Chapter 17 Neurological Emergencies

Individuals with chronic alcoholism are predisposed to intracranial bleeding and hypoglycemia secondary to abnormalities in the: Select one: A. kidneys. B. liver. C. brain. D. pancreas.

Chapter 17, Altered Mental Status, Page 686 The correct answer is: liver.

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 valproate (Depakote) for her seizures, but has not taken it in a few days. He also tells you that she has diabetes. In addition to administering oxygen, you should: Select one: A. place her in the recovery position and transport her with lights and siren. B. monitor her airway and breathing status and assess her blood glucose level. C. give her small cups of water to drink and observe for further seizure activity. D. administer one tube of oral glucose and prepare for immediate transport.

Chapter 17, Altered Mental Status, Page 686 The correct answer is: monitor her airway and breathing status and assess her blood glucose level.

The spinal cord exits the cranium through the: Select one: A. foramen magnum. B. vertebral foramen. C. cauda equina. D. foramen lamina.

Chapter 17, Anatomy and Physiology, Page 676 The correct answer is: foramen magnum.

When transporting a stable stroke patient with a paralyzed extremity, place the patient in a: Select one: A. sitting position with the head at a 45° to 90° angle. B. recumbent position with the paralyzed side down. C. recumbent position with the paralyzed side up. D. supine position with the legs elevated 6 feet to 12 feet.

Chapter 17, Emergency Medical Care, Page 695-696 The correct answer is: recumbent position with the paralyzed side down.

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, is breathing at a normal rate with adequate depth, and has an oxygen saturation of 96%. You should: Select one: A. insert an oral airway, apply oxygen, and transport. B. administer one tube of oral glucose and transport. C. suction her oropharynx and transport immediately. D. assist her ventilations with a bag-valve mask.

Chapter 17, Patient Assessment, Page 687 The correct answer is: suction her oropharynx and transport immediately.

You arrive at the residence of a 33-year-old woman who is experiencing a generalized (tonic-clonic) seizure. She has a small amount of vomitus draining from the side of her mouth. After protecting her from further injury, you should: Select one: 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. 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. C. place a bite block in between her teeth, apply high-flow oxygen via a nonrebreathing mask, and consider inserting a nasopharyngeal airway. D. wait for the seizure to stop, manually open her airway, insert an oropharyngeal airway, and assess her oxygen saturation with the pulse oximeter.

Chapter 17, Patient Assessment, Page 687-688 The correct answer is: maintain her airway with manual head positioning, suction her airway to remove the vomitus, insert a nasopharyngeal airway, and administer high-flow oxygen.

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

Chapter 17, Patient Assessment, Page 688 The correct answer is: initiate CPR and attach an AED as soon as possible.

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: Select one: A. instruct the patient to keep her eyes open and then repeat the arm drift test. B. repeat the arm drift test and ensure that her palms are facing downward. C. repeat the arm drift test, but move the patient's arms into position yourself. D. defer this part of the test and assess her for facial droop and slurred speech.

Chapter 17, Patient Assessment, Page 692 The correct answer is: repeat the arm drift test, but move the patient's arms into position yourself.

Which of the following is a metabolic cause of a seizure? Select one: A. Head trauma B. Brain tumor C. Massive stroke D. Poisoning

Chapter 17, Seizures, Page 683 The correct answer is: Poisoning

A transient ischemic attack (TIA) occurs when: Select one: A. a small clot in a cerebral artery causes temporary symptoms. B. signs and symptoms resolve spontaneously within 48 hours. C. a small cerebral artery ruptures and causes minimal damage. D. medications are given to dissolve a cerebral blood clot.

Chapter 17, Stroke, Page 680 The correct answer is: a small clot in a cerebral artery causes temporary symptoms.

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

Chapter 17, page 676, Anatomy and Physiology The correct answer is: the right side of the body.

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

Chapter 17, page 679, Stroke The correct answer is: hypertension.

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

Chapter 17, page 682, Seizures The correct answer is: A seizure that begins in one extremity

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

Chapter 17, page 682, Seizures The correct answer is: Confusion and fatigue

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: Select one: A. call medical control and request permission to give the child aspirin. 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. cover the child with wet towels and give oxygen via nasal cannula.

Chapter 17, page 684, Seizures The correct answer is: transport the child to the hospital and reassure the mother en route.

A patient with an altered mental status is: Select one: A. usually able to be aroused with a painful stimulus. B. completely unresponsive to all forms of stimuli. C. not thinking clearly or is incapable of being aroused. D. typically alert but is confused as to preceding events.

Chapter 17, page 685, Altered Mental Status The correct answer is: not thinking clearly or is incapable of being aroused.

When caring for a patient with documented hypoglycemia, you should be MOST alert for: Select one: A. a febrile convulsion. B. respiratory distress. C. an acute stroke. D. a seizure.

Chapter 17, page 686, Altered Mental Status The correct answer is: a seizure.

You are caring for a 68-year-old man with sudden onset of left-sided paralysis and slurred speech. His airway is patent, his respirations are 14 breaths/min with adequate depth, and his oxygen saturation is 98%. Treatment for this patient should include: Select one: A. ventilatory assistance and transport. B. oral glucose gel and transport. C. recovery position and transport. D. high-flow oxygen and transport.

Chapter 17, page 688, Patient Assessment The correct answer is: recovery position and transport.

When you are obtaining medical history from the family of a suspected stroke patient, it is MOST important to determine: Select one: A. if the patient has been hospitalized before. B. the patient's overall medication compliance. C. when the patient last appeared normal. D. if there is a family history of a stroke.

Chapter 17, page 689, Patient Assessment The correct answer is: when the patient last appeared normal.

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

Chapter 17, pages 687-688, Patient Assessment The correct answer is: ensure a patent airway and support ventilation as needed.