3. Dry, scaly, cracked skin on your foot. Major cracks, or fissures, may become
infected if left untreated.
4. Weakened muscles in your legs. Gangrene (tissue death), which may require
amputation
10. Does a patient can only aspirate while swallowing? Support your answer.
It can be provided if the patient is suffering from any swallong disorders
experiencing difficulty in swallowing, or if the patient is a left/right sided paralysis.
11. How can a nurse tell if a patient has receptive or expressive aphasia?
- With expressive aphasia, the person knows what he or she wants to say, yet has
difficulty communicating it to others. It doesn't matter whether the person is trying to
say or write what he or she is trying to communicate while receptive aphasia the
person can hear a voice or read the print, but may not understand the meaning of
the message. Oftentimes, someone with receptive aphasia takes language literally.
Their own speech may be disturbed because they do not understand their own
language.
12. One complication of cerebral aneurysm repair is vasospasm. What is cerebral
vasospasm?

Is narrowing of a cerebral blood vessel and causes reduced blood flow distally, which
may lead to delayed ischemic deficit and cerebral infarction if left untreated.
13. What is deep brain stimulation?
- is a surgical procedure used to treat a variety of disabling neurological symptoms
most commonly the debilitating symptoms of Parkinsons disease (PD), such
as tremor,rigidity, stiffness, slowed movement, and walking problems.
- is also used to treat essential tremor, a common neurological movement disorder.
14. What are the possible adverse reactions with deep brain stimulation?
- The possible adverse reactions with deep brain stimulation aredeath from cerebral
hemorrahge, depression, falls, gait disturbance, dyskinesia, motor dysfunction,
balance disorder, depression, and dystonia.
15. Does a patient receiving phenytoin can continue taking her oral contraceptives? Why?
- Yes they can still continue taking their oral contraceptives but since phenytoin
increases the clearance of oral contraceptive pills they should use preparations
containing at least 50 g of ethinyl estradiol in order to reduce the chance of
pregnancy.