Chapter 53: Care of the Patient with a Neurologic Disorder

41. A is a diagnostic procedure used to identify lesions by observing the flow of radiopaque dye through the subarachnoid space.

ANS: myelogram Preparation for this procedure is the same as for lumbar puncture. PTS: 1 DIF: Cognitive Level: Comprehension REF: Page 1907 OBJ: 11 TOP: Diagnostic tests KEY: Nursing Process Step: Planning

43. Involuntary rhythmic movement of the eyes, with oscillations that may be horizontal, vertical, or mixed movements, is called

ANS: nystagmus Nystagmus is a rhythmic movement of the eyes, which may be horizontal, vertical, or mixed in directional movement. The eye movement cannot be controlled by the patient. PTS: 1 DIF: Cognitive Level: Knowledge REF: Page 1924 OBJ: 9 TOP: Anatomy and physiology KEY: Nursing Process Step: Assessment

42. The nurse explains that the triad of signs of Parkinson disease is: , and

ANS: tremor, rigidity, bradykinesia tremor, bradykinesia, rigidity bradykinesia, tremor, rigidity bradykinesia, rigidity, tremor rigidity, bradykinesia, tremor rigidity, tremor, bradykinesia Tremor, rigidity, and bradykinesia are the triad that make up the signs of Parkinson disease. PTS: 1 DIF: Cognitive Level: Comprehension REF: Page 1927 OBJ: 21 TOP: Parkinson disease KEY: Nursing Process Step: Assessment

40. is/are responsible for the transmission of impulses between synapses.

ANS: Neurotransmitters Neurotransmitters (acetylcholine, norepinephrine, dopamine, and serotonin) function to conduct transmission between the synapses. PTS: 1 DIF: Cognitive Level: Knowledge REF: Page 1897 OBJ: 1 TOP: Neurotransmitters KEY: Nursing Process Step: N/A

44. The waxy substance that covers the neuron fibers and increases the rate of transmission of impulses is the .

ANS: myelin Myelin is the waxy substance that covers the neuron fibers (axons and dendrites) and increases the rate of transmission of impulses. PTS: 1 DIF: Cognitive Level: Knowledge REF: Page 1897 OBJ: 2 TOP: Myelin KEY: Nursing Process Step: N/A

28. A patient is in which stage of Alzheimer disease when she demonstrates "sundowning"? a. Early stage b. Second stage c. Third stage d. Final stage

ANS: B "Sundowning" is seen in the AD patient in the second stage of the disease. PTS: 1 DIF: Cognitive Level: Knowledge REF: Pages 1932-1933 OBJ: 15 TOP: Alzheimer disease KEY: Nursing Process Step: Assessment

45. The nurse explains that the two divisions of the autonomic nervous system work to maintain homeostasis. Place in order the autonomic events. (Separate letters by a comma and space as follows: A, B, C, D) a. Parasympathetic nervous system dominates b. Extremely stressful or frightening event c. Blood pressure, heart rate, and adrenaline output decrease d. Sympathetic nervous system dominates e. Heart rate and blood pressure rise, secretion of adrenaline

ANS: B, D, E, A, C In the event of a frightening event, the sympathetic nervous system dominates and increases the blood pressure, heart rate, and adrenaline output in the "fight or flight" mechanism. The body is calmed by the parasympathetic nervous system dominating and reducing the heart rate, blood pressure, and adrenaline output. PTS: 1 DIF: Cognitive Level: Analysis REF: Page 1901 OBJ: 1 TOP: Autonomic nervous system KEY: Nursing Process Step: Implementation

18. The nurse is caring for a home health patient who had a spinal cord injury at C5 three years ago. The nurse bases the plan of care on the knowledge that the patient will be able to: a. feed self with setup and adaptive equipment. b. transfer self to wheelchair. c. stand erect with full leg braces. d. sit with good balance.

ANS: A A cord injury at C5 allows for ability to drive an electric wheelchair with mobile hand supports and feed self with adaptive equipment. PTS: 1 DIF: Cognitive Level: Analysis REF: Page 1950, Table 53-8 OBJ: 30 TOP: Spinal cord injury KEY: Nursing Process Step: Assessment

8. A patient, age 45, is to have a myelogram to confirm the presence of a herniated intervertebral disk. Which nursing action should be planned with respect to this diagnostic test? a. Obtain an allergy history before the test. b. Ambulate the patient when returned to the room after the test. c. Use heated blanket to keep patient warm after procedure. d. Keep NPO for 6 to 8 hours after the test.

ANS: A Before the dye is injected, patients must be asked whether they have any allergies, specifically whether they have had any anaphylactic or hypotensive episodes from other dyes. PTS: 1 DIF: Cognitive Level: Application REF: Page 1907 OBJ: 11 TOP: Diagnostic procedures KEY: Nursing Process Step: Planning

3. The newly admitted patient to the emergency room 30 minutes ago after a fall off a ladder has gradually decreased in consciousness and has slowly reacting pupils, a widening pulse pressure, and verbal responses that are slow and unintelligible. What is the most appropriate position for the patient? a. Neck placed in a neutral position b. Head raised slightly with hips flexed c. Supine in gravity neutral position d. Turn on right side with head elevated

ANS: A Place the neck in a neutral position (not flexed or extended) to promote venous drainage. PTS: 1 DIF: Cognitive Level: Application REF: Page 1915 OBJ: 12 TOP: Intracranial pressure (ICP) KEY: Nursing Process Step: Planning

14. The nurse assures an anxious family member of a 92-year-old patient who is demonstrating signs of dementia that many causes of dementia are reversible and preventable. What is one example? a. Hypotension b. Alzheimer disease c. Diabetes d. Parkinson disease

ANS: A Some forms of dementia are reversible. Dementia caused by hypotension, anemia, drug toxicity, metabolic disturbance, and malnutrition can all be corrected to abolish the dementia. PTS: 1 DIF: Cognitive Level: Application REF: Page 1902 OBJ: 117 TOP: Causes of dementia KEY: Nursing Process Step: Implementation

10. What are surgical navigational systems? a. Computerized devices that guide the surgeon b. A set of detailed anatomic maps pinpointing specific areas of the brain c. A written set of progressive processes for the resection of small brain tumors d. The use of radioactive materials to pinpoint small tumors of the brain

ANS: A Surgical navigational systems are computerized devices that guide the surgeon and make possible the resection of tumors that were once thought to be inoperable. PTS: 1 DIF: Cognitive Level: Comprehension REF: Page 1951 OBJ: 30 TOP: Hematoma KEY: Nursing Process Step: Planning

32. What is the first sign of Bell's palsy? a. Inability to wrinkle forehead and pucker lips on affected side b. Sudden pain in nostril on affected side c. Excessive salivation on the affected side d. Excessive mucus running from nostril on affected side

ANS: A Unilateral weakness of the facial muscles usually occurs, resulting in a flaccidity of the affected side of the face with inability to wrinkle the forehead, close the eyelid, pucker the lips, smile, frown, whistle, or retract the mouth on that side. The face appears asymmetric. PTS: 1 DIF: Cognitive Level: Comprehension REF: Page 1945 OBJ: 17 TOP: Bell's palsy KEY: Nursing Process Step: Assessment

23. The nurse is aware that the drug t-PA (Activase), a tissue plasminogen activator, must be given in hours of the onset of symptoms to have maximum benefit. a. 3 hours b. 4 hours c. 6 hours d. 8 hours

ANS: A t-PA must be given within 3 hours of the onset of symptoms to be beneficial. PTS: 1 DIF: Cognitive Level: Application REF: Page 1941 OBJ: 14 TOP: t-PA KEY: Nursing Process Step: Planning

38. What is the reticular activating system (RAS) essential to? (Select all that apply.) a. Concentration b. Wakefulness c. Speech d. Attention e. Memory f. Introspection

ANS: A, B, D, F The RAS, located on the brainstem, is essential to wakefulness, attention, concentration, and introspection. PTS: 1 DIF: Cognitive Level: Analysis REF: Page 1903 OBJ: 1 TOP: reticular activating system KEY: Nursing Process Step: Planning

7. As the result of a stroke, a patient has difficulty discerning the position of his body without looking at it. In the nurse's documentation, which would best describe the patient's inability to assess spatial position of his body? a. Agnosia b. Proprioception c. Apraxia d. Sensation

ANS: B Patients may experience a loss of proprioception with a stroke. This may include apraxia and agnosia (a total or partial loss of the ability to recognize familiar objects or people). PTS: 1 DIF: Cognitive Level: Application REF: Page 1919 OBJ: 19 TOP: Stroke KEY: Nursing Process Step: Assessment

30. What should the nurse do when the child arrives on the floor with the diagnosis of bacterial meningitis? a. Arrange for humidified oxygen per mask b. Place the child in respiratory isolation c. Inquire about drug allergy d. Hold NPO until orders arrive

ANS: B Persons with bacterial meningitis are placed in respiratory isolation until the pathogen can no longer be cultured, usually 24 hours. PTS: 1 DIF: Cognitive Level: Comprehension REF: Page 1947 OBJ: 18 TOP: Bacterial meningitis KEY: Nursing Process Step: Implementation

9. A patient has recently suffered a stroke with left-sided weakness and has problems with choking, especially when drinking thin liquids. What nursing interventions would be most helpful in assisting this patient to swallow safely? a. Use a straw b. Tuck chin when swallowing c. Take a sip of liquid with each bite d. Turn head to the left

ANS: B The patient should sit at a 90-degree angle with the head up and chin slightly tucked. PTS: 1 DIF: Cognitive Level: Application REF: Page 1917 OBJ: 16 TOP: Stroke KEY: Nursing Process Step: Implementation

21. The nurse is aware that the characteristic gait of the person with Parkinson disease is a propulsive gait, which causes the patient to: a. stagger and need support of a walker. b. shuffle with arms flexed. c. fall over to one wide when walking. d. take small steps balanced on the toes.

ANS: B The propulsive gait causes the patient to shuffle with his arms flexed and with a loss of postural reflexes. PTS: 1 DIF: Cognitive Level: Comprehension REF: Page 1927 OBJ: 21 TOP: Parkinsonism KEY: Nursing Process Step: Assessment

17. What is the nurse aware of when assessing a person with a craniocerebral injury? a. Most injuries of this type are irreversible b. Open injuries are always more serious than closed injuries c. Signs and symptoms may not occur until several days after the trauma d. Trauma to the frontal lobe is more significant than to any other area

ANS: C If a patient who has been conscious for several days after head injury loses consciousness or develops neurologic signs and symptoms, a subdural hematoma should be suspected. PTS: 1 DIF: Cognitive Level: Analysis REF: Page 1952 OBJ: 19 TOP: Trauma KEY: Nursing Process Step: Assessment

27. What is the basic problem that prompts most of the early signs of Alzheimer disease? a. Changes in mood b. Misplacing things c. Memory loss that disrupts daily life d. Problems with words in speaking

ANS: C Memory loss that disrupts daily life is the basic problem that prompts most of the early signs of AD. PTS: 1 DIF: Cognitive Level: Application REF: Page 1930, Box 53-2 OBJ: 15 TOP: Alzheimer disease KEY: Nursing Process Step: Planning

33. Following a myelogram the nurse should include in the postprocedure care assessment for: a. elevation of blood pressure. b. urine retention. c. sensation in lower extremities. d. slurred speech.

ANS: C Postmyelogram care includes the assessment to ensure there is no leakage of CSF, sensation and strength of the lower extremities, or headache. To avoid a headache, the patient should be flat for a few hours. PTS: 1 DIF: Cognitive Level: Analysis REF: Page 1908 OBJ: 11 TOP: Myelogram KEY: Nursing Process Step: Assessment

5. What is the cardinal sign of increased intracranial pressure in a brain injured patient? a. Pupil changes b. Ipsilateral paralysis c. Vomiting d. Decrease in the level of consciousness

ANS: D Collection of objective data includes a change in level of consciousness. A change in the level of consciousness is the earliest sign of increased intracranial pressure. PTS: 1 DIF: Cognitive Level: Analysis REF: Page 1913 OBJ: 12 TOP: Intracranial pressure (ICP) KEY: Nursing Process Step: Assessment

15. What is the nurse assessing when asking the patient, "Who is the president of the United States?" during a level of consciousness assessment? a. Orientation b. Memory c. Calculation d. Fund of knowledge

ANS: D Fund of knowledge is tested by questions such as "Who is the president?" or asking about current events. PTS: 1 DIF: Cognitive Level: Comprehension REF: Page 1903 OBJ: 9 TOP: Level of Consciousness KEY: Nursing Process Step: Implementation

2. What is the cranial nerve that supplies most of the organs in the thoracic and abdominal cavities and also carries motor fibers to glands that produce digestive juices and other secretions? a. Somatic motor nerve b. Visceral sensory nerve c. Abducens nerve d. Vagus nerve

ANS: D The vagus nerve extends from the throat, larynx, and organs in the thoracic and abdominal cavities. It is responsible for sensations and will accelerate peristalsis when stimulated. PTS: 1 DIF: Cognitive Level: Knowledge REF: Page 1901, Table 53-1 OBJ: 5 TOP: Anatomy and physiology KEY: Nursing Process Step: Assessment

35. Which foods should the person who suffers from migraine headaches avoid? (Select all that apply.) a. Yogurt b. Caffeine c. Beef d. Pears e. Marinated foods f. Milk

ANS: A, B, E Some foods may cause or worsen headaches. Foods that may provoke headaches include vinegar, chocolate, yogurt, alcohol, fermented or marinated foods, ripened cheese, cured sandwich meat, caffeine, and pork. PTS: 1 DIF: Cognitive Level: Analysis REF: Page 1909 OBJ: N/A TOP: Headache KEY: Nursing Process Step: Assessment

24. An 83-year-old patient has had a stroke. He is right-handed and has a history of hypertension and "little" strokes. He presents with right hemiplegia. To afford him the best visual field, the nurse should approach him: a. from the right side. b. from the left side. c. from the center. d. from either side.

ANS: B Another perceptual problem is hemianopia, which is characterized by defective vision or blindness in half of the visual field. If the patient has hemianopia, which is common, the patient should be approached from the nonparalyzed side for care. PTS: 1 DIF: Cognitive Level: Analysis REF: Page 1942 OBJ: 13 TOP: Hemianopia KEY: Nursing Process Step: Implementation

19. A frantic family member is distressed about the flaccid paralysis of her son following a spinal cord injury several hours ago. What does the nurse know about this condition? a. It is an ominous indicator of permanent paralysis. b. It is possibly a temporary condition and will clear. c. It degenerates into a spastic paralysis. d. It will progress up the cord to cause seizures.

ANS: B A period of flaccid paralysis following a cord injury is called areflexia, or spinal shock, and may be temporary. PTS: 1 DIF: Cognitive Level: Application REF: Page 1954 OBJ: 20 TOP: Trauma KEY: Nursing Process Step: Assessment

37. Which of the following techniques are necessary for safely feeding a hemiplegic patient? (Select all that apply.) a. Mixing liquids and solid foods together b. Taking the patient's dentures out to prevent choking c. Checking the affected side of mouth for food accumulation d. Offering small bites of food e. Elevating the patient to no more than 30 degrees f. Adding a thickening agent to liquids

ANS: C, D, F Important nursing measures include avoiding foods that cause choking, checking the affected side of the mouth for accumulation of food and resultant poor hygiene, not mixing liquids and solid foods, and encouraging the patient to take small bites. PTS: 1 DIF: Cognitive Level: Application REF: Page 1917 OBJ: 18 TOP: Hemiplegia KEY: Nursing Process Step: Planning

13. Which symptom is specific to migraine headaches? a. Tachycardia b. They become worse in the evening c. They involve the entire head d. They are preceded by an aura

ANS: D Migraine headaches are unusual in that signs and symptoms occur before the acute attack. PTS: 1 DIF: Cognitive Level: Application REF: Page 1909 OBJ: 9 TOP: Headaches KEY: Nursing Process Step: Assessment

29. Why are the drugs neostigmine (Prostigmin) and pyridostigmine (Mestinon) helpful to the person with myasthenia gravis? a. Improves speech b. Improves visual disturbances c. Reduces pain d. Promotes nerve impulse transmission

ANS: D Prostigmine and Mestinon improve the nerve impulses and alleviate the symptoms. PTS: 1 DIF: Cognitive Level: Knowledge REF: Page 1935 OBJ: 21 TOP: Myasthenia gravis KEY: Nursing Process Step: Implementation

12. How would a nurse record the behavior when a patient with Alzheimer disease attempts to eat using a napkin rather than a fork? a. Apraxia b. Agnosia c. Aphasia d. Dysphagia

ANS: B Agnosia is a total or partial loss of the ability to recognize familiar objects or people through sensory stimuli as a result of organic brain damage. PTS: 1 DIF: Cognitive Level: Comprehension REF: Page 1933 OBJ: 13 TOP: Agnosia KEY: Nursing Process Step: Assessment

39. What are the effects of normal aging on the nervous system? (Select all that apply.) a. Small vessel occlusion b. Loss of neurons c. Calcification of cerebrum d. Reduction of cerebral blood flow e. Lipofuscin f. Decrease in oxygen use

ANS: B, D, E, F As the person ages, normal age-related changes occur such as loss of neurons, reduction of cerebral blood flow, appearance of lipofuscin, a decrease in oxygen use and brain metabolism, and a decline in velocity of nerve impulses. PTS: 1 DIF: Cognitive Level: Application REF: Page 1901 OBJ: 6 TOP: Age-related changes KEY: Nursing Process Step: Implementation

31. What is the purpose of a "drug holiday" in the treatment of Parkinson disease? a. Change all drugs b. Allow the natural dopamine levels to rise c. Restart drugs at a lower dosage with favorable results d. Reduce the extrapyramidal symptoms

ANS: C A "drug holiday" is a period of time when all drugs are withdrawn from the person with Parkinson disease. The drugs are then restarted at a lower dose with favorable results. PTS: 1 DIF: Cognitive Level: Analysis REF: Page 1929 OBJ: 21 TOP: Drug holiday KEY: Nursing Process Step: N/A

4. Which question is likely to elicit the most valid response from the patient who is being interviewed about a neurologic problem? a. "Do you have any sensations of pins and needles in your feet?" b. "Does the pain radiate from your back into your legs?" c. "Can you describe the sensations you are having?" d. "Do you ever have any nausea or dizziness?"

ANS: C For patients with suspected neurologic conditions, the presence of many symptoms or subjective data may be significant. Offering leading questions is not beneficial and may allow the patient to give misinformation. Questions should be specific about symptoms. PTS: 1 DIF: Cognitive Level: Application REF: Page 1902 OBJ: 8 TOP: Assessment KEY: Nursing Process Step: Assessment

34. Why is the patient with suspected Guillain-Barre Syndrome (GBS) hospitalized immediately? a. The infection needs to be treated with IV antibiotics to prevent paralysis b. The brain may swell quickly causing seizures c. The disease can rapidly progress into respiratory failure d. IV hydration is needed to prevent possible fatal hypotension

ANS: C Hospitalization is necessary for GBS patients because the disease progresses very quickly and respiratory failure may occur. PTS: 1 DIF: Cognitive Level: Analysis REF: Page 1946 OBJ: 18 TOP: Guillain-Barre KEY: Nursing Process Step: Assessment

6. The nurse is aware that when assessing a patient by the FOUR score coma scale, the patient is assessed in four categories: eye response, brainstem reflexes, motor response, and respiration. How are these results reported? a. As a sum of the scores of the four categories b. As part of the Glasgow coma scale c. As individual scores in each category d. As progressive scores during a 24-hour period

ANS: C The FOUR score coma scale assesses the patient in four categories: eye response, brainstem reflexes, motor response, and respiration. The scores are reported as individual scores in each category. It is frequently done in conjunction with the Glasgow coma scale, not part of it. PTS: 1 DIF: Cognitive Level: Comprehension REF: Page 1994 OBJ: 11 TOP: FOUR Score Coma Scale KEY: Nursing Process Step: Assessment

26. How would the nurse instruct a patient with Parkinson disease to improve activity level? a. To use a soft mattress to relax the spine b. To walk with a shuffling gait to avoid tripping c. To walk with hands clasped behind back to help balance d. To sit in hard chair with arms for posture control

ANS: C The patient with Parkinson disease can improve the activity level by sleeping on a firm mattress without a pillow to prevent spinal curvature, hold hands clasped behind to keep better balance, and keep the arms from hanging stiffly at the side. Walk with a lifting of the feet to avoid tripping and "freezing." PTS: 1 DIF: Cognitive Level: Application REF: Page 1931 OBJ: 21 TOP: Parkinson disease KEY: Nursing Process Step: Planning

25. The newly admitted patient to the emergency room after a motorcycle accident has serosanguineous drainage coming from the nose. What is the most appropriate nursing response to this assessment? a. Cleanse nose with a soft cotton-tipped swab b. Gently suction the nasal cavity c. Gently wipe nose with absorbent gauze d. Ask patient to blow his nose

ANS: C The patient's ear and nose are checked carefully for signs of blood and serous drainage, which indicate that the meninges are torn and spinal fluid is escaping. No attempt should be made to clean out the orifice or to blow the nose. The drainage can be wiped away. The drainage can be tested for the presence of glucose, which would confirm that the fluid is spinal fluid and not mucus. PTS: 1 DIF: Cognitive Level: Application REF: Page 1953 OBJ: 20 TOP: Trauma KEY: Nursing Process Step: Implementation

36. What are the three signs of Cushing response? (Select all that apply.) a. Increased pulse rate b. Increased blood pressure c. Widened pulse pressure d. Bradycardia e. Increased systolic blood pressure f. Uncontrolled thermoregulation

ANS: C, D, E A widened pulse pressure, increased systolic blood pressure, and bradycardia are together called Cushing response. It is considered an important diagnostic sign of late-stage brain herniation. PTS: 1 DIF: Cognitive Level: Analysis REF: Page 1913 OBJ: 19 TOP: Increased intracranial pressure KEY: Nursing Process Step: Assessment

11. A family member of a patient who has just suffered a tonic-clonic seizure is concerned about the patient's deep sleep. What is this behavior called? a. Convalescent period b. Neural recovery period c. Sombulant period d. Postictal period

ANS: D Seizures are followed by a rest period of variable length, called a postictal period. PTS: 1 DIF: Cognitive Level: Knowledge REF: Page 1920 OBJ: 14 TOP: Seizures KEY: Nursing Process Step: Implementation

16. What Glasgow Coma Scale rating would a patient receive who opens the eyes spontaneously, but has incomprehensible speech and obeys commands for movement? a. 8 b. 10 c. 11 d. 12

ANS: D The Glasgow coma scale was developed in 1974, and it consists of three parts of the neurologic assessment: eye opening, best motor response, and best verbal response. This patient gets a 4 for eye opening, a 2 for incomprehensible speech, and a 6 for moving on demand. PTS: 1 DIF: Cognitive Level: Application REF: Page 1903, Table 53-3 OBJ: 10 TOP: Glasgow coma scale KEY: Nursing Process Step: Assessment

1. What are the two divisions of the nervous system? a. Somatic and the autonomic b. Cerebellum and the brainstem c. Medulla oblongata and the diencephalon d. Central and the peripheral

ANS: D The central and the peripheral are the two divisions of the nervous system. The autonomic and the somatic are the division of the peripheral nervous system. PTS: 1 DIF: Cognitive Level: Knowledge REF: Page 1896 OBJ: 1 TOP: Anatomy and physiology KEY: Nursing Process Step: Assessment

22. What does the nurse know about the stroke patient who has expressive aphasia? a. Has difficulty comprehending spoken and written communication b. Cannot make any vocal sounds c. Has total loss and comprehension of language d. Can understand the spoken word, but cannot speak

ANS: D The patient with expressive aphasia has difficulty articulating words, but can understand the written and spoken word. PTS: 1 DIF: Cognitive Level: Application REF: Page 1940 OBJ: 16 TOP: Aphasia KEY: Nursing Process Step: Planning

20. A patient with a spinal cord injury at T1 complains of stuffiness of the nose and a headache. The nurse notes a flushing of the neck and "goose flesh." What should be the primary nursing intervention based on these assessments? a. Place patient in flat position and check temperature b. Administer oxygen and check oxygen saturation c. Place on side and check for leg swelling d. Sit upright and check blood pressure

ANS: D These are indicators of autonomic dysreflexia or hyperreflexia. It is a medical emergency. The patient should be placed in an upright position to decrease blood pressure and the blood pressure should be checked. Assessments for impaction, full bladder, or a urine infection can help to evaluate this condition. PTS: 1 DIF: Cognitive Level: Analysis REF: Pages 1954, Box 53-4 OBJ: 20 TOP: Dysreflexia KEY: Nursing Process Step: Intervention