Chapter 17 - Neurologic Emergencies

26. Which of the following MOST accurately describes a simple partial seizure? A. a seizure that begins in one extremity B. a seizure that causes the patient to stare blankly C. a seizure that is not preceded by an aura D. a generalized seizure without incontinence

A. a seizure that begins in one extremity

5. 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.

25. Which of the following MOST accurately describes the cause of an ischemic stroke? A. blockage of a cerebral artery B. acute atherosclerotic disease C. rupture of a cerebral artery D. narrowing of a carotid artery

A. blockage of a cerebral artery

22. The most basic functions of the body, such as breathing, blood pressure, and swallowing, are controlled by the: A. brain stem. B. cerebrum. C. cerebellum. D. cerebral cortex.

A. brain stem.

29. When assessing arm movement of a patient with a suspected stroke, you should: A. observe for approximately 5 minutes. B. expect to see one arm slowly drift down to the patient's side. 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 or her eyes during the assessment.

4. 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.

C. assist ventilations, perform a rapid exam, and prepare for immediate transport

31. Interruption of cerebral blood flow may result from all of the following, EXCEPT: A. a thrombus. B. an embolism. C. cerebral vasodilation. D. an acute arterial rupture.

C. cerebral vasodilation.

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.

C. monitor her airway and breathing status and assess her blood glucose level.

40. The left cerebral hemisphere controls: A. the right side of the face. B. heart rate and pupil reaction. C. the right side of the body. D. breathing and blood pressure.

C. the right side of the body.

17. The three major parts of the brain are the: A. cerebellum, medulla, and occiput. B. brain stem, midbrain, and spinal cord. C. midbrain, cerebellum, and spinal cord. D. cerebrum, cerebellum, and brain stem.

D. cerebrum, cerebellum, and brain stem.

6. During the primary assessment of a semiconscious 70-year-old female, you should: A. insert a nasopharyngeal airway and assist ventilations. B. immediately determine the patient's blood glucose level. C. ask family members if the patient has a history of stroke. D. ensure a patent airway and support ventilation as needed.

D. ensure a patent airway and support ventilation as needed.

35. A patient who is possibly experiencing a stroke is NOT eligible for thrombolytic (fibrinolytic) therapy if he or she: A. has had a prior heart attack. B. is older than 60 years of age. C. has a GCS score that is less than 8. D. has bleeding within the brain.

D. has bleeding within the brain.

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. usually able to be aroused with a painful stimulus. D. not thinking clearly or is incapable of being aroused.

D. not thinking clearly or is incapable of being aroused.

36. Status epilepticus is characterized by: A. generalized seizures that last less than 5 minutes. B. an absence seizure that is not preceded by an aura. C. profound tachycardia and total muscle flaccidity. D. prolonged seizures without a return of consciousness.

D. prolonged seizures without a return of consciousness.

23. 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, left lateral recumbent position, and transport. B. assisted ventilation with a bag-mask device, right lateral recumbent position, and transport. C. an oral airway, assisted ventilation with a bag-mask device, Fowler's position, and transport. D. oxygen via a nonrebreathing mask, supine position with legs elevated 6″ to 12″, and transport.

A. oxygen via a nonrebreathing mask, left lateral recumbent position, and transport.

27. Which of the following is a metabolic cause of a seizure? A. poisoning B. head trauma C. brain tumor D. massive stroke

A. poisoning

14. A generalized seizure is characterized by: A. severe twitching of all the body's muscles. B. a blank stare and brief lapse of consciousness. C. unconsciousness for greater than 30 minutes. D. a core body temperature of greater than 103°F (40°C).

A. severe twitching of all the body's muscles.

30. What Glasgow Coma Scale (GCS) score would you assign to a patient who responds to painful stimuli, uses inappropriate words, and maintains his or her arms in a flexed position? A. 6 B. 8 C. 9 D. 10

B. 8

16. Which of the following patients would MOST likely demonstrate typical signs of infection, such as a fever? A. a 3-month-old female who was born prematurely B. a 17-year-old male with depression and anxiety C. a 35-year-old female in the later stages of AIDS D. an 88-year-old male with chronic renal problems

B. a 17-year-old male with depression and anxiety

18. The mental status of a patient who has experienced a typical seizure: A. progressively worsens over a period of a few hours. B. is easily differentiated from that of acute hypoglycemia. C. is likely to improve over a period of 5 to 30 minutes. D. typically does not improve, even after several minutes.

C. is likely to improve over a period of 5 to 30 minutes.

38. Which of the following conditions would MOST likely affect the entire brain? A. blocked cerebral artery in the frontal lobe B. reduced blood supply to the left hemisphere C. ruptured cerebral artery in the occipital lobe D. respiratory failure or cardiopulmonary arrest

D. respiratory failure or cardiopulmonary arrest

The principal clinical difference between a stroke and hypoglycemia is that patients with hypoglycemia: A. always take oral medications to maintain normal blood glucose levels. B. do not present with slurred speech or weakness to one side of the body. C. are typically alert and attempt to communicate with health care providers. D. usually have an altered mental status or decreased level of consciousness.

D. usually have an altered mental status or decreased level of consciousness.

28. 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: A. suction her oropharynx and apply 100% oxygen. B. insert an oral airway, apply oxygen, and transport. C. use a bag-mask device to assist her ventilations. D. place her on her side and prepare for rapid transport.

A. suction her oropharynx and apply 100% oxygen.

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.

B. a ruptured cerebral artery.

An area of swelling or enlargement in a weakened arterial wall is called: A. a thrombus. B. an aneurysm. C. an embolism. D. atherosclerosis.

B. an aneurysm

37. Muscle control and body coordination are controlled by the: A. cerebrum. B. cerebellum. C. brain stem. D. cerebral cortex.

B. cerebellum.

33. A patient whose speech is slurred and difficult to understand is experiencing: A. aphasia. B. dysarthria. C. dysphagia. D. paraplegia.

B. dysarthria.

15. The anterior aspect of the cerebrum controls: A. touch. B. emotion. C. movement. D. vision.

B. emotion.

24. Which of the following medications is NOT used to treat patients with a history of seizures? A. phenytoin (Dilantin) B. hydromorphone (Dilaudid) C. carbamazepine (Tegretol) D. phenobarbital

B. hydromorphone (Dilaudid)

39. The MOST significant risk factor for a hemorrhagic stroke is: A. severe stress. B. hypertension. C. heavy exertion. D. diabetes mellitus.

B. hypertension.

34. Which of the following conditions would be the LEAST likely to mimic the signs and symptoms of a stroke? A. hypoglycemia B. hypovolemia C. a postictal state D. intracranial bleeding

B. hypovolemia

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: A. assess the patient for a facial droop and hemiparesis. B. initiate cardiopulmonary resuscitation (CPR) and attach an automated external defibrillator (AED) as soon as possible. C. obtain a blood glucose sample to rule out hypoglycemia. D. perform CPR for 5 minutes before applying the AED.

B. initiate cardiopulmonary resuscitation (CPR) and attach an automated external defibrillator (AED) as soon as possible.

20. 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 up. B. recumbent position with the paralyzed side down. C. sitting position with the head at a 45° to 90° angle. D. supine position with the legs elevated 6″ to 12″.

B. recumbent position with the paralyzed side down.

13. Which of the following conditions is NOT a common cause of seizures? A. poisoning or overdose B. severe hypovolemia C. acute hypoglycemia D. acute alcohol withdrawal

B. severe hypovolemia

3. 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: A. cover the child with wet towels and give oxygen via nasal cannula. B. transport the child to the hospital and reassure the mother en route. C. advise the mother to take her child to the doctor the following day. D. call medical control and request permission to give the child aspirin.

B. transport the child to the hospital and reassure the mother en route.

12. Which of the following MOST accurately describes what the patient will experience during the postictal state that follows a seizure? A. hyperventilation and hypersalivation B. a rapidly improving level of consciousness C. confusion and fatigue D. a gradually decreasing level of consciousness

C. confusion and fatigue

21. A patient who is experiencing aphasia is: A. not able to swallow without choking. B. experiencing a right hemispheric stroke. C. unable to produce or understand speech. D. usually conscious but has slurred speech.

C. unable to produce or understand speech.

19. 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: A. assisting him with his migraine medication and transporting without lights and siren. B. placing him in a supine position and transporting with lights and siren to a stroke center. C. applying warm compresses to the back of his neck and transporting with lights and siren. D. dimming the lights in the back of the ambulance and transporting without lights and siren.

D. dimming the lights in the back of the ambulance and transporting without lights and siren.

32. 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. place a bite block in between her teeth, apply high-flow oxygen via a nonrebreathing mask, and consider inserting a nasopharyngeal airway. 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. 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. D. maintain her airway with manual head positioning, suction her airway to remove the vomitus, insert a nasopharyngeal airway, and administer high-flow oxygen.

D. maintain her airway with manual head positioning, suction her airway to remove the vomitus, insert a nasopharyngeal airway, and administer high-flow oxygen.

2. Successful treatment of a stroke depends on whether: A. surgical intervention is performed to remove obstructive clots. B. medications are given to restore the function of infarcted cells. C. the stroke occurs within the left or right hemisphere of the brain. D. thrombolytic therapy is given within 3 hours after symptoms began.

D. thrombolytic therapy is given within 3 hours after symptoms began.