Chapter 15 Neurologic Emergencies
which of the following conditions would most likely mimic the signs and symptoms of a stroke? A) alcohol intoxication B) acute poisoning C) hypoglycemia D) high fever
hypoglycemia
You arrive at the residence of a 33-year-old woman who is experiencing a generalized seizure. She has a small amount of vomitus draining from the side of her mouth. After protecting her from further injury, you should: A. maintain her airway with manual head positioning, suction her airway to remove the vomitus, insert a nasopharyngeal airway, and administer high-flow oxygen. B. wait for the seizure to stop, manually open her airway, insert an oropharyngeal airway, and assess her oxygen saturation with the pulse oximeter. C. place a bite block in between her teeth, apply high-flow oxygen via a nonrebreathing mask, and consider inserting a nasopharyngeal airway. D. restrain her extremities to prevent her from injuring herself, suction her airway to remove the vomitus, and assist her ventilations with a bag-mask device.
A - Maintain her airway with manual head positioning, suction her airway to remove the vomitus, insert a nasopharyngeal airway, and administer high-flow oxygen.
Successful treatment of a stroke depends on whether: A. thrombolytic therapy is given within 3 hours after symptoms began. B. the stroke occurs within the left or right hemisphere of the brain. C. surgical intervention is performed to remove obstructive clots. D. medications are given to restore the function of infarcted cells.
A - Thrombolytic therapy is given within 3 hours after symptoms began.
When caring for a patient with documented hypoglycemia, you should be MOST alert for: A. a seizure. B. an acute stroke. C. respiratory distress. D. a febrile convulsion.
A - A seizure
Which of the following MOST accurately describes a simple partial seizure? A. a seizure that begins in one extremity B. a seizure that is not preceded by an aura C. a seizure that causes the patient to stare blankly D. a generalized seizure without incontinence
A - A seizure that begins in one extremity.
Febrile seizures: A. are usually benign but should be evaluated. B. occur when a child's fever progressively rises. C. often result in permanent brain damage. D. are also referred to as petit mal seizures.
A - Are usually benign but should be evaluated.
The most basic functions of the body, such as breathing, blood pressure, and swallowing, are controlled by the: A. brain stem. B. cerebellum. C. cerebral cortex. D. cerebrum.
A - Brain stem.
Which of the following conditions is NOT a common cause of seizures? A. severe hypovolemia B. acute hypoglycemia C. acute alcohol withdrawal D. poisoning or overdose
A - Severe hypovolemia.
The MOST significant risk factor for a hemorrhagic stroke is: A. severe stress. B. hypertension. C. heavy exertion. D. diabetes mellitus.
B - HTN
Individuals with chronic alcoholism are predisposed to intracranial bleeding and hypoglycemia secondary to abnormalities in the: A. brain. B. liver. C. pancreas. D. kidneys.
B - Liver
You are caring for a semiconscious man with left-sided paralysis. His airway is patent and his respirations are 14 breaths/min with adequate tidal volume. Treatment for this patient should include: A. oxygen via a nonrebreathing mask, supine position with legs elevated 6″ to 12″, and transport. B. oxygen via a nonrebreathing mask, left lateral recumbent position, and transport. C. assisted ventilation with a bag-mask device, right lateral recumbent position, and transport. D. an oral airway, assisted ventilation with a bag-mask device, Fowler's position, and transport.
B - Oxygen via a nonrebreathing mask, left lateral recumbent position, and transport.
When assessing arm movement of a patient with a suspected stroke, you should: Answers: A. expect to see one arm slowly drift down to the patient's side. B. observe for approximately 5 minutes. C. ask the patient to close his or her eyes during the assessment. D. ask the patient to hold his or her arms up with the palms down.
C - Ask the patient to close his/her eyes during the assessment.
A patient with an altered mental status is: A. completely unresponsive to all forms of stimuli. B. typically alert but is confused as to preceding events. C. not thinking clearly or is incapable of being aroused. D. usually able to be aroused with a painful stimulus
C - Not thinking clearly or is incapable of being aroused.
Status epilepticus is characterized by: A. profound tachycardia and total muscle flaccidity. B. generalized seizures that last less than 5 minutes. C. prolonged seizures without a return of consciousness. D. an absence seizure that is not preceded by an aura.
C - Prolonged seizures without a return of consciousness.
You are assessing the arm drift component of the Cincinnati Prehospital Stroke Scale on a 60-year-old woman. When she holds both of her arms out in front of her and closes her eyes, both of her arms immediately fall to her sides. You should: A. repeat the arm drift test and ensure that her palms are facing downward. B. defer this part of the test and assess her for facial droop and slurred speech. C. repeat the arm drift test, but move the patient's arms into position yourself. D. instruct the patient to keep her eyes open and then repeat the arm drift test.
C - Repeat the arm drift test, but move the patient's arms into position yourself.
An area of swelling or enlargement in a weakened arterial wall is called: A. a thrombus. B. atherosclerosis. C. an embolism. D. an aneurysm.
D - An aneurysm.
Muscle control and body coordination are controlled by the: A. cerebral cortex. B. cerebrum. C. brain stem. D. cerebellum.
D - Cerebellum
The anterior aspect of the cerebrum controls: A. vision. B. touch. C. movement. D. emotion.
D - Emotion
which of the following medications is not used to treat patients with a history of seizures? A) Tegretol B) Dilantin C) Dilaudid D) Phenobarbital
Dilaudid
which of the following patients would most likely demonstrate typical signs of infection or fever? A) an 88-year-old male with chronic renal problems B) a 17-year-old male with depression and anxiety C) a 3-month-old female who was born prematurely D) a 35-year-old female in the later stages of AIDS
a 17-year-old male with depression and anxiety
Which of the following patients would MOST likely demonstrate typical signs of infection, such as a fever?
a 17-year-old male with no past medical history
you are assessing a 49-year-old man who, according to his wife, experienced a sudden, severe headache and then passed out. He is unresponsive and has slow, irregular breathing. his blood pressure is 190/94 mm Hg and his pulse rate is 50 beats/min. his wife tells you that he has hypertension and diabetes. he has MOST likely experienced: A) acute hypoglycemia. B) a ruptured cerebral artery. C) a complex partial seizure. D) an occluded cerebral artery.
a ruptured cerebral artery
When assessing arm movement of a patient with a suspected stroke, you should:
ask the patient to close his or her eyes during the assessment.
law enforcement has summoned you to a nightclub, where a 22-year-old female was found unconscious in an adjacent alley. your primary assessment reveals that her respirations are rapid and shallow and her pulse is rapid and weak. she is wearing a medical alert bracelet that identifies her as an epileptic. there is an empty bottle of vodka next to the patient. you should: A) place a bite block in her mouth in case she has a seizure and transport at once. B) apply oxygen via a nonrebreathing mask, place her on her left side, and transport. C) assist ventilations, perform a rapid exam, and prepare for immediate transport. D) apply oxygen via nonrebreathing mask and transport her for a blood-alcohol test.
assist ventilations, perform a rapid exam, and prepare for immediate transport.
Which of the following MOST accurately describes the cause of an ischemic stroke?
blockage of a cerebral artery
Muscle control and body coordination are controlled by the:
cerebellum.
interruption of cerebral blood flow may result from all of the following, except: A) a thrombus B) cerebral vasodilation C) an acute arterial rupture D) an embolism
cerebral vasodilation
The three major parts of the brain are the
cerebrum, cerebellum, and brain stem.
Which of the following MOST accurately describes what the patient will experience during the postictal state that follows a seizure?
confusion and fatigue
which of the following most accurately describes the postictal state that follows a seizure? A) rapidly improving level of consciousness B) dazed, confused, or combative appearance C) hyperventilation and hypersalivation D) gradually decreasing level of consciousness
dazed, confused, or combative appearance
A 58-year-old male presents with confusion, right-sided weakness, and slurred speech. Your initial impression is that the patient is having a stroke. The patient's wife is present and she is very upset. As your partner is applying oxygen, which of the following has a direct impact on how this patient will be treated once he is taken to the ER?
determine how long this has been happening
A 29-year-old male complains of a severe headache and nausea that has gradually worsened over the past 12 hours. He is conscious, alert, and oriented and tells you that his physician diagnosed him with migraine headaches. He further tells you that he has taken numerous different medications, but none of them seem to help. His blood pressure is 132/74 mm Hg, his pulse is 110 beats/min and strong, and his respirations are 20 breaths/min and adequate. In addition to high-flow oxygen, further treatment should include:
dimming the lights in the back of the ambulance and transporting without lights and siren.
A patient without a history of seizures experiences a sudden convulsion. The LEAST likely cause of this seizure is
epilepsy.
A patient without a history of seizures experiences a sudden convulsion. The LEAST likely cause of this seizure is:
epilepsy.
The spinal cord exits the cranium through the:
foramen magnum
A patient who is possibly experiencing a stroke is NOT eligible for thrombolytic (fibrinolytic) therapy if he or she:
has bleeding within the brain.
The left cerebral hemisphere controls
he right side of the body.
Which of the following medications is NOT used to treat patients with a history of
hydromorphone (Dilaudid)
The MOST significant risk factor for a hemorrhagic stroke is:
hypertension.
The mental status of a patient who has experienced a typical seizure:
is likely to improve over a period of 5 to 30 minutes.
Individuals with chronic alcoholism are predisposed to intracranial bleeding and hypoglycemia secondary to abnormalities in the:
liver.
You arrive at the residence of a 33-year-old woman who is experiencing a generalized seizure. She has a small amount of vomitus draining from the side of her mouth. After protecting her from further injury, you should:
maintain her airway with manual head positioning, suction her airway to remove the vomitus, insert a nasopharyngeal airway, and administer high- flow oxygen.
Which of the following is NOT an assessment parameter included in the Cincinnati Prehospital Stroke Scale?
memory
which of the following is not an assessment parameter included in the Cincinnati Stoke Scale? A) memory B) arm drift C) facial droop D) speech
memory
You arrive at a local grocery store approximately 5 minutes after a 21-year-old female stopped seizing. She is confused and disoriented; she keeps asking you what happened and tells you that she is thirsty. Her brother, who witnessed the seizure, tells you that she takes phenytoin (Dilantin) for her seizures, but has not taken it in a few days. He also tells you that she has diabetes. In addition to applying high-flow oxygen, you should: A) administer one tube of oral glucose and prepare for immediate transport. B) place her in the recovery position and transport her with lights and siren. C) monitor her airway and breathing status and assess her blood glucose level. D) give her small cups of water to drink and observe for further seizure activity.
monitor her airway and breathing status and assess her blood glucose level
You are dispatched to a residence for a 66-year-old male who, according to family members, has suffered a massive stroke. Your primary assessment reveals that the patient is unresponsive, apneic, and pulseless. You should:
nitiate cardiopulmonary resuscitation (CPR) and attach an automated external defibrillator (AED) as soon as possible.
A patient with an altered mental status is:
not thinking clearly or is incapable of being aroused.
You arrive at a grocery store shortly after a 35-year-old male stopped seizing. Your assessment reveals that he is confused and incontinent of urine. The patient's girlfriend tells you that he has a history of seizures and takes carbamazepine (Tegretol). When obtaining further medical history from the girlfriend, it is MOST important to:
obtain a description of how the seizure developed
You arrive at a grocery store shortly after a 35-year-old male stopped seizing. Your assessment reveals that he is confused and incontinent of urine. The patient's girlfriend tells you that he has a history of seizures and takes carbamazepine (Tegretol). When obtaining further medical history from the girlfriend, it is MOST important to:
obtain a description of how the seizure developed.
You are caring for a semiconscious man with left-sided paralysis. His airway is patent and his respirations are 14 breaths/min with adequate tidal volume. Treatment for this patient should include:
oxygen via a nonrebreathing mask, left lateral recumbent position, and transport.
An absence seizure is also referred to as a
petit mal seizure.
which of the following is a metabolic cause of a seizure? A) brain tumor B) massive stroke C) poisoning D) head trauma
poisoning
Status epilepticus is characterized by:
prolonged seizures without a return of consciousness.
You are assessing the arm drift component of the Cincinnati Prehospital Stroke Scale on a 60-year-old woman. When she holds both of her arms out in front of her and closes her eyes, both of her arms immediately fall to her sides. You should
repeat the arm drift test, but move the patient's arms into position yourself.
You are assessing the arm drift component of the Cincinnati Prehospital Stroke Scale on a 60-year-old woman. When she holds both of her arms out in front of her and closes her eyes, both of her arms immediately fall to her sides. You should:
repeat the arm drift test, but move the patient's arms into position yourself.
Which of the following conditions would MOST likely affect the entire brain?
respiratory failure or cardiopulmonary arrest
which of the following conditions would most likely affect the entire brain? A) blocked cerebral artery in the frontal lobe B) respiratory failure or cardiopulmonary arrest C) reduced blood supply to the left hemisphere D) ruptured cerebral artery in the occipital lobe
respiratory failure or cardiopulmonary arrest
Which of the following conditions is NOT a common cause of seizures?
severe hypovolemia
which of the following conditions is not a common cause of seizures? A) acute alcohol withdrawal B) severe hypovolemia C) acute hypoglycemia D) poisoning or overdose
severe hypovolemia
A generalized seizure is characterized by
severe twitching of all the body's muscles.
You are caring for a 70-year-old female with signs and symptoms of an acute stroke. She is conscious, has secretions in her mouth, and is breathing at a normal rate with adequate depth. You should:
suction her oropharynx and apply 100% oxygen.
which of the following clinical signs would be most suggestive of a ruptured cerebral artery? A) unilateral hemiparesis B) nasal discharge of blood C) confusion and weakness D) sudden, severe headache
sudden, severe headache
You respond to a residence for a child who is having a seizure. Upon arrival at the scene, you enter the residence and find the mother holding her child, a 2-year-old male. The child is conscious and crying. According to the mother, the child had been running a high fever and then experienced a seizure that lasted approximately 3 minutes. You should:
transport the child to the hospital and reassure the mother en route.
A patient who is experiencing aphasia is:
unable to produce or understand speech.
The principal clinical difference between a stroke and hypoglycemia is that patients with hypoglycemia:
usually have an altered mental status or decreased level of consciousness.
when obtaining medical history information from the family of a suspected stroke patient, it is MOST important to determine: A) when the patient last appeared normal. B) if there is a family history of a stroke. C) if the patient has been hospitalized before. D) the patient's overall medication compliance
when the patient last appeared normal
A patient whose speech is slurred and difficult to understand is experiencing: A. paraplegia. B. dysphagia. C. aphasia. D. dysarthria.
D - Dysarthria
A patient who is possibly experiencing a stroke is NOT eligible for thrombolytic (fibrinolytic) therapy if he or she: A. has a GCS score that is less than 8. B. is older than 60 years of age. C. has had a prior heart attack. D. has bleeding within the brain.
D - Has bleeding within the brain.
Which of the following conditions would be the LEAST likely to mimic the signs and symptoms of a stroke? A. intracranial bleeding B. a postictal state C. hypoglycemia D. hypovolemia
D - Hypovolemia
Which of the following is NOT an assessment parameter included in the Cincinnati Prehospital Stroke Scale? A. facial droop B. arm drift C. speech D. memory
D - Memory
When transporting a stable stroke patient with unilateral paralysis, it is best to place the patient in a: A. recumbent position with the paralyzed side down. B. supine position with the legs elevated 6″ to 12″. C. sitting position with the head at a 45° to 90° angle. D. recumbent position with the paralyzed side up.
D - Recumbent position with the paralyzed side up.
When caring for a patient with documented hypoglycemia, you should be MOST alert for?
a seizure
Which of the following MOST accurately describes a simple partial seizure?
a seizure that begins in one extremity
which of the following most accurately describes a focal seizure? A) a seizure that begins in one extremity B) generalized seizures without incontinence C) a seizure that is not preceded by an aura D) a blank stare without muscle contractions
a seizure that begins in one extremity
which of the following most accurately describes the cause of an ischemic stoke? A) acute atherosclerotic disease B) narrowing of a carotid artery C) rupture of a cerebral artery D) blockage of a cerebral artery
blockage of a cerebral artery