Exam #5: Neuro
Which cranial nerves are responsible for motor functions of the eye? (Select all that apply.) a. Optic nerve b. Oculomotor c. Trochlear d. Trigeminal e. Abducens f. Acoustic.
B. Oculomotor C. Trochlear E. Abducens
How is rtPA administered?
10% as IVP, the other 90% over 60 minute infusion
What is normal cerebral perfusion pressure (CPP)?
50-150
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
The patient was admitted with a head injury and an intracranial pressure (ICP) monitoring device was placed. The nurse knows to notify the practitioner if what type of wave start to appear on the monitor? a. A waves b. B wave c. C waves d. D waves
A. A waves
A patient is admitted to the critical care unit with a subdural hematoma. The nurse is assessing the patient's Glasgow Coma Scale (GCS) score. When assessing the patient's best motor response, which movement would receive the lowest score? a. Abnormal extension b. Localizing pain c. Withdrawing from pain d. Decorticate posturing
A. Abnormal extension
The nurse is performing an assessment of cranial nerve III. Which testing is appropriate? a. Pupil constriction b. Deep tendon reflexes c. Upper muscle strength d. Speech and language
A. Pupil constriction
What is the first sign of increased intracranial pressure?
Change in level of consciousness
The anterior and posterior arterial circulations make up the.....which supplies blood to brain
Circle of Willis
When the cause of stroke cannot be identified, the stroke is known as
Cryptogenic Stroke
What are the 3 categories of GCS assessment?
1. Eye opening 2. Verbal Response 3. Motor Response
What DTR grading is considered normal?
2
Stimulation of what nerve will elicit the gag reflex? a. Glossopharyngeal b. Facial c. Spinal accessory d. Hypoglossal
A. Glossopharyngeal
Which medication is a fast-acting, short-duration agent used for breakthrough seizures? a. Lorazepam b. Phenytoin c. Phenobarbital d. Midazolam
A. Lorazepam
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
What is the most common cause of a cardioembolic stroke?
Atrial Fibrillation
Which type of hematoma results from traumatic injury involving the middle meningeal artery? a. Subdural b. Epidural c. Subarachnoid d. Intercerebral
B. Epidural
Substances most likely to pass across the blood-brain barrier have what characteristics? a. Low pH compared with body fluids b. Lipid solubility c. Large particle size d. A close relation to toxic metabolites
B. Lipid Solubility
The nurse is caring for a patient with a head injury who is obtunded. The nurse is going to use noxious stimuli to elicit a response. What is an acceptable method? a. Nipple pinch b. Nail bed pressure c. Supraorbital pressure d. Sternal rub
B. Nail bed pressure
The primary functions of which lobe are hearing, speech, behavior, and memory? a. Frontal lobe b. Temporal lobe c. Occipital lobe d. Parietal lobe
B. Temporal Lobe
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
The nurse is caring for a patient who has sustained a traumatic head injury. The practitioner has asked the nurse to test the patient's oculocephalic reflex. Which findings indicate that the patient has an intact oculocephalic reflex? a. The patient's eyes move in the same direction the head is turned. b. The patient's eyes move in the opposite direction to the movement of the patient's head. c. The patient's eyes rove and move in opposite directions from each other. d. The patient's eyes move up and down and then back and forth.
B. The patient's eyes move in the opposite direction to the movement of the patient's head
Cranial nerves IX, X, XI, and XII are located in which section of the brainstem? a. Midbrain b. Pons c. Medulla oblongata d. Reticular formation
C. Medulla Oblongata
What is the tissue that adheres directly to the brain called? a. Dura mater b. Arachnoid mater c. Pia mater d. Blood-brain barrier
C. Pia Mater
After neurosurgery, the patient is at risk of developing what problem? a. Aspiration b. Diabetes mellitus c. Seizures d. Corneal abrasions
C. Seizures
The sensory, motor, and cognitive functions are the primary functions of which area of the brain? a. Diencephalon b. Basal ganglia c. Cerebellum d. Cerebrum
D. Cerebrum
Which afferent pathway carries sensory impulses from the body into the spinal cord? a. Subarachnoid b. Spinal nerves c. Ventral root d. Dorsal root
D. Doral Root
The nurse is starting a peripheral intravenous catheter in the right hand of an unconscious patient. During the procedure the patient reaches over with his left hand and tries to remove the noxious stimuli. How would the nurse document this response? a. Decorticate posturing b. Decerebrate posturing c. Withdrawal d. Localization
D. Localization
Which lobe of the brain deals primarily with sensory function? a. Frontal lobe b. Temporal lobe c. Occipital lobe d. Parietal lobe
D. Parietal Lobe
A patient has been admitted with acute confusion and other focal neurologic signs. The practitioner is going to perform a lumbar puncture. What is an abnormal finding in the cerebrospinal fluid? a. Clear and colorless b. Glucose of 60 mg/dL c. Protein of 20 mg/dL d. 30 red blood cells
D. 30 red blood cells
According to the 2007 Brain Trauma Foundation guidelines, the recommended CPP range is: a. 10 to 30 mm Hg. b. 30 to 50 mm Hg. c. 50 to 70 mm Hg. d. 70 to 85 mm Hg.
C. 50-70 mm Hg
What is one cause of metabolic coma? a. Trauma b. Ischemic stroke c. Drug overdose d. Intracerebral hemorrhage
C. Drug overdose
Which medication is prescribed to decrease cerebral vasospasm? a. Phenytoin b. Phenobarbital c. Nimodipine d. Vecuronium
C. Nimodipine
What is the region of the brain that acts as a relay station for both motor and sensory activity called? a. Cerebrum b. Cerebellum c. Thalamus d. Hypothalamus
C. Thalamus
Cerebral infarction is a serious complication of which procedure? a. Extracranial Doppler b. Evoked potential testing c. Myelography d. Cerebral angiography
D. Cerebral angiography
Motor information is transmitted from the CNS to the periphery by what type of fibers?
Efferent
Describe Cranial Nerve I
Olfactory; sensory/smell
houses two respiratory centers,the apneustic & pneumotaxic center
pons
Seizures in this lobe can cause auditory, visual, and tactile hallucinations
temporal lobe
primary functions of this lobe are hearing, speech, behavior, and memory
temporal lobe
What is the central nervous system comprised of?
the brain and spinal cord
The somatic, or voluntary nervous system communicates with what part of the body?
the skeletal muscles and skin
What is true regarding a focal stroke?
the tissue can be salvaged if blood flow is restored; localized area of hypoperfused tissue
What is the recommended dose for rtPA?
0.9 mg/kg, up to maximum dose of 90 mg
A change of how many points on the NIHSS indicates a significant neurologic change?
4
Which statement would the nurse include when teaching the assistive personnel (AP) about how to care for a client with cranial nerve II impairment? a. "Tell the client where food items are on the breakfast tray." b. "Place the client in a high-Fowler position for all meals." c. "Make sure the client's food is visually appetizing." d. "Assist the client by placing the fork in the left hand."
A. "Tell the client where food items are on the breakfast tray."
The nurse knows that change in pupil size is a significant neurologic finding particularly in the patient with a head injury. How much of a size difference between the two pupils is still considered normal? a. 1 mm b. 1.5 mm c. 2 mm d. 2.5 mm
A. 1 mm
Which of these substances are examples of small-molecule transmitters? (Select all that apply.) a. Acetylcholine b. Glucose c. Norepinephrine d. Dopamine e. Epinephrine f. GABA receptors
A. Acetylcholine C. Norepinephrine D. Dopamine E. Epinephrine F. GABA receptors
A client is admitted with a diagnosis of cerebellar stroke. What intervention is most appropriate to include on the client's plan of care? a. Ambulate only with a gait belt. b. Encourage double swallowing. c. Monitor lung sounds after eating. d. Perform postvoid residuals.
A. Ambulate only with a gait belt
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
A client is admitted with a sudden decline in level of consciousness. What is the nursing action at this time? a. Assess the client for hypoglycemia and hypoxia. b. Place the client on his or her side. c. Prepare for administration of a fibrinolytic agent. d. Start a continuous IV heparin sodium infusion.
A. Assess the client for hypoglycemia and hypoxia
If the right internal carotid artery is blocked, what happens to the blood flow to the right side of the brain? a. Blood flow is delivered via the circle of Willis b. Blood flow is diminished by 25% c. Blood flow is diminished by 50% d. Blood flow ceases
A. Blood flow is delivered via the circle of Willis
The nurse is caring for a severely head injured comatose patient who is dying. The practitioner asks to be notified when the patient starts to exhibit signs of Cushing reflex. The nurse would call the practitioner when the patient starts to show what signs? a. Bradycardia, systolic hypertension, and widening pulse pressure b. Tachycardia, systolic hypotension, and tachypnea c. Headache, nuchal rigidity, and hyperthermia d. Bradycardia, aphasia, and visual field disturbances
A. Bradycardia, systolic hypertension, and widening pulse pressure
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
Indications for the use of electroencephalography (EEG) include (Select all that apply.) a. cerebral infarct. b. metabolic encephalopathy. c. confirmation of brain death. d. altered consciousness. e. all head injuries.
A. Cerebral infarct B. Metabolic encephalopathy C. Confirmation of brain death D. Altered consciousness
A nurse assesses a client with an injury to the medulla. Which clinical manifestations would the nurse expect to find? (Select all that apply.) a. Decreased respiratory rate b. Impaired swallowing c. Visual changes d. Inability to shrug shoulders e. Loss of gag reflex
A. Decreased respiratory rate B. Impaired swallowing D. Inability to shrug shoulders E. Loss of gag reflex
Which neurologic structure carries nerve impulses from the central nervous system (CNS) to the periphery to produce a response such as contraction of the skeletal muscles? a. Efferent fibers b. Afferent fibers c. Sensory fibers d. Neurotransmitters
A. Efferent Fibers
The nurse is caring for a patient who has just had a cerebral angiogram. Which intervention should be part of the nursing management plan? a. Ensuring that the patient is adequately hydrated b. Maintaining the patient on an NPO status c. Administering antibiotics to the patient d. Keeping the patient flat in bed for 24 hours
A. Ensuring the patient is adequately hydrated
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
A patient has neurologic damage to the limbic system. Which assessment finding is specific to this type of deficit? a. Flat affect with periods of emotional lability b. Unable to recall early events c. Disorientation to place and time d. Unable to interpret written words
A. Flat affect with periods of emotional lability
Which area of the ventricular system is usually cannulated for intracranial pressure monitoring? a. Frontal horn of the lateral ventricle b. Aqueduct of Sylvius c. Foramen of Monro d. Fourth ventricle
A. Frontal horn of the lateral ventricle
A nurse assesses a client with a brain tumor. Which newly identified assessment findings would alert the nurse to urgently communicate with the primary health care provider? (Select all that apply.) a. Glasgow Coma Scale score of 8 b. Decerebrate posturing c. Reactive pupils d. Uninhibited speech e. Decreasing level of consciousness
A. Glascow Coma Scale score of 8 B. Decerebrate posturing E. Decreasing level of consciousness
A critical care patient is diagnosed with massive head trauma. The patient is receiving brain tissue oxygen pressure (PbtO2) monitoring. The nurse recognized that the goal of this treatment is to maintain PbtO2: a. greater than 20 mm Hg. b. less than 15 mm Hg. c. between 15 and 20 mm Hg. d. between 10 and 20 mm Hg.
A. Greater than 20 mm Hg
The nurse is assessing a client who has symptoms of stroke. What are the leading causes of a stroke for which the nurse would assess for this client? (Select all that apply.) a. Heavy alcohol intake b. Diabetes mellitus c. Elevated cholesterol d. Obesity e. Smoking f. Hypertension
A. Heavy alcohol intake B. Diabetes mellitus C. Elevated cholesterol D. Obesity E. Smoking F. Hypertension
Considering anatomic location, which cranial nerve will be affected first by downward pressure onto the infratentorial structures? a. III b. VI c. IX d. X
A. III
Mannitol (Osmitrol) has been ordered for a patient with acute renal failure. The nurse will administer this drug using which procedure? a. Intravenously, through a filter b. By rapid intravenous bolus c. By mouth in a single morning dose d. Through a gravity intravenous drip with standard tubing
A. Intravenously, through a filter
What sites can be used for monitoring intracranial pressure (ICP)? (Select all that apply.) a. Intraventricular space b. Epidural space c. Jugular veins d. Subdural space e. Parenchyma
A. Intraventricular Space B. Epidural space D. Subdural space E. Parenchyma
A patient is admitted to the critical care unit with a subdural hematoma. The nurse is assessing the patient's Glasgow Coma Scale (GCS) score. Which statement is true concerning the GCS? a. It provides data about level of consciousness only. b. It is considered equivalent to a complete neurologic examination. c. It is a sensitive tool for evaluation of an altered sensorium. d. It is the most critical assessment parameter to account for possible aphasia.
A. It provides data about level of consciousness only
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 lack of which two substances can cause disruption in neuronal function and irreversible damage? a. Oxygen and glucose b. Protein and insulin c. Oxygen and protein d. Protein and glucose
A. Oxygen and glucose
A nurse assesses a client recovering from a cerebral angiography via the right femoral artery. Which assessment would the nurse complete? a. Palpate bilateral lower extremity pulses. b. Obtain orthostatic blood pressure readings. c. Perform a funduscopic examination. d. Assess the gag reflex prior to eating.
A. Palpate bilateral lower extremity pulses
A nurse assesses cerebrospinal fluid leaking onto a client's surgical dressing. What actions would the nurse take? (Select all that apply.) a. Place the client in a flat position. b. Monitor vital signs for hypotension. c. Utilize a bedside commode. d. Assess for abdominal distension. e. Report the leak to the surgeon.
A. Place the client in a flat position E. Report the leak to the surgeon
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 nurse is caring for a patient who has sustained a traumatic head injury. The practitioner has asked the nurse to test the patient's oculocephalic reflex. What must the nurse verity prior to performing the test? a. The absence of cervical injury b. The depth and rate of respiration c. The patient's ability to swallow d. The patient's ability to follow a verbal command
A. The absence of cervical injury
Which statements are correct regarding the assessment of motor function in the neurologically impaired patient? (Select all that apply.) a. The presence of a Babinski reflex is an abnormal finding in an adult. b. Lower extremity muscle tone is assessed by asking the patient to push or pull his or her foot against resistance. c. When using noxious stimuli to elicit a motor response, each limb is tested separately. d. The presence of abnormal extension indicates a less positive outcome for the patient than abnormal flexion. e. The evaluation of deep tendon reflexes is an essential part of the nursing neurologic assessment.
A. The presence of a Babinski reflex is an abnormal finding in an adult C. When using noxious stimuli to elicit a motor response, each limb is tested separately D. The presence of abnormal extension indicates a less positive outcome for the patient than abnormal flexion
A patient is undergoing a preoperative evaluation for carotid arteries. What two test should the nurse expect to see ordered for the patient? a. Ultrasound and magnetic resonance angiography b. Conventional angiography and evoked potential c. Computed tomography (CT) and magnetic resonance angiography d. Transcranial Doppler and extracranial Doppler
A. Ultrasound and magnetic resonance angiography
Describe Cranial Nerve VI
Abducens; motor; turns eye laterally; proprioception
Which two neurotransmitters produce either an excitatory or inhibitory response?
Acetylcholine and Dopamine
Sensory information is transmitted to the CNS by what type of fibers?
Afferent
Which structure in the brain is associated with the emotion of fear?
Amygdala
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
A patient with a serious head injury has been admitted. The nurse knows that certain neurologic findings can indicate the prognosis for the patient. Which finding denotes the most serious prognosis? a. Decorticate posturing b. Decerebrate posturing c. Absence of Babinski reflex d. Glasgow Coma Scale (GCS) score of 14
B. Decerebrate Posturing
A patient has been admitted with acute confusion and other focal neurologic signs. The practitioner orders magnetic resonance imaging (MRI). The nurse knows in certain situations an MRI is superior to computed tomography (CT). What is one those situations? a. Brain death determination b. Detection of central nervous system infection c. Estimation of intracranial pressure d. Identification of subarachnoid hemorrhage
B. Detection of central nervous system infection
A person with a cerebellar lesion will have difficulty with which physiologic mechanism? a. Breathing b. Equilibrium c. Memory d. Speech
B. Equilibrium
The nurse and a new graduate nurse are caring for a comatose patient on continuous electroencephalography (cEEG) monitor. The new graduate says "This monitor is great. How come we don't use it on all the neuro patients?" What are the drawbacks to using this type of monitor? (Select all that apply.) a. Size of machine b. Expensive c. Labor-intensive program d. Requires expertise for interpretation e. Artifacts from ICU environment
B. Expensive C. Labor-intensive program D. Requires expertise for interpretation E. Artifacts from ICU environment
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
An 84-year-old client who is usually alert and oriented experiences an acute cognitive decline. Which of the following factors would the nurse anticipate as contributing to this neurologic change? (Select all that apply.) a. Chronic hearing loss b. Infection c. Drug toxicity d. Dementia e. Hypoxia f. Aging
B. Infection C. Drug toxicity E. Hypoxia
The nurse is caring for a patient immediately after a craniotomy. When assessing the size and shape of the patient's pupils the nurse notes the patient's left pupil is oval. What does this finding indicate? a. Cortical dysfunction b. Intracranial hypertension c. Hydrocephalus d. Metabolic coma
B. Intracranial Hypertension
Which of the following statements best describes assessment of arousal? a. It measures content of consciousness and is a higher-level function. b. It is an evaluation of the reticular activating system and its connection with the thalamus and the cerebral cortex. c. It becomes a valid parameter when the patient is able to respond to verbal stimuli, such as squeezing the hands on command. d. Noxious stimuli are not to be used as an assessment parameter.
B. It is an evaluation of the reticular activating system and its connection with the thalamus and the cerebral cortex
The nurses are admitting a neurologically impaired patient. The patient's family is present. How comprehensive should the initial history be? a. It should be limited to the chief complaint and personal habits. b. It should be all-inclusive, including events preceding hospitalization. c. It should be confined to current medications and family history. d. It should be restricted to only information that the patient can provide.
B. It should be all-inclusive, including events preceding hospitalization
The nurse is precepting a nursing student. The student asks about testing of extraocular eye movements. What should the nurse tell the student? a. It tests the pupillary response to light. b. It tests function of the three cranial nerves. c. It tests the ability of the eyes to accommodate to a closer moving object. d. It tests the oculocephalic reflex.
B. It tests function of the three cranial nerves
A nurse assesses a patient who is recovering from a lumbar puncture (LP). Which complication of this procedure would alert the nurse to urgently contact the primary health care provider? a. Weak pedal pulses b. Nausea and vomiting c. Increased thirst d. Hives on the chest
B. Nausea and Vomiting
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. Non-contrast computed tomography
The patient's intracranial pressure (ICP) reading has gradually climbed from 15 to 23 mm Hg. The nurse's primary action is to: a. drain off 7 mm of cerebrospinal fluid (CSF) from the catheter. b. notify the physician. c. place the patient in a high Fowler position to decrease the pressure. d. check level of consciousness.
B. Notify the physician
A patient in the neurologic intensive care unit is being treated for cerebral edema. Which class of diuretic is used to reduce intracranial pressure? a. Loop diuretics b. Osmotic diuretics c. Thiazide diuretics d. Vasodilators
B. Osmotic Diuretics
Control of the rate of respirations occurs in the in which brain center? a. Apneustic center b. Pneumotaxic center c. Reticular activating system d. Midbrain
B. Pneumotaxic Center
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 is herniated
Which statement best describes the role of neuroglial cells? a. They are fewer in number than neurons. b. They provide support to the neuron in nutrients and structural formation. c. They protect the central nervous system (CNS) from nonmetabolic primary neoplasms. d. They produce a steady supply of neurotransmitters.
B. They provide support to the neuron in nutrients and structural formation
The nurse is caring for a severely head injured comatose patient who is dying. The nurse knows the patient has entered the late stages of intracranial hypertension when the nurse observes which signs? a. Pupils are equal and reactive b. Widening pulse pressure c. Eupnea d. Decreased intracranial pressure
B. Widening pulse pressure
Which structure of the brain is responsible for regulating extrapyramidal involuntary movement?
Basal Ganglia
Which area is known as the expressive speech center?
Broca's area
A nurse asks a client to take deep breaths during an electroencephalography. The client asks, "Why are you asking me to do this?" How would the nurse respond? a. "Hyperventilation causes vascular dilation of cerebral arteries, which decreases electoral activity in the brain." b. "Deep breathing helps you to relax and allows the electroencephalograph to obtain a better waveform." c. "Hyperventilation causes cerebral vasoconstriction and increases the likelihood of seizure activity." d. "Deep breathing will help you to blow off carbon dioxide and decreases intracranial pressures."
C. "Hyperventilation causes cerebral vasoconstriction and increases the likelihood of seizure activity."
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
Obstructive hydrocephalus can occur in the presence of what abnormality? a. Blockage in the arachnoid villi b. Malformation of the falx cerebelli c. Blockage of cerebrospinal fluid (CSF) flow in the ventricular system d. Increased production of CSF
C. Blockage of cerebrospinal fluid flow in the ventricular system
A patient has been admitted with acute confusion and other focal neurologic signs. The practitioner is going to perform a lumbar puncture. What is the most serious complication of lumbar puncture? a. Meningitis b. Dural tear c. Brainstem herniation d. Spinal cord trauma
C. Brainstem herniation
The nurse is caring for a patient who is going to have digital subtraction angiography. The patient asks what is the difference between conventional and digital subtraction angiography. What should the nurse tell the patient? a. Digital subtraction angiography has fewer complications. b. Digital subtraction angiography is noninvasive. c. Digital subtraction angiography uses significantly less dye. d. Digital subtraction angiography is done through the femoral vein.
C. Digital subtraction angiography uses significantly less dye
The nurse is precepting a new graduate nurse. The new graduate asks about the difference between electroencephalography and evoked potentials. What should the nurse tell the new graduate? a. Evoked potentials measure and record electric and muscle activity in response to noxious stimuli. b. Electroencephalography measures cerebral blood flow and oxygen extraction. c. Evoked potentials measure cerebral electrical impulses generated in response to sensory stimuli. d. Electroencephalography measures the biochemical changes in the brain to assess metabolic activity.
C. Evoked potentials measure cerebral electrical impulses generated in response to sensory stimuli
Why is assessment of level of conscious (LOC) the most important aspect of the neurologic examination? a. The LOC is the most prognostic indicator of the patient's outcome. b. The LOC is generally limited to the Glasgow Coma Scale making it the quickest part of the assessment. c. In most situations the LOC deteriorates before any other neurologic changes are noted. d. The LOC is the easiest part of the neurologic exam and thus is generally performed first.
C. In most situations the LOC deteriorates before any other neurologic changes are noted
The nursing management plan for a patient undergoing a water-based contrast myelogram should include intervention? a. Maintain the patient flat in bed for 4 to 6 hours b. Observe the puncture sight every 15 minutes for 2 hours for signs of bleeding c. Keep the patient's head elevated 30 to 45 degrees for 8 hours d. Administer a sedative to keep the patient from moving around
C. Keep the patient's head elevated 30 to 45 degrees for 8 hours
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
The practitioner wishes to evaluate the functional integrity of cerebral motor pathways in a brain-injured patient. Which test should the nurse anticipate the practitioner will order? a. Electroencephalography b. Xenon computed tomography (CT) c. Motor-evoked potentials d. Emission tomography
C. Motor-evoked potentials
The nurse is caring for a patient with a closed head injury with a Glasgow Coma Scale (GCS) score of 6. What does this score indicate about the patient's neurologic status? a. Patient is in a vegetative state. b. Patient is a paraplegic. c. Patient is in a coma. d. Patient is able to obey commands.
C. Patient is in a coma
The nurse is caring for a critically injured patient who can only be aroused by vigorous external stimuli. Which category should the nurse use to document the patient's level of consciousness? a. Lethargic b. Obtunded c. Stuporous d. Comatose
C. Stuporous
A patient has coherent speech but the words are illogical. Which part of the brain has been affected? a. The cerebellum b. The Broca area c. The Wernicke area d. The hypothalamus
C. The Wernicke area
The nurse is preparing a client for discharge from the emergency department after experiencing a transient ischemic attack (TIA). Before discharge, which factor would the nurse identify as placing the client at high risk for a stroke? a. Age greater than or equal to 75 b. Blood pressure greater than or equal to 160/95 c. Unilateral weakness during a TIA d. TIA symptoms lasting less than a minute
C. Unilateral weakness during a TIA
Which structure(s) form(s) the blood-brain barrier? a. Postsynaptic terminals b. Pia mater c. Vascular endothelial cells d. Myelin sheath
C. Vascular Endothelial Cells
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 anoxic brain injury. The nurse notes abnormal extension of both extremities to noxious stimuli. This finding indicates dysfunction in which area of the central nervous system? a. Cerebral cortex b. Thalamus c. Cerebellum d. Brainstem
D. Brainstem
The nurse is caring for a patient with a head injury and observes a rhythmic increase and decrease in the rate and depth of respiration followed by brief periods of apnea. What should the nurse document under breathing pattern? a. Central neurogenic hyperventilation b. Apneustic breathing c. Ataxic respirations d. Cheyne-Stokes respirations
D. Cheyne-Stokes respirations
The nurse is taking a history from a daughter about her father's onset of stroke signs and symptoms. Which statement by the daughter indicates that the client likely had an embolic stroke? a. Client's symptoms occurred slowly over several hours. b. Client because increasingly lethargic and drowsy. c. Client reported severe headache before other symptoms. d. Client has a long history of atrial fibrillation.
D. Client has a long history of atrial fibrillation
The nursing is caring for a comatose patient with a brain tumor. When the nurse touches the palm of the patient's hand, the patient grasps the nurse's hand. What is this sign indicative of? a. There is damage to the brainstem. b. It's a normal finding. c. The patient is getting better. d. Cortical damage is present.
D. Cortical damage is present
A client is admitted to the emergency department with a probable traumatic brain injury. Which assessment finding would be the priority for the nurse to report to the primary health care provider? a. Mild temporal headache b. Pupils equal and react to light c. Alert and oriented 3 d. Decreasing level of consciousness
D. Decreasing level of consciousness
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 patient with neurologic damage continues with extremely high core body temperature despite interventions to lower temperature. The nurse suspects the patient has sustained damage to which area of the brain? a. Cerebrum b. Cerebellum c. Thalamus d. Hypothalamus
D. Hypothalamus
Damage to the upper portion of the reticular activating system results in which condition? a. Seizures b. Diabetes insipidus c. Apnea d. Impaired consciousness
D. Impaired consciousness
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 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
While the Glasgow Coma Scale (GCS) is part of the routine neurologic assessment, the nurse knows that it is not a valid measure for certain types of patients. In which patient is the GCS not valid? a. Patient with hemiplegia b. Patient with Parkinson disease c. Patient with dyslexia d. Patient who is intoxicated
D. Patient who is intoxicated
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
The nurse is assessing a client diagnosed with trigeminal neuralgia affecting cranial nerve V. What assessment findings will the nurse expect for this client? a. Expressive aphasia b. Ptosis (eyelid drooping) c. Slurred speech d. Severe facial pain
D. Severe facial pain
The ability to access cerebrospinal fluid (CSF) by a lumbar puncture is attributable to the flow of CSF in which space? a. Subdural b. Subpia c. Epidural d. Subarachnoid
D. Subarachnoid
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
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 precepting a new graduate nurse. The new graduate asks about testing the oculovestibular reflex. What should the nurse tell the new graduate? a. The test should not be performed on an unconscious patient because of the risk of aspiration. b. An abnormal response is manifested by conjugate, slow, tonic nystagmus, deviating toward the irrigated ear. c. This test should be included in the nursing neurologic examination of a patient with a head injury. d. This test is one of the final clinical assessments of brainstem function.
D. This test is one of the final clinical assessments of brainstem function
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 cerebrospinal fluid leak
The extrusion of cerebral tissue through the cranium is what type of herniation? a. Transcalvarial b. Uncal c. Cingulate d. Transtentorial
D. Transtentorial
What is the concept behind an ischemic stroke?
Decreased cerebral perfusion causing ischemia to the neurons
Describe Cranial nerve VII
Facial; sensory and motor; controls most facial expressions, secretion of tears and saliva, taste, ability to raise eyebrows
What is the job of the astrocyte neuroglia?
Forms the blood brain barrier
What is the job of the Schwann cell?
Forms the myelin sheath in the PNS
Describe Cranial Nerve IX
Glossopharyngeal; sensory and motor; taste, swallowing
For a pt with increased ICP, what is the best position to place the pt?
HOB elevated 30 degrees
What type of stroke has the highest mortality rate?
Hemorrhagic
Which structure in the brain is responsible for consolidating short-term memory to long-term?
Hippocampus
What is the greatest risk factor for stroke?
Hypertension
Describe Cranial Nerve XII
Hypoglossal; motor; control tongue movements
What is apraxia?
Inability to perform a learned movement voluntarily
If the initial CT of the brain is negative for SAH, what test is indicated next?
Lumbar Puncture
Describe Cranial Nerve III
Oculomotor; motor/eyelid and eyeball movement
Describe Cranial Nerve II
Optic; sensory/vision; use Snellen chart to assess visual acuity
What is the most common cause of mitral valve stenosis?
Rheumatic fever from strep throat
Which lobe, which is more pronounced in animals, is concerned with self-preservation?
Rhinencephalon (Limbic Lobe)
What are symptoms of mitral valve stenosis?
SOB, fatigue, dizziness or fainting, coughing up blood, chest pain, edema in extremities, heart palpitations, heart murmur
Describe Cranial Nerve XI
Spinal Accessory; motor; controls sternocleidomastoid and trapezius, shoulder movement/shoulder shrug
Communication between neurons is called
Synapse
What is described as neurologic deficit that lasts less than 24 hours & then returns to normal?
Transient Ischemic Attack (TIA)
Describe Cranial Nerve V
Trigeminal; motor and sensory; chewing, corneal reflex
Describe Cranial Nerve IV
Trochlear; motor; inferior lateral movement of eye
Describe Cranial Nerve X
Vagus; sensory and motor; slows heart rate, gag reflex
What is the tell-tale sign of endocarditis on the echocardiogram?
Vegetation is noted on heart valves
Describe Cranial Nerve VIII
Vestibulocochlear; sensory; hearing, equilibrium sensation
Which area is known as the receptive speech center?
Wernicke area
What are the components of Cushing's triad?
bradypnea, bradycardia, and systolic hypertension
After an SAH is diagnosed, what procedure is done to determine the location of the AVM/aneurysm
cerebral angiogram
What is the definitive treatment for a cerebral aneurysm?
craniotomy to expose the aneurysm and surgically clip it; craniotomy to expose the aneurysm with endovascular coiling
A client with a stroke is being evaluated for fibrinolytic therapy. What information from the client or family is most important for the nurse to obtain? a. Loss of bladder control b. Other medical conditions c. Progression of symptoms d. Time of symptom onset
d. Time of symptom onset
What is hemianopia?
decreased vision or blindness in 1/2 the visual field
When should BP be treated in ischemic stroke when the pt has not received fibrinolytics?
diastolic > 120, systolic > 220
What is the best way to diagnose mitral valve stenosis?
echocardiogram
Which symptom manifested by a pt indicates that the brain has "herniated" aka midline shift?
fixed and dilated pupils
lobe of the cerebrum responsible for cognitive function, language, & voluntary motor function
frontal lobe
forms junction between the pons & the diencephalon, relay station for motor & sensory stimuli
midbrain
What is mitral valve stenosis?
mitral valve is narrow, blocking blood flow to the left ventricle
What are some causes of cardioembolic strokes?
mitral valve stenosis, atrial fibrillation, recent MI, mechanical heart valves, endocarditis
What is the first indication of cerebral vasospasm?
new focal or global neurologic deficits
lobe concerned with sensory function, awareness of body parts, and recognition of objects
parietal lobe
What is the recommended treatment for Guillain-Barre Syndrome?
plasmapheresis; immunoglobulin therapy
What occurs during the repolarization phase in a nerve impulse?
potassium moves out of the cell
brain structure that is responsible for level of consciousness, trauma may cause concussion
reticular formation
What type of conduction occurs in myelinated fibers to support rapid transmission of impulses?
saltatory conduction
Which 3 neurotransmitters produce an inhibitory response?
serotonin, GABA, glycine
What occurs during the depolarization phase of a nerve impulse?
sodium moves into the cell
