Chapter 23 Neurologic Disorders and Therapeutic Management

How often should lubricating eye drops be administered to a patient in coma to prevent corneal epithelial breakdown? a. 2 hours b. 4 hours c. 8 hours d. 12 hours

a. 2 hours

Which patient has the best prognosis based on the cause of coma? a. A 36-year-old man with closed head injury b. A 50-year-old woman with hepatic encephalopathy c. A 46-year-old woman with subarachnoid hemorrhage d. A 72-year-old man with hypertensive intracerebral hemorrhage

a. A 36-year-old man with closed head injury

The patient has sustained an ischemic stroke involving the left cerebral hemisphere. Which of the following neurologic abnormalities would you expect to see? (Select all that apply.) a. Aphasia b. Left visual field defect c. Difficulty balancing his checkbook d. Ataxic gait e. Somnolence

a. Aphasia c. Difficulty balancing his checkbook

A patient has been admitted with an ischemic stroke. The patient received recombinant tissue plasminogen activator (rtPA) in the emergency department. The nurse checks the medication administration record to make sure the patient does not have which medications for the next 24 hours? (Select all that apply.) a. Aspirin b. Sodium nitroprusside c. Warfarin d. Labetalol e. Any antiplatelet drugs

a. Aspirin c. Warfarin e. Any antiplatelet drugs

Downward displacement of the hemispheres, basal ganglia, and diencephalon through the tentorial notch is indicative of what type of herniation? a. Central b. Uncal c. Cingulate d. Infratentorial

a. Central

A patient has had an ischemic stroke and now having difficulty with speech. The nurse knows the patient is experiencing what problem? a. Expressive aphasia b. Global aphasia c. Receptive aphasia d. Apraxia

a. Expressive aphasia

The incidence of rebleeding after a ruptured cerebral aneurysm is highest during which of the following time periods? a. First 24 hours b. 4 to 12 days c. 3 to 4 weeks d. 3 to 6 months

a. First 24 hours

Which medication is a fast-acting, short-duration agent used for breakthrough seizures? a. Lorazepam b. Phenytoin c. Phenobarbital d. Midazolam

a. Lorazepam

Which diuretic is the most effective in the reduction of increased intracranial pressure (ICP)? a. Mannitol b. Furosemide c. Urea d. Glycerol

a. Mannitol

Which statement is true regarding the occurrence of subarachnoid hemorrhages (SAHs)? a. Occurrence is greater in men than women younger than the age of 40 years old. b. Occurrence is greater in men than women older than the age of 40 years old. c. 90% of SAHs are caused by traumatic injury. d. Patients with SAHs have a better survival rate than patients with arteriovenous malformations.

a. Occurrence is greater in men than women younger than the age of 40 years old.

A right-handed patient has been admitted with an intracerebral hemorrhage. A computed tomography (CT) scan of the patient's head reveals a large left parietal area bleed. Based on the type of stroke, which signs and symptoms might the patient exhibit? a. Right-sided hemiplegia and receptive aphasia b. Left-sided hemiplegia and tactile agnosia c. Decorticate posturing and unequal pupils d. Unilateral neglect and dressing apraxia

a. Right-sided hemiplegia and receptive aphasia

The extrusion of cerebral tissue through the cranium is what type of herniation? a. Transcalvarial b. Uncal c. Cingulate d. Transtentorial

a. Transcalvarial

Ideally fibrinolytic therapy should be administered within how many hours of the onset of stroke symptoms? a. 1 b. 3 c. 6 d. 10

b. 3

Which assessment finding in a patient in coma 10 to 12 hours after cardiopulmonary arrest is indicative of unlikely survival? a. Decorticate posturing b. Absent pupillary light reflexes c. Decerebrate posturing d. Central hyperventilation

b. Absent pupillary light reflexes

Which nursing intervention will help prevent spikes in intracranial pressure in the post-neurosurgical patient? a. Keep the head of the bed elevated 45 to 90 degrees. b. Administer an antiemetic to prevent vomiting. c. Provide fluid restriction. d. Help with turn, cough, and deep breathe exercises.

b. Administer an antiemetic to prevent vomiting.

A patient's ICP is 34 mm Hg, and his cerebral perfusion pressure is 65 mm Hg. Given that the practitioner has left appropriate orders, which action should the nurse take next? a. No action is required. b. Administer mannitol 1 to 2 g/kg IV. c. Place the patient supine and flat in bed. d. Suction the patient.

b. Administer mannitol 1 to 2 g/kg IV.

A female right-handed patient has been admitted with an intracerebral hemorrhage. A computed tomography (CT) scan of the patient's head reveals a large left parietal area bleed. While assisting with personal care, the nurse notes that the patient is unable to comb her hair with her left hand. The nurse suspects the patient may be experiencing which complication? a. Agnosia b. Apraxia c. Broca aphasia d. Wernicke aphasia

b. Apraxia

A patient has been experiencing drowsiness, confusion, and slight focal deficits for several days. The initial noncontract computed tomography (CT) findings are negative. The patient is being prepared for a lumbar puncture. What appearance does the nurse anticipate that the cerebrospinal fluid (CSF) would look? a. Cloudy b. Bloody c. Xanthochromic d. Clear

b. Bloody

The patient has uncontrolled intracranial pressure and now is receiving high-dose barbiturate therapy. The nursing management plan for this patient should include monitoring the patient for what complication? a. Hypothermia b. Hypotension c. Myocardial depression d. Dehydration

b. Hypotension

Appropriate therapy for ischemic stroke depends on rapid completion of which diagnostic study? a. Magnetic resonance imaging b. Noncontrast computed tomography c. Contrast computed tomography d. Lumbar puncture

b. Noncontrast computed tomography

A male patient post right-sided stroke is experiencing hemiagnosia. This is evidenced by which finding? a. The patient only reads the right side of the newspaper. b. The patient refuses to acknowledge the left side of his body. c. The patient is hyperresponsive when approached on the right side. d. The patient attempts to comb his hair with a toothbrush.

b. The patient refuses to acknowledge the left side of his body.

A patient becomes flaccid with fixed and dilated pupils. The patient's intracranial pressure (ICP) falls from 65 to 12 mm Hg. What should the nurse suspect is happening? a. The patient is having a seizure. b. The patient's brain has herniated. c. The patient's cerebral edema is resolving. d. The patient is excessively dehydrated from the mannitol.

b. The patient's brain has herniated.

When an object is placed in the hand of a patient with neurologic impairment during assessment, the patient is unable to recognize the placement. What is this complication called? a. Homonymous hemianopsia b. Aphasia c. Agnosia d. Apraxia

c. Agnosia

Which intervention should be considered LAST in treating uncontrolled intracranial hypertension? a. Sedatives b. Analgesics c. Barbiturates d. Hyperventilation

c. Barbiturates

What is one of the earliest signs of increased intracranial pressure (ICP)? a. Cushing triad b. Decerebrate posturing (abnormal extension) c. Change in level of consciousness d. Increase in pupillary size

c. Change in level of consciousness

What is one cause of metabolic coma? a. Trauma b. Ischemic stroke c. Drug overdose d. Intracerebral hemorrhage

c. Drug overdose

Which patient position is optimal to prevent elevated intracranial (ICP) pressures? a. The head of the bed elevated 30 to 40 degrees b. Supine with the patient's neck in a neutral alignment c. Individualized head position to minimize ICP measurements d. The head of the bed elevated with flexion of the hips

c. Individualized head position to minimize ICP measurements

Nursing management of a patient with a clipped cerebral aneurysm receiving hemodynamic augmentation includes which intervention? a. Administering osmotic diuretics and vasodilator agents b. Providing the patient with a quiet environment c. Maintaining the patient's systolic blood pressure at 150 to 160 mm Hg d. Keeping the patient's central venous pressure at 5 to 8 mm Hg

c. Maintaining the patient's systolic blood pressure at 150 to 160 mm Hg

Which medication is prescribed to decrease cerebral vasospasm? a. Phenytoin b. Phenobarbital c. Nimodipine d. Vecuronium

c. Nimodipine

After neurosurgery, the patient is at risk of developing what problem? a. Aspiration b. Diabetes mellitus c. Seizures d. Corneal abrasions

c. Seizures

What is the target range for PaCO2 in the patient with intracranial hypertension? a. 25 to 30 mm Hg b. 25 to 35 mm Hg c. 35 to 40 mm Hg d. 33 to 37 mm Hg

d. 33 to 37 mm Hg

Which independent nursing measures can assist in reducing increased intracranial pressure (ICP)? a. Decreasing the ventilator rate b. Decreasing noxious stimuli c. Frequent orientation checks d. Administration of loop diuretics

d. Administration of loop diuretics

A patient is admitted with an acute head injury after a motor vehicle accident. The patient is intubated and ventilated, and a ventriculostomy is placed. In addition to monitoring of intracranial pressure, what treatment can be provided with the ventriculostomy? a. Instillation of mannitol b. Drainage of subdural hematoma c. Brain tissue sampling d. Cerebrospinal fluid drainage

d. Cerebrospinal fluid drainage

A patient has been told he has a nonencapsulated tumor that has infiltrated the brain tissue. Why type of tumor does the nurse suspect the patient has? a. Angioma b. Pituitary adenoma c. Meningioma d. Glioma

d. Glioma

A ventriculoperitoneal shunt may be placed in a post-stroke patient to treat which complication? a. Hyponatremia b. Intracerebral hemorrhage c. Spontaneous intracerebral hemorrhage d. Hydrocephalus

d. Hydrocephalus

Which nursing diagnosis has the highest priority in the nursing management plan for a patient with Guillain-Barré syndrome? a. Imbalanced nutrition: less than body requirements related to lack of exogenous nutrients or increased metabolic demand b. Acute pain related to transmission and perception of cutaneous, visceral, muscular, or ischemic impulses c. Risk for aspiration d. Ineffective breathing pattern related to musculoskeletal fatigue or neuromuscular impairment

d. Ineffective breathing pattern related to musculoskeletal fatigue or neuromuscular impairment

A right-handed patient has been admitted with an intracerebral hemorrhage. A computed tomography (CT) of the patient's head reveals a large left parietal area bleed. Patient assessment includes temperature (T), 98.7° F; pulse (P), 98 beats/min and thready; respirations (R), 8 breaths/min; and blood pressure (BP), 168/100 mm Hg. Initial management of the patient includes which intervention? a. Placing the patient in the Trendelenburg position b. Administering an antihypertensive agent c. Initiating induced hypertensive therapy d. Intubating and ventilating the patient

d. Intubating and ventilating the patient

A patient presents with aphasia, decreased level of consciousness, and right-sided weakness. The patient has a history of heart disease, hyperlipidemia, and transient ischemic attacks. Based on the history, the nurse suspects that the patient has sustained which type of stroke? a. Hemorrhagic stroke b. Intracerebral hemorrhages c. Subarachnoid hemorrhages d. Ischemic stroke

d. Ischemic stroke

What is a pathologic consequence of an unruptured cerebral aneurysm? a. It shunts blood away from the surrounding tissues. b. It leaks blood into the subarachnoid space. c. It causes damage the middle layer of the arterial wall. d. It places pressure on the surrounding tissues.

d. It places pressure on the surrounding tissues.

What are the most common medications used in high-dose barbiturate therapy? a. Phenytoin and fosphenytoin b. Mannitol and nimodipine c. Lidocaine and phenobarbital d. Pentobarbital and thiopental

d. Pentobarbital and thiopental

A patient has been admitted post craniotomy for a brain tumor. The nursing management plan should include monitoring the patient for what complication? a. Diabetes mellitus b. Fluid retention c. Intracranial hypotension d. Surgical hemorrhage

d. Surgical hemorrhage

Which of the following statements regarding Guillain-Barré syndrome (GBS) supports the admission to a critical care unit? a. The demyelination process of the peripheral nerves is irreversible. b. The demyelination process is limited to the peripheral nervous system only. c. The paralysis associated with the syndrome occurs in a descending pattern. d. The most common cause of death is respiratory arrest.

d. The most common cause of death is respiratory arrest.

2. Emergency treatment of coma of unknown cause includes rapid intravenous administration of which three agents? a. Epinephrine, hydrocortisone, and Benadryl b. Dopamine, 10% dextrose in distilled water, and calcium chloride c. Mannitol, dexamethasone, and sodium bicarbonate d. Thiamine, glucose, and opioid antagonist

d. Thiamine, glucose, and opioid antagonist

The nurse is caring for a patient who is had trans-sphenoidal surgery for removal of a pituitary tumor. The nurse observes a large amount of clear drainage from the nose. The provider requests the drainage be tested for the presence of glucose. Why did the physician order this test? a. To assess for an infection b. To check for a shift in osmolality c. To check for occult blood d. To assess for a cerebrospinal fluid leak

d. To assess for a cerebrospinal fluid leak