Med-Surg Chronic Neuro

The nurse is about to administer a contrast medium to the client undergoing diagnostic testing. Which question does the nurse first ask the client? "Are you in pain?" "Are you taking ibuprofen daily?" "Are you wearing any metal?" "Do you know what this test is for?"

"Are you taking ibuprofen daily?"

The nurse is teaching a client about the risk factors of restless legs syndrome. Which statement by the client indicates a correct understanding of the nurse's instruction? "Cigarettes and alcohol must be avoided." "I need to exercise my legs before bedtime." "It is important to stay off my feet." "Over-the-counter drugs must not be taken."

"Cigarettes and alcohol must be avoided." Clients with restless legs syndrome should avoid as many risk factors as possible or make lifestyle modifications. Examples include avoiding caffeine and alcohol, quitting smoking, losing weight, and exercising. These clients should not engage in strenuous activity within 2 to 3 hours before bedtime, but general exercise is recommended. Use of over-the-counter drugs is not contraindicated for clients with restless legs syndrome.

A client's spouse expresses concern that the client, who has Guillain-Barré syndrome (GBS), is becoming very depressed and will not leave the house. What is the nurse's best response? "Contact the Guillain-Barré Syndrome Foundation International for resources. Here is their contact information." "Try inviting several people over so the client won't have to go out." "Let your spouse stay alone. Your spouse will get used to it." "This behavior is normal."

"Contact the Guillain-Barré Syndrome Foundation International for resources. Here is their contact information." The Guillain-Barré Syndrome Foundation International (www.gbs-cidp.org) provides resources and information for clients and their families. The client and family should be referred to self-help and support groups for clients with chronic illness, if indicated. Inviting one close friend over is appropriate, but more than one might overwhelm the client. Although depression is expected initially, some action does need to be taken to prevent further deterioration.

The nursing instructor asks a nursing student to compare Bell's palsy and trigeminal neuralgia. Which statement by the nursing student is correct? "Difficulty chewing may occur in both disorders." "Both are disorders of the autonomic nervous system." "Facial twitching occurs in both disorders." "Both disorders are caused by the herpes simplex virus, which inflames and irritates cranial nerve V."

"Difficulty chewing may occur in both disorders." Both Bell's palsy and trigeminal neuralgia can affect cranial nerve V, which affects facial expressions and chewing. Both are disorders of the cranial nerves. Facial twitching can be a sign of trigeminal neuralgia, whereas Bell's palsy causes a unilateral facial paralysis. Bell's palsy is caused by the herpes simplex virus, unlike trigeminal neuralgia, which is thought to be caused by excessive firing of irritated nerve fibers in the trigeminal nerve.

A client is scheduled for an electroencephalogram (EEG) in the morning. Which instruction does the nurse give the client? "Do not take any sedatives 12-24 hours before the test." "Please do not have anything to eat or drink after midnight." "You may bring some music to listen to for distraction." "You will need to have someone to drive you home."

"Do not take any sedatives 12-24 hours before the test."

The spouse of the client with Alzheimer's disease is listening to the home health nurse explain the client's drug regimen. Which statement by the spouse indicates an understanding of the nurse's instruction? "Donepezil (Aricept) will treat the symptoms of Alzheimer's disease." "Memantine (Namenda) is indicated for treatment of early symptoms of Alzheimer's disease. "Rivastigmine (Exelon) is used to treat depression." "Sertraline (Zoloft) will treat the symptoms of Alzheimer's disease."

"Donepezil (Aricept) will treat the symptoms of Alzheimer's disease." The comment that shows that the spouse understands the nurse's instructions is that Aricept will treat symptoms of Alzheimer's. Cholinesterase inhibitors (e.g., donepezil) are approved for the symptomatic treatment of Alzheimer's disease. This class of medication delays the destruction of acetylcholine (ACh) by the enzyme cholinesterase. Memantine (Namenda) is indicated for advanced Alzheimer's disease. Memantine blocks excess amounts of glutamate which can damage nerve cells. Rivastigmine (Exelon) is a cholinesterase inhibitor that is used to treat Alzheimer's symptoms. Selective serotonin reuptake inhibitors like sertraline (Zoloft) are antidepressants and may be used in Alzheimer's clients who develop depression.

The nurse's friend fears that something is wrong with his grandmother, saying that she is becoming extremely forgetful and disoriented and is beginning to wander. What is the nurse's best response? "Have you taken her for a check-up?" "She has Alzheimer's disease." "That is a normal part of aging." "You should look into respite care."

"Have you taken her for a check-up?" The best response by the nurse to a friend whose grandmother is forgetful and wandering is to ask her friend if he/she has taken the grandmother for a check-up. The grandmother's symptoms could indicate possible Alzheimer's disease or some other physiologic imbalance, and she needs to be assessed further by the primary care provider.The nurse's role is not to diagnose Alzheimer's disease but to advocate for the friend's grandmother to be evaluated. Becoming extremely forgetful, disoriented, and wandering is not normal age related behavior. Respite care is for caregivers, not for clients.

A client newly diagnosed with myasthenia gravis (MG) is being discharged, and the nurse is teaching about proper medication administration. Which statement by the client demonstrates a need for further teaching? "It is important to post my medicine schedule at home, so my family knows my schedule." "I can continue to take over-the-counter drugs like before." "An extra supply of medicine must be kept in my car." "Wearing a watch with an alarm will remind me to take my medicine."

"I can continue to take over-the-counter drugs like before." Clients with MG should not take any over-the-counter medications without checking with their health care provider. The client's medication schedule may be posted in the home for the benefit of family members. An extra supply of medication should be kept in the client's car or workplace to maintain therapeutic levels in case a dose was missed. The client may wear a watch with an alarm as a medication reminder to maintain therapeutic levels.

The nurse is teaching a client, newly diagnosed with migraines, about trigger control. Which statement made by the client demonstrates good understanding of the teaching plan? "I can still eat Chinese food." "I must not miss meals." "It is okay to drink a few wine coolers." "I need to use fake sugar in my coffee."

"I must not miss meals." The client understands the teaching plan about trigger control for migraines when the client states that he/she must not miss meals. Until triggers are identified, a headache diary would be considered. Missing meals is a trigger for many people suffering from migraines. The client must not skip any meals until the triggers are identified.Chinese food frequently contains monosodium glutamate. Monosodium glutamate-containing foods, alcohol, and artificial sweeteners are triggers for many people suffering from migraines and need to be eliminated until the triggers are identified.

A female client with newly diagnosed migraines is being discharged with a prescription for sumatriptan (Imitrex). Which comment by the client indicates an understanding of the nurse's discharge instructions? "Birth control is not needed while taking sumatriptan." "I must report any chest pain right away." "St. John's wort can also be taken to help my symptoms." "Sumatriptan can be taken as a last resort."

"I must report any chest pain right away." The client comment that shows that she understands the discharge instructions is that any chest pain must be reported right away. Chest pain must be reported immediately with the use of sumatriptan because triptans cause vasoconstriction.Remind the client to use contraception (birth control) while taking the drug because it may not be safe for women who are pregnant. Triptans would not be taken with selective serotonin reuptake inhibitors or St. John's wort, an herb used commonly for depression. Sumatriptan must be taken as soon as migraine symptoms appear.

An older client presents to the clinic after a ground level fall at home. What statement by the client indicates the need for more injury prevention education? "I always take my medicine as directed." "I only eat little snacks so I don't gain weight." "I will make sure I drink enough water." "I make sure to get as much sleep as I used to."

"I only eat little snacks so I don't gain weight."

A client with myasthenia gravis (MG) is receiving cholinesterase inhibitor drugs to improve muscle strength. The nurse is educating the family about this therapy. Which statement by a family member indicates a correct understanding of the nurse's instruction? "I will call 911 if a sudden increase in weakness occurs." "I will increase the dose if a sudden increase in weakness occurs." "The medication must be taken with a large meal." "The medication must be taken on an empty stomach."

"I will call 911 if a sudden increase in weakness occurs." A potential adverse effect of cholinesterase inhibitors is cholinergic crisis. Sudden increases in weakness and the inability to clear secretions, swallow, or breathe adequately indicate that the client is experiencing crisis. The family member should call 911 for emergency assistance. The dose of cholinesterase inhibitors should never be increased without provider supervision. The client should eat meals 45 to 60 minutes after taking cholinesterase inhibitors to avoid aspiration. Cholinesterase inhibitors should be taken with a small amount of food to help alleviate GI side effects.

The home health nurse is checking in on a client with dementia and the client's spouse. The spouse confides to the nurse, "I am so tired and worn out." What is the nurse's best response? "Can't you take care of your spouse?" "Establishing goals and a daily plan can help." "Make sure you take some time off and take care of yourself too." "That's not a very nice thing to say."

"Make sure you take some time off and take care of yourself too." The nurse's best response to the spouse of the client with dementia is to encourage the wife to take some time off to take care of herself. This response is supportive and reminds the spouse that he or she cannot care for the client when exhausted.Questioning the spouse's ability to provide care is not supportive and may offend the spouse. Establishing goals and a daily plan may be helpful to the situation but is not responding to the spouse's need. Reprimanding the spouse does not validate his or her feelings and does not allow the nurse to further explore the statement.

A client with new-onset Bell's palsy is being dismissed from the hospital. Which statement made by the client demonstrates a need for further teaching by the nurse? "I'll need artificial tears at least four times a day." "I will eat a soft diet." "My eye must be taped or patched at bedtime." "Narcotics will be needed for pain relief."

"Narcotics will be needed for pain relief." Mild analgesics, not narcotics, are used for pain associated with Bell's palsy. Artificial tears and taping the affected eye at night protect the cornea from drying out and potentially ulcerating because of the eye's inability to close. Mastication is often impaired with Bell's palsy, so soft foods are indicated.

Neuro assessment includes:

-Family history and genetic risks -Current health problems -LOC and orientation -Memory (recent and remote) -Attent -Language -Level of cognition -Cranial nerve assessment -Sensory function -Motor function -Cerebellar function

Parkinson's Disease Dementia

-Occurs with progression of Parkinson's caused by protein clumps in the substantia nigra of the brain and can resemble both LBD and Alzheimer's -deficient dopamine in brain: stiffness, loss of balance, tremors o Tx: increase dopamine levels o Typically progresses over 10 years o Can only be diagnosed if Parkinson's Dementia if dementia onset is 1+ years after the onset of Parkinson's symptoms

The nurse is caring for a client who begins to experience seizure activity while in bed. Which actions should the nurse take? Select all that apply. 1. Loosening restrictive clothing 2.Restraining the client's limbs 3.Removing the pillow and raising padded side rails 4.Positioning the client to the side, if possible, with the head flexed forward 5.Keeping the curtain around the client and the room door open so when help arrives they can quickly enter to assist

1. Loosening restrictive clothing 3.Removing the pillow and raising padded side rails 4.Positioning the client to the side, if possible, with the head flexed forward Nursing actions during a seizure include providing for privacy, loosening restrictive clothing, removing the pillow and raising padded side rails in the bed, and placing the client on one side with the head flexed forward, if possible, to allow the tongue to fall forward and facilitate drainage. The limbs are never restrained because the strong muscle contractions could cause the client harm. If the client is not in bed when seizure activity begins, the nurse lowers the client to the floor, if possible; protects the head from injury; and moves furniture that may injure the client.

A client with a spinal cord injury is prone to experiencing autonomic dysreflexia. The nurse should include which measures in the plan of care to minimize the risk of occurrence? Select all that apply. 1.Keeping the linens wrinkle-free under the client 2.Preventing unnecessary pressure on the lower limbs 3.Limiting bladder catheterization to once every 12 hours 4.Turning and repositioning the client at least every 2 hours 5.Ensuring that the client has a bowel movement at least once a week

1.Keeping the linens wrinkle-free under the client 2.Preventing unnecessary pressure on the lower limbs 4.Turning and repositioning the client at least every 2 hours The most frequent cause of autonomic dysreflexia is a distended bladder. Straight catheterization should be done every 4 to 6 hours (catheterization every 12 hours is too infrequent), and urinary catheters should be checked frequently to prevent kinks in the tubing. Constipation and fecal impaction are other causes, so maintaining bowel regularity is important. Ensuring a bowel movement once a week is much too infrequent. Other causes include stimulation of the skin from tactile, thermal, or painful stimuli. The nurse administers care to minimize risk in these areas.

The nurse is instituting seizure precautions for a client who is being admitted from the emergency department. Which measures should the nurse include in planning for the client's safety? Select all that apply. 1.Padding the side rails of the bed 2.Placing an airway at the bedside 3.Placing the bed in the high position 4.Putting a padded tongue blade at the head of the bed 5.Placing oxygen and suction equipment at the bedside 6.Flushing the intravenous catheter to ensure that the site is patent

1.Padding the side rails of the bed 2.Placing an airway at the bedside 5.Placing oxygen and suction equipment at the bedside 6.Flushing the intravenous catheter to ensure that the site is patent

The nurse is teaching a client with myasthenia gravis about the prevention of myasthenic and cholinergic crises. Which client activity suggests that teaching is most effective? 1.Taking medications as scheduled 2.Eating large, well-balanced meals 3.Doing muscle-strengthening exercises 4.Doing all chores early in the day while less fatigued

1.Taking medications as scheduled

The nurse is assigned to care for a client with complete right-sided hemiparesis from a stroke (brain attack). Which characteristics are associated with this condition? Select all that apply. 1.The client is aphasic. 2.The client has weakness on the right side of the body. 3.The client has complete bilateral paralysis of the arms and legs. 4.The client has weakness on the right side of the face and tongue. 5.The client has lost the ability to move the right arm but is able to walk independently. 6.The client has lost the ability to ambulate independently but is able to feed and bathe himself or herself without assistance

1.The client is aphasic. 2.The client has weakness on the right side of the body. 4.The client has weakness on the right side of the face and tongue. Hemiparesis is a weakness of one side of the body that may occur after a stroke. It involves weakness of the face and tongue, arm, and leg on one side. These clients are also aphasic: unable to discriminate words and letters. They are generally very cautious and get anxious when attempting a new task. Complete bilateral paralysis does not occur in hemiparesis. The client with right-sided hemiparesis has weakness of the right arm and leg and needs assistance with feeding, bathing, and ambulating.

If GCS decreases by ____ points, notify doctor immediately and request CT scan

2 points

A client has a neurological deficit involving the limbic system. On assessment, which finding is specific to this type of deficit? 1.Is disoriented to person, place, and time 2.Affect is flat, with periods of emotional lability 3.Cannot recall what was eaten for breakfast today 4.Demonstrates inability to add and subtract; does not know who is the president of the United States

2.Affect is flat, with periods of emotional lability The limbic system is responsible for feelings (affect) and emotions. Calculation ability and knowledge of current events relate to function of the frontal lobe. The cerebral hemispheres, with specific regional functions, control orientation. Recall of recent events is controlled by the hippocampus.

The nurse is caring for the client with increased intracranial pressure. The nurse would note which trend in vital signs if the intracranial pressure is rising? 1.Increasing temperature, increasing pulse, increasing respirations, decreasing blood pressure 2.Increasing temperature, decreasing pulse, decreasing respirations, increasing blood pressure 3.Decreasing temperature, decreasing pulse, increasing respirations, decreasing blood pressure 4.Decreasing temperature, increasing pulse, decreasing respirations, increasing blood pressure

2.Increasing temperature, decreasing pulse, decreasing respirations, increasing blood pressure A change in vital signs may be a late sign of increased intracranial pressure. Trends include increasing temperature and blood pressure and decreasing pulse and respirations. Respiratory irregularities also may occur.

The nurse is evaluating the neurological signs of a client in spinal shock following spinal cord injury. Which observation indicates that spinal shock persists? 1.Hyperreflexia 2.Positive reflexes 3.Flaccid paralysis 4.Reflex emptying of the bladder

3. Flaccid paralysis Resolution of spinal shock is occurring when there is return of reflexes (especially flexors to noxious cutaneous stimuli), a state of hyperreflexia rather than flaccidity, and reflex emptying of the bladder.

The nurse is evaluating the status of a client who had a craniotomy 3 days ago. Which assessment finding would indicate that the client is developing meningitis as a complication of surgery? 1.A negative Kernig's sign 2.Absence of nuchal rigidity 3.A positive Brudzinski's sign 4.A Glasgow Coma Scale score of 15

3.A positive Brudzinski's sign

What is the window to administer TPA for ischemic stroke?

4 hours from LKWT

The nurse is instructing a client with Parkinson's disease about preventing falls. Which client statement reflects a need for further teaching? 1."I can sit down to put on my pants and shoes." 2."I try to exercise every day and rest when I'm tired." 3."My son removed all loose rugs from my bedroom." 4."I don't need to use my walker to get to the bathroom.

4."I don't need to use my walker to get to the bathroom.

The nurse has given suggestions to a client with trigeminal neuralgia about strategies to minimize episodes of pain. The nurse determines that the client needs further teaching if the client makes which statement? 1."I will wash my face with cotton pads." 2."I'll have to start chewing on my unaffected side." 3."I should rinse my mouth if toothbrushing is painful." 4."I'll try to eat my food either very warm or very cold."

4."I'll try to eat my food either very warm or very cold."

The nurse has instructed the family of a client with stroke (brain attack) who has homonymous hemianopsia about measures to help the client overcome the deficit. Which statement suggests that the family understands the measures to use when caring for the client? 1."We need to discourage him from wearing eyeglasses." 2."We need to place objects in his impaired field of vision." 3."We need to approach him from the impaired field of vision." 4."We need to remind him to turn his head to scan the lost visual field."

4."We need to remind him to turn his head to scan the lost visual field." Homonymous hemianopsia is loss of half of the visual field. The client with homonymous hemianopsia should have objects placed in the intact field of vision, and the nurse also should approach the client from the intact side. The nurse instructs the client to scan the environment to overcome the visual deficit and does client teaching from within the intact field of vision. The nurse encourages the use of personal eyeglasses, if they are available.

The nurse is assessing the adaptation of a client to changes in functional status after a stroke (brain attack). Which observation indicates to the nurse that the client is adapting most successfully? 1.Gets angry with family if they interrupt a task 2.Experiences bouts of depression and irritability 3.Has difficulty with using modified feeding utensils 4.Consistently uses adaptive equipment in dressing self

4.Consistently uses adaptive equipment in dressing self Clients are evaluated as coping successfully with lifestyle changes after a stroke if they make appropriate lifestyle alterations, use the assistance of others, and have appropriate social interactions. Options 1 and 2 are not adaptive behaviors; option 3 indicates a not yet successful attempt to adapt.

The nurse is admitting a client with Guillain-Barré syndrome to the nursing unit. The client has ascending paralysis to the level of the waist. Knowing the complications of the disorder, the nurse should bring which most essential items into the client's room? 1.Nebulizer and pulse oximeter 2.Blood pressure cuff and flashlight 3.Flashlight and incentive spirometer 4.Electrocardiographic monitoring electrodes and intubation tray

4.Electrocardiographic monitoring electrodes and intubation tray

A client recovering from a head injury is participating in care. The nurse determines that the client understands measures to prevent elevations in intracranial pressure if the nurse observes the client doing which activity? 1.Blowing the nose 2.Isometric exercises 3.Coughing vigorously 4.Exhaling during repositioning

4.Exhaling during repositioning Activities that increase intrathoracic and intraabdominal pressures cause an indirect elevation of the intracranial pressure. Some of these activities include isometric exercises, Valsalva's maneuver, coughing, sneezing, and blowing the nose. Exhaling during activities such as repositioning or pulling up in bed opens the glottis, which prevents intrathoracic pressure from rising.

A client has clear fluid leaking from the nose following a basilar skull fracture. Which finding would alert the nurse that cerebrospinal fluid is present? 1.Fluid is clear and tests negative for glucose. 2.Fluid is grossly bloody in appearance and has a pH of 6. 3.Fluid clumps together on the dressing and has a pH of 7. 4.Fluid separates into concentric rings and tests positive for glucose.

4.Fluid separates into concentric rings and tests positive for glucose. Leakage of cerebrospinal fluid (CSF) from the ears or nose may accompany basilar skull fracture. CSF can be distinguished from other body fluids because the drainage will separate into bloody and yellow concentric rings on dressing material, called a halo sign. The fluid also tests positive for glucose.

The client is admitted to the hospital with a diagnosis of Guillain-Barré syndrome. Which past medical history finding makes the client most at risk for this disease? 1.Meningitis or encephalitis during the last 5 years 2.Seizures or trauma to the brain within the last year 3.Back injury or trauma to the spinal cord during the last 2 years 4.Respiratory or gastrointestinal infection during the previous month

4.Respiratory or gastrointestinal infection during the previous month

GCS total scoring

<8: severe 9-12: moderate 13-15: minor

Cerebral angiogram

A diagnostic procedure in neurology that entails the injection of a tracer element (contrast) into the bloodstream prior to taking X-rays of the cerebral vasculature Identifies an AV (ateriovenous) malformations, narrowed vessels, aneurysm

Glasgow Coma Scale

A scale used to assess level of consciousness and reaction to stimuli in a neurologically impaired patient based on performance in three categories: eye opening, verbal response-performance, and motor responsiveness. Scores range from 3-15, with 3 being nearly braindead and 15 being fully alert. 3-8: coma

CT Scan

A series of x-ray photographs taken from different angles and combined by computer into a composite representation of a slice through the brain Detects hemorrhage, infarction, abscesses, tumors

MRI

A technique that uses magnetic fields and radio waves to produce computer-generated images that distinguish among different types of soft tissue; allows us to see structures within the brain

What are the 5 possible options for LOC?

ALOSC Alert Lethargic Obtunded Stuporous Comatose

The nurse is assessing the verbal response of a patient on a Glasgow scale. What score does the nurse determine when the patient makes incomprehensible sounds? A. 1 B. 2 C. 3 D. 4

ANS: B

Which statement about delirium in older adults is correct? A. The onset of delirium is usually slow. B. Surgery and infection can cause delirium. C. Reorientation is not an effective nursing intervention. D. Management is based solely on symptomatic treatment.

ANS: B

When caring for an anxious, fearful client, the nurse would identify which of the following as an indication of sympathetic nervous system control? A. Dry skin B. Skin pallor C. Pulse rate of 60 D. Constriction of pupils

ANS: B Rationale: in SNS response, it shunts blood to core from periphery. Patient would also have sweating skin, high pulse rate, and dilated pupils

A patient has been pronounced dead. Which findings would the nurse observe? (Select all that apply). A. Decerebrate posturing B. Dilated nonreactive pupils C. Deep Tendon Reflexes D. Absent Corneal Reflexes

ANS: B, D

A Glasgow Coma Scale is ordered on a patient. The nurse observes these signs and symptoms upon initial assessment: opens eyes to sound; localizes pain; confused conversation. What does the nurse record as this patient's Glasgow Coma Scale score? A. 15 B. 13 C. 12 D. 8

ANS: C

What signs and symptoms are characteristic of a patient who is described as lethargic (LOC)? A. The patient is awake and responsive. B. The patient is aroused by painful stimulation. C. The patient is drowsy but easily awakened. D. The patient cannot be aroused.

ANS: C

What is the first indication that central neurologic function has declined in a patient? A. Presence of lethargy B. Irregular depth of respirations C. Change in level of consciousness D. Decorticate or decerebrate posturing

ANS: C Rationale: change in LOC is first sign; lethargy, irregular respirations, pupil dilation, and posturing are LATE signs

The RN is arriving for night duty at an acute care hospital. Which patient does the RN assess first? A. 65-year-old who is scheduled for surgery the next day B. 68-year-old who has chronic protein-calorie malnutrition C. 70-year-old who has a history of gout and is reporting joint pain D. 72-year-old who was admitted to the unit with postoperative delirium

ANS: D

What is the purpose of the Glasgow Coma Scale used by health care personnel? A. To assess the cranial nerves B. To detect motor functions C. To test sensory perception D. To assess level of consciousness

ANS: D

A client is being evaluated for signs associated with myasthenic crisis or cholinergic crisis. Which symptoms lead the nurse to suspect that the client is experiencing a cholinergic crisis? Abdominal cramps, blurred vision, facial muscle twitching Bowel and bladder incontinence, pallor, cyanosis Increased pulse, anoxia, decreased urine output Restlessness, increased salivation and tearing, dyspnea

Abdominal cramps, blurred vision, facial muscle twitching Abdominal cramps, blurred vision, and facial muscle twitching are signs of an acute exacerbation of muscle weakness symptoms of cholinergic crisis caused by overmedication with cholinergic (anticholinesterase) drugs. Bowel and bladder incontinence, pallor, cyanosis, increased pulse, anoxia, and decreased urine output are symptoms indicating a myasthenic crisis. Restlessness, increased salivation and tearing, and dyspnea are symptoms indicating a mixed myasthenic-cholinergic crisis.

Opposing NT for SNS

Acetylcholine

Cranial nerve assessment is generally reserved for....

Actual neuro units Yet we do this without fully knowing it--- is patient able to track with where you are in the room? Are they able to hear you and respond to you? etc.

A client newly diagnosed with Parkinson disease (PD) is being discharged. Which instruction is best for the nurse to provide to the client's spouse? Administer medications promptly on schedule to maintain therapeutic drug levels. Complete activities of daily living for the client. Provide high-fiber, high-carbohydrate foods. Speak loudly for better understanding.

Administer medications promptly on schedule to maintain therapeutic drug levels. Administering medications promptly on schedule is a correct statement.The best instruction the nurse can give to the spouse of a PD client about to be discharged is to give schedule medications promptly in order to keep drug levels therapeutic.

A client with trigeminal neuralgia is admitted for a percutaneous stereotactic rhizotomy in the morning. The client currently reports pain. What does the nurse do next? Administers pain medication as requested Ensures that the client has nothing by mouth (NPO) Ensures that the preoperative laboratory work is complete Performs a preoperative assessment

Administers pain medication as requested Addressing the client's pain is the priority nursing intervention because pain is the main symptom of trigeminal neuralgia. This client is not required to be NPO until after midnight. Percutaneous stereotactic rhizotomy can be performed in an ambulatory care setting under general anesthesia, which would not require preoperative testing (except clotting time if the client were on anticoagulant therapy). A preoperative assessment can be performed after the client's pain has been addressed.

Which client will the neurologic unit charge nurse assign to a registered nurse who has floated from the labor/delivery unit for the shift? Adult client who has just returned from having a cerebral arteriogram and needs vital sign checks every 15 minutes. Older adult client who was just admitted with a stroke and needs an admission assessment. Young adult client who has had a lumbar puncture and reports, "Light hurts my eyes." Middle-aged client who has a possible brain tumor and has questions about the scheduled magnetic resonance imaging.

Adult client who has just returned from having a cerebral arteriogram and needs vital sign checks every 15 minutes.

A client presents to the clinic with a migraine and is lying in a darkened room with a wet cloth on the head after receiving treatment. In preparation for dismissal home, what does the nurse do next? Allow the client to remain undisturbed. Assess the client's vital signs. Remove the cloth because it can harbor microorganisms. Turn on the lights for a neurologic assessment.

Allow the client to remain undisturbed. The next action by the nurse is to allow the client to remain undisturbed. The client may be able to alleviate pain by lying down in a darkened room with a cool cloth on his or her forehead. If the client falls asleep, he or she would remain undisturbed until awakening.Assessing the client's vital signs, although important, will disturb the client unnecessarily. A cool cloth is helpful for the client with a migraine and does not present enough of a risk that it would be removed. Turning on the lights for a neurologic assessment is not appropriate because light can cause the migraine to worsen.

Early changes in neuro status

Altered LOC Anxiety, confusion, restlessness Loss of recent memory

Breakdown of dementia % by cause

Alzheimer's: 60-80% Vascular dementia: 20% Lewy Body Dementia: 10% Other types: frontotemporal, Parkinson's, normal pressure hydrocephalus, Creutzfeldt-Jakob

Most common types of dementia

Alzheimers Vascular dementia Dementia with Lewy bodies

The wife of a client with Alzheimer's disease mentions to the home health nurse that, although she loves him, she is exhausted caring for her husband. What does the nurse do to alleviate caregiver stress? Arranges for respite care Provides positive reinforcement and support to the wife Restrains the client for a short time each day, to allow the wife to rest Teaches the client improved self-care

Arranges for respite care The home health nurse can help relieve caregiver stress for the wife caring for her husband with Alzheimer's disease by arranging for respite care for the wife. Respite care can give the wife some time to reenergize and will provide a social outlet for the client.Providing positive reinforcement and support is important but does not help provide a solution to the wife's situation. Restraints are almost never appropriate and are used only as a last resort. The client with Alzheimer's disease typically is unable to learn improved self-care.

Post-CT nursing responsibilites

Assess for allergic reaction Encourage fluids

A client is admitted with bacterial meningitis. Which nursing intervention is the highest priority for this client? Assessing neurologic status at least every 2-4 hours Decreasing environmental stimuli Managing pain through drug and nondrug methods Strict monitoring of hourly intake and output

Assessing neurologic status at least every 2-4 hours The highest priority nursing intervention for the newly admitted client with bacterial meningitis is to accurately monitor and record the client's neurologic status every 2-4 hours. The neurologic status, vital signs, and vascular status must be assessed at least every 4 hours or more often, if clinically indicated, to rapidly determine any deterioration in status.Decreasing environmental stimuli is helpful for the client with bacterial meningitis but is not the highest priority. Clients with bacterial meningitis report severe headaches requiring pain management which may be accomplished through both pharmacologic and nonpharmacologic methods. Assessing fluid balance while preventing overload is not the highest priority however intake and output must be monitored.

How to test for sensory function

Assessment of pain: nailbed pressure, needles along dermatomes, cotton swab on face or arm Needing to inflict more serious pain to get a reaction (sternal rub, trap pinch) is sign of neuro dysfunction

Acoustic neuroma

Assessment: Deafness, partial initially twitching or grimacing of facial muscles, dizziness Cause: benign tumor of 8th cranial nerve Tx: surgical excision of tumor; comfort measures

A client is being discharged to home with progressing stage I Alzheimer's disease. The family expresses concern to the nurse about caring for their parent. What is the priority for best continuity of care? Assigning a case manager Ensuring that all family questions are answered before discharge Providing a safe environment Referring the family to the Alzheimer's Association

Assigning a case manager The priority for the best continuity of care for a client about to be discharged with progressing Stage I Alzheimer's disease is to assign a case manager to the client and family. Whenever possible, the client and family need the services of a case manager who can assess their needs for health care resources and facilitate appropriate placement throughout the continuum of care. Continuity of care is important through all stages of Alzheimer's disease.Ensuring all questions are answered and providing a safe environment are necessary for family support. The Alzheimer's Association will also be able to help provide information and support to the family.

The nurse is caring for a client with advanced Alzheimer's disease. Which communication technique is best to use with this client? Assuming that the client is not totally confused Providing the client with several options to choose from Waiting for the client to express a need Writing down instructions for the client

Assuming that the client is not totally confused The best communication technique to use for a client with advanced Alzheimer's disease is to not assume that the client is totally confused and cannot understand what is being said. Choices need to be limited. Too many choices cause frustration and increased confusion in the client. Rather than waiting for the client to express a need, try to anticipate the client's needs and interpret nonverbal communication. Just writing down instructions may be confusing for the client. It is better to provide the client instructions with pictures, and put them in a highly visible place.

When to do complete neuro assessment?

At the beginning of every shift and thereafter per hospital policy

Which task does the nurse plan to delegate to the unlicensed assistive personnel (UAP) caring for a group of clients in the neurosurgical unit? Assist the health care provider in performing a lumbar puncture on a confused client Attend to the care needs of a client who has had a transcranial Doppler study Educate a client about what to expect during an electroencephalogram (EEG) Prepare a client who is going to radiology for a cerebral arteriogram

Attend to the care needs of a client who has had a transcranial Doppler study

Definition of alert LOC

Awake, engaged, responsive

Why is a neuro assessment always a priority at beginning of shift?

Because you always need a baseline understand of what a patient's neuro status is; you need to be able to recognize changes from baseline

The nurse is reviewing the history of a client who has been prescribed topiramate (Topamax) for prevention of migraines. The nurse plans to contact the primary care provider (PCP) if the client has which condition? Bipolar disorder Diabetes mellitus Glaucoma Hypothyroidism

Bipolar disorder The nurse contacts the PCP after reviewing the history of a client with bipolar disorder who has been prescribed topiramate. Cases of suicide have been associated with topiramate when it is used in larger doses of 400 mg daily, most often in clients with bipolar disorder. Topiramate is not contraindicated in clients with diabetes mellitus, glaucoma, or hypothyroidism.

A client has just returned from cerebral angiography. Which symptom does the client display that causes the nurse to act immediately? Bleeding Increased temperature Severe headache Urge to void

Bleeding

The nurse encourages a ventilated client with advanced Guillain-Barré syndrome (GBS) to communicate by which simple technique? Blinking for "yes" or "no" Moving lips to speak Using sign language Using a laptop to write

Blinking for "yes" or "no" A simple technique involving eye blinking or moving a finger to indicate "yes" and "no" is the best way for the ventilated client with GBS to communicate. Moving the lips is difficult to do around an endotracheal tube and is exhausting for the client. Sign language is very time-consuming to learn, unless the client and family already know it. Use of a laptop may prove too challenging for the client in advanced stages of GBS.

The nurse is evaluating a patient's equilibrium. When the patient stands with eyes closed, the patient begins to sway back and forth; with the eyes open, the patient remains erect. How does the nurse identify this assessment? A. Ipisilateral phenomenon B. Positive Babinski's sign C. Romberg sign D. Pronator drift

C. Romberg sign

CT or MRI for stroke diagnosis?

CT CT chosen over MRI because if it's ischemic, you'll miss your window to administer TPA (4 hours from LKWT last known well time)

The nurse is caring for a client who is scheduled to have a transcranial Doppler (TCD). What does this diagnostic test evaluate? Cerebral vasospasm Cerebrospinal fluid Evoked potentials Intracranial pressure

Cerebral vasospasm

A client is admitted into the emergency department (ED) with frontal-temporal pain, preceded by a visual disturbance. The client is upset and thinks it is a stroke. What does the nurse suspect may be occurring? Classic migraine Meningitis Stroke West Nile virus

Classic migraine The nurse suspects that a classic migraine could be present when an ED client complains of frontal-temporal pain preceded by a visual disturbance. These symptoms are most typical of a classic migraine.Meningitis may present with a headache and visual disturbance but is usually accompanied by nuchal rigidity (neck stiffness) and fever. The symptoms of stroke will vary depending upon the area affected. Mild cases of West Nile virus may be asymptomatic or present with flu-like symptoms, whereas severe cases may lead to loss of consciousness and death.

The nurse has just received report on a group of clients. Which client does the nurse assess first? Client who was in a car accident and has a Glasgow Coma Scale score of 14 Client who had a cerebral arteriogram and has a cool, pale leg Client who has a headache after undergoing a lumbar puncture Client who has expressive aphasia after a left-sided stroke

Client who had a cerebral arteriogram and has a cool, pale leg

The nurse has just received report on a group of clients on the neurosurgical unit. Which client is the nurse's first priority? Client whose deep tendon reflexes have become hyperactive Client who displays plantar flexion when the bottom of the foot is stroked Client who consistently demonstrates decortication when stimulated Client whose Glasgow Coma Scale (GCS) has changed from 15 to 13.

Client whose Glasgow Coma Scale (GCS) has changed from 15 to 13.

Which change in the cerebrospinal fluid (CSF) indicates to the nurse that a client may have bacterial meningitis? Cloudy, turbid CSF Decreased white blood cells Decreased protein Increased glucose

Cloudy, turbid CSF Cloudy, turbid CSF indicates to the nurse that the client may have bacterial meningitis.Clear fluid is a sign of viral meningitis. Increased white blood cells, increased protein, and decreased glucose are signs of bacterial meningitis.

If there's an injury to brainstem, thalamus, or cerebral cortex, loss of motor and/or sensory function will be (pick one): contralateral; ipsilateral

Contralateral

The nurse prepares to assess a client with diabetes mellitus for sensory loss. Which equipment is the best choice for the nurse use to perform this assessment? Cotton-tipped applicator Glucometer Hammer Safety pin

Cotton-tipped applicator

Ways to test for cognition

Counting backward in intervals, unscrambling words, word searches, etc.

A nurse is teaching a patient scheduled to undergo an electroencephalogram (EEG). Which action of the patient implies a good understanding about the instructions? A. Does not wash the hair before the test B. Takes central nervous system stimulants before the test C. Takes central nervous system depressants before the test D. Avoids any caffeine-containing beverages on the day of the test

D. Avoids any caffeine-containing beverages on the day of the test

The daughter of a patient with early familial Alzheimer's disease (AD) asks how AD is different from forgetfulness. You describe early warning signs of AD, including: A. Forgetting a colleague's name at a party B. Repeatedly misplacing car keys or a wallet C. Leaving a pot on the stove that boils dry and burns D. Having no memory of preparing a meal and forgetting to serve or eat it

D. Having no memory of preparing a meal and forgetting to serve or eat it

Which is more severe- decorticate or decerebrate posturing?

Decerebrate is more intense Decorticate: arms flexed in towards core Decerebrate: arms extended out `

Late signs of neurologic deterioration

Decerebrate or decorticate posturing pinpoint, severely dilated, or nonreactive pupils

The nurse is performing a neurologic assessment on an 81-year-old client. Which physiologic change does the nurse expect to find because of the client's age? Decreased coordination Increased sleeping during the night Increased touch sensation Nightly confusion

Decreased coordination

NIH Stroke Scale (NIHSS)

Developed by the National Institutes of Health (NIH) Designed to assist with rapid diagnosis of stroke in an emergency situation Out of 42 points, with 0 being no stroke symptoms and 21-42 being severe stroke

Alzheimer's Diagnostic Criteria

Diagnostic Criteria: • Interference with ability to function at work or at usual activities • A decline from a previous level of functioning and performing • Not explained by delirium or major psychiatric disorder • Cognitive impairment established by history-taking from the patient and a knowledgeable informant; and objective bedside mental status examination or neuropsychological testing • Cognitive impairment involving a minimum of two of the following domains: • impaired ability to acquire and remember new information • impaired reasoning and handing of complex tasks, poor judgment • impaired visuospatial abilities • impaired language functions • changes in personality and/or behavior Common dx test: · CBC, CHEM, TSH, B12, CT, MRI, PET · Cog function tests, EEG, CSF sample New dx test: • Biomarkers - beta-amyloid and tau levels in cerebrospinal fluid • Brain Imaging/ Neuroimaging • PET Scan • Decreased glucose metabolism • Visualize amyloid plaques • CSF Proteins • Genetic Testing - APOE-e4 All together these form a picture of what type of disease is going on

The nurse is reviewing the medication history of a client diagnosed with myasthenia gravis (MG) who has been prescribed a cholinesterase (ChE) inhibitor. The nurse contacts the primary health care provider (PHCP) if the client is taking which medication? Acetaminophen (Tylenol) Diazepam (Valium) Furosemide (Lasix) Ibuprofen (Motrin)

Diazepam (Valium)

Impact of dementia on individuals and society

Disrupts individual's ability to work, social function, family responsibility, ability to perform ADLS Affects 15% of older Americans Over 100 causes 60-80% of patients with dementia have Alzheimer's Half of these residents live in long-term care facilities

NT of sympathetic nervous system

Dopamine in CNS Epi and norepi in PNS

What other conditions can inhibit motor function?

Drug and alcohol intoxiciation After seizures Liver disease

Etiology of dementia

Due to treatable and non-treatable causes Treatable conditions can become irreversible with prolonged exposure or diseases Most common causes: neurodegenerative conditions and vascular disorders

When to do focused neuro assessment?

During the shift with any neurological change noticed Any change from baseline should be reported to doctor immediately

The nurse admits a client with suspected myasthenia gravis (MG). The nurse anticipates that the primary health care provider (PHCP) will request which medication to aid in the diagnosis of MG? Atropine Edrophonium chloride (Tensilon) Methylprednisolone (Solu-Medrol) Ropinirole (Requip)

Edrophonium chloride (Tensilon) Edrophonium chloride (Tensilon) and neostigmine bromide (Prostigmin) may be used for testing for MG. Tensilon is used most often because of its rapid onset and brief duration of action. This drug inhibits the breakdown of acetylcholine (ACh) at the postsynaptic membrane, which increases the availability of ACh for excitation of postsynaptic receptors. Atropine has parasympatholytic effects and is the antidote for edrophonium chloride. Methylprednisolone (Solu-Medrol) is a glucocorticoid that is used to treat inflammatory disorders. Morphine is an opioid analgesic and is not used in the diagnosis of MG.

A client will be receiving plasmapheresis for treatment of Guillain-Barre'syndrome (GBS). Which posttreatment test will the nurse anticipate to be ordered? Electrolyte panel Electroencephalogram (EEG) Lumbar puncture Urinalysis

Electrolyte panel For the client receiving plasmapheresis for treatment of GBS, the nurse expects that an electrolyte panel will be ordered. Electrolytes will be checked since citrate-induced hypocalcemia is a complication of plasmapheresis.An electroencephalogram evaluates brain waves and is useful in detecting seizure activity. It would not be beneficial in this situation. A lumbar puncture might have been performed as part of the diagnostic process initially but not as part of posttreatment. There is no role for a urinalysis after plasmapheresis.

The nurse admits a client with suspected Eaton-Lambert syndrome. The nurse anticipates that the primary health care provider (PHCP) will request which test to confirm the diagnosis? Doppler study Electromyography (EMG) Magnetic resonance imaging (MRI) Tensilon test

Electromyography (EMG) EMG is used to confirm the diagnosis of Eaton-Lambert syndrome, which is a form of myasthenia gravis (MG) that is often seen with small cell carcinoma of the lung. Doppler study is used frequently in the diagnosis of vascular disorders; Eaton-Lambert syndrome is a neurologic disorder. MRI is not used to confirm the diagnosis of Eaton-Lambert syndrome. The Tensilon test is used as a diagnostic test in MG, but it is not used to confirm the diagnosis of Eaton-Lambert syndrome.

Pre-cerebral angiogram nurse responsibilities

Ensure informed and written consent has been obtained Ask about allergies, esp. to contrast, shellfish, iodine Keep patient well hydrated because dye is flushed through the kidneys Assess kidney function: if BUN or creatinine are elevated, contrast could put patient into renal failure Peripheral pulse check: dye likely being injected through femoral artery; checking that it has circulation Skin prep Explain procedure and that injection may produce warm feeling, like they peed their pants

Pre-CT nurse responsibilites

Ensure informed and written consent has been obtained Explain that procedure is painless but patient must stay immobile during Ask about allergies to iodine, shellfish, contrast if contrast is being used If contrast: explain flushing sensation and check BUN/CREAT levels

Pupil assessment

Equal, round, reactive to light, reactive to accommodation

A client admitted with cerebral edema suddenly begins to have a seizure while the nurse is in the room. What does the nurse do first? Administer phenytoin (Dilantin). Draw the client's blood. Establish an airway. Start an intravenous (IV) line.

Establish an airway. When a client admitted with cerebral edema begins to have a seizure, the nurse must first establish an airway. The primary goal is to open and maintain an airway and then assess the client for the need of additional support during the seizure.Phenytoin (Dilantin) is administered to prevent the recurrence of seizures, not to treat a seizure already underway. Drawing blood or starting an IV is not the priority in this situation. Remember the ABCs during an emergency situation.

How often is GCS performed?

Every 4 hours with head to toe, unless ordered Q1h with neuro assessment

GCS scoring

Eyes: 1-4 -4 Open spontaneously -3 Opens on verbal -2 Opens on pain -1 Unresponsive Speech: 1-5 -5 Speaks spontaneously, makes sense -4 Speaks spontaneously, but is confused -3 Speaks spontaneously, but uses inappropriate words -2 Makes only incomprehensible sounds -1 No verbal response Motor: 1-6 -6 Obeys verbal commands to move +Moves due to stimuli -5 Localizes pain -4 Flexion/Withdrawal from pain -3 Decorticate posture to pain -2 Decerebrate posture to pain -1 No motor response

A client has Guillain-Barré syndrome. Which interdisciplinary health care team members does the nurse plan to collaborate with to help prevent pressure ulcers related to immobility in this client? Select all that apply. Certified hospital chaplain Family members Dietitian Occupational therapist (OT), Social worker

Family members Dietitian Occupational therapist (OT) The nurse should collaborate with the client's family to develop interventions to prevent complications such as pressure ulcers. The family will mostly likely be directly involved in the client's care and should be included. Malnutrition puts the client at greater risk for pressure ulcers, so the dietitian should be included as well. The OT can provide assistive devices that will help prevent ulcers. The certified hospital chaplain and the social worker can assist with providing additional psychosocial support, but would not be involved with direction prevention of ulcers.

SNS functions

Fight or flight: HR increases, BP increases, bronchodilation, pupil dilation, blood shunted from periphery to core (cold extremities), sweating

Which is the most effective way for a college student to minimize the risk for bacterial meningitis? Avoid large crowds. Get the meningococcal vaccine. Take a high dose vitamin C daily. Take prophylactic antibiotics.

Get the meningococcal vaccine. The most effective way for a college student to minimize the risk for bacterial meningitis is to get the meningococcal vaccine. Individuals ages 16-21 years have the highest rates of meningococcal infection and need to be immunized against the virus.Avoiding large crowds is helpful, but is not practical for a college student. Taking a high dose of vitamin C every day does not minimize the risk of bacterial meningitis. However, maintaining a healthy lifestyle, with adequate sleep and nutrition, can improve immunity. Taking prophylactic antibiotics is inappropriate because it leads to antibiotic-resistant strains of microorganisms.

The nurse is performing a rapid neurologic assessment on a trauma client. Which assessment findings are normal? Select all that apply. Decerebrate posturing Glasgow Coma Score (GCS) 15 Lethargy Minimal response to stimulation Pupil constriction to light

Glasgow Coma Score (GCS) 15 Pupil constriction to light

The nurse is providing medication instructions for a client for whom phenytoin (Dilantin) has been ordered for treatment of epilepsy. The nurse instructs the client to avoid which beverage? Apple juice Grape juice Grapefruit juice Prune juice

Grapefruit juice The nurse instructs the client taking phenytoin for epilepsy to avoid taking grapefruit juice. Some citrus fruits and juices, like grapefruit juice, can interfere with the metabolism of phenytoin potentially leading to an increased blood level and toxicity.Apple, grape, and prune juices are not contraindicated for a client taking phenytoin (Dilantin).

The nurse is caring for a client with Guillain-Barré syndrome (GBS) who is receiving intravenous immunoglobulin (IVIG). Which assessment finding warrants immediate evaluation? Chills Generalized malaise Headache with stiff neck Temperature of 99° F (37° C)

Headache with stiff neck A headache with a stiff neck may be a sign of aseptic meningitis, a possible serious complication of IVIG therapy. Chills, generalized malaise, and a low-grade fever are minor adverse effects of IVIG therapy and do not indicate that the therapy should be stopped.

The nurse is caring for a client diagnosed with partial seizures after encephalitis, who is to receive carbamazepine (Tegretol). The nurse plans to monitor the client for which adverse effects? Select all that apply. Alopecia Headaches Dizziness Diplopia Increased blood glucose

Headaches Dizziness Diplopia Adverse effects the nurse must monitor for in a client taking carbamazepine for partial seizures after encephalitis include: headaches, dizziness, and diplopia. Carbamazepine affects the central nervous system, although it's mechanism of action is unclear.Carbamazepine does not cause alopecia and does not increase blood glucose. Divalproex (Depakote) and valproic acid (Depakene) may cause alopecia.

Vascular dementia pathophysiology

Impaired blood flow to brain leads to infarction of brain tissue

All types of dementia cause

Impaired language, judgement, behavior, and ability to learn new info As it progresses, functional ability declines and death occurs

Contraindications for lumbar puncture

Infection, fever, increased WBC count

A client has returned to the unit after a thymectomy and is extubated. The client begins to report chest pain. What does the nurse do next? Calls the Rapid Response Team for immediate intubation Gives sublingual nitroglycerin (Nitrostat) Increases the intravenous (IV) rate Informs the surgeon immediately

Informs the surgeon immediately The client's chest pain is a symptom of a hemothorax or pneumothorax and must be reported to the surgeon immediately. Intubation is indicated only with severe respiratory distress. The cause of chest pain is noncardiac in nature, so nitroglycerin is not warranted. An increase in the IV rate is not indicated for this client.

A client has been admitted with new-onset status epilepticus. Which seizure precautions does the nurse put in place? Select all that apply. Bite block at the bedside Intravenous access (IV) Continuous sedation Suction equipment at the bedside Side-rails raised

Intravenous access (IV) Suction equipment at the bedside Side-rails raised Seizure precautions the nurse institutes for an admitted client with new-onset status epilepticus include IV access, suctioning equipment at the bedside and raised siderails. IV access is needed to administer medications. Suctioning equipment must be available to suction secretions and facilitate an open airway during a seizure. Raised, padded siderails may be used to protect the client from falling out of bed during a seizure.Bite blocks or padded tongue blades would not be used because the client's jaw may clench, causing teeth to break and possibly obstructing the airway. Continuous sedation is a medical intervention and not a seizure precaution

A client with Parkinson disease (PD) is being discharged home with his wife. To ensure success with the management plan, which discharge action is most effective? Involving the client and his wife in developing a plan of care Setting up visitations by a home health nurse Telling his wife what the client needs Writing up a detailed plan of care according to standards

Involving the client and his wife in developing a plan of care The discharge plan most effective when discharging a client home with his spouse is to involve both the client and his wife in developing the plan of care. Involving the client and spouse in drawing up a plan of care is the best way to ensure success with the management plan.Home health nurse visitations are generally helpful but may not be needed for this client. The management plan must be collaborative and include not only the spouse but the client to ensure buy-in. Evidence-based guidelines would be utilized.

If there's an injury to cerebellum, loss of motor and/or sensory function will be (pick one): contralateral; ipsilateral

Ipsilateral

Pre-lumbar puncture nursing responsibilities

Make sure informed consent has been obtained Explain procedure Pre-medicate as ordered

Vascular dementia risk factors

Males Age over 65 Hx of heart disease, stroke, hyperlipidemia, obesity, HTN, etc.

EEG

Measures electrical activity of the brain wires hooked up to the head-- a paste hooks wires to the head and turns into like a cement quiet room painless hold meds such as sedatives know what drugs they are on, including caffeine, tea, monsters etc. for min of 24 hours may hyperventilate if on a ventilator to induce seizure activity so the EEG can pick it up. Monitor patient closely, post procedure paste out of hair. Watch for seizure activity.

The nurse has just received change-of-shift report about a group of clients on the neurosurgical unit. Which client does the nurse attend to first? Adult postoperative left craniotomy client whose hand grip is weaker on the right Middle-aged adult client who had a cerebral aneurysm clipping and is becoming increasingly confused Older adult client who had a carotid endarterectomy and is unable to state the day of the week Young adult client involved in a motor vehicle crash (MVC) who is yelling obscenities at the nursing staff

Middle-aged adult client who had a cerebral aneurysm clipping and is becoming increasingly confused

A client has Parkinson's disease (PD). Which nursing intervention best protects the client from injury? Discouraging the client from activity Encouraging the client to watch the feet when walking Monitoring the client's sleep patterns Suggesting that the client obtain assistance in performing activities of daily living (ADLs)

Monitoring the client's sleep patterns The nursing intervention that best protects the PD client from injury is to monitor the client's sleep patterns. Clients with PD tend to not sleep well at night because of drug therapy and the disease itself. Some clients nap for short periods during the day and may not be aware that they have done so. This sleep misperception could put the client at risk for injury (e.g., falling asleep while driving).Active and passive range-of-motion exercises, muscle stretching, and activity are important to keep the client with PD mobile and flexible. The client with PD needs to avoid watching his or her feet when walking to prevent falls and would be encouraged to participate as much as possible in self-management, including ADLs. Occupational and physical therapists can provide training in ADLs and the use of adaptive devices, as needed, to facilitate independence.

A client arrives in the emergency department with new-onset ptosis, diplopia, and dysphagia. The nurse anticipates that the client will be tested for which neurologic disease? Bell's palsy Guillain-Barré syndrome (GBS) Myasthenia gravis (MG) Trigeminal neuralgia

Myasthenia gravis (MG) Sudden-onset ptosis, diplopia, and dysphagia are classic symptoms of MG. Laboratory studies and a cholinesterase inhibitor test (e.g., Tensilon challenge test) most likely will be done to confirm the diagnosis. Symptoms of Bell's palsy include facial paralysis; the face appears masklike and sags. Symptoms of GBS typically begin in the legs and spread to the arms and upper body. Trigeminal neuralgia is a chronic pain syndrome; this client's symptoms were of sudden onset.

The nurse is assessing the motor and sensory function of an unconscious client. The nurse should use which technique to test the client's peripheral response to pain? Sternal rub Nail bed pressure Pressure on the orbital rim Squeezing of the sternocleidomastoid muscle

Nail bed pressure Nail bed pressure tests a basic motor and sensory peripheral response. Cerebral responses to pain are tested using a sternal rub, placing upward pressure on the orbital rim, or squeezing the clavicle or sternocleidomastoid muscle.

Post-lumbar puncture nursing responsibilities

Neuro assessment q15 min Position patient flat for 2-3 hours Analgesic for headache Ensure sterile dressing on puncture site Observe for complication of bleeding

Reason for family history / genetic risk screening in neuro exam

Neuro diseases present in family history and can relate to current health problems

Staging of Alzheimer's Disease

Note: -patient may bypass a stage -patient may exhibit S/S from multiple stages (depends on environment, fatigue, etc.)

Cause of death in dementia patients

Often from infections and aspiration pneumonia Technically die of complications from loss of brain function

AD risk factors

Older age e4 allele of apolipoprotein gene Family history of dementia Family history of early onset AD or AD in 1st degree relative Family history of Parkinson disease Downs syndrome Head injury with loss of consciousness Very low education (< 6 years) Female gender (+/-) Diabetes and cardiovascular disease

What are other reasons for changes in pupils?

Overdose: still reactive to light, but sluggish Atropine (SNS) stimulation: dilated pupils

Neurodegenerative conditions that cause dementia

PDD, Lewy Body

Role of acetylcholine in PNS and CNS

PNS: activates muscles CNS: supports cognitive brain function

Post-cerebral angiogram nurse responsibilites

Perform neuro and vascular assessments every 15 min until stable (risk of bleeding or clotting in brain) Keep patient flat Assess puncture site and prevent hematoma Assess pulses Continue to monitor renal function for at least 24-48 hours after injection Continue IV fluids to help kidneys flush the dye

Oriented x4

Person, place, time, situation

Which information is most important for the nurse to communicate to the primary care provider (PCP) about a client who is scheduled for CT angiography? Allergy to penicillin History of bacterial meningitis Poor skin turgor and dry mucous membranes The client's dose of metformin (Glucophage) held today

Poor skin turgor and dry mucous membranes

The nurse is administering the intake assessment for a newly admitted client with a history of seizures. The client suddenly begins to seize. What does the nurse do next? Documents the length and time of the seizure. Forces a tongue blade in the mouth. Positions the client on the side. Restrains the client.

Positions the client on the side. When a newly admitted client with a history of seizures begins to seize, the nurse must turn the client on his/her side. Turning the client on the side during a generalized tonic-clonic or complex partial seizure is indicated because he or she may lose consciousness resulting in potential loss of a patent airway.Documenting the length and time of seizures is important, but not the priority intervention. Both forcing a tongue blade in the mouth and restraining the client can cause injury.

A client with myasthenia gravis is admitted with generalized fatigue, a weak voice, and dysphagia. Which client problem has the highest priority? Inability to tolerate everyday activities related to severe fatigue Inability to communicate verbally related to vocal weakness Inability to care for self-related to muscle weakness Potential for aspiration related to difficulty with swallowing

Potential for aspiration related to difficulty with swallowing The potential for aspiration is the highest priority client problem because the client's ability to maintain airway patency is compromised. Although important, an inability to tolerate everyday activities, an inability to communicate verbally related to vocal weakness, and an inability to care for oneself related to muscle weakness are not the nurse's highest priority.

A client with early-stage Alzheimer's disease is admitted to the surgical unit for a biopsy. Which client problem is the priority? Potential for injury related to chronic confusion and physical deficits Risk for reduced mobility related to progression of disability Potential for skin breakdown related to immobility and/or impaired nutritional status Lack of social contact related to personality and behavior changes

Potential for injury related to chronic confusion and physical deficits The priority client problem related to a client admitted to the surgical unit for biopsy is the potential for injury due to chronic confusion and physical deficits. The most important intervention for interdisciplinary care is safety. Chronic confusion and physical deficits place the client with Alzheimer's disease at high risk for injury.Reduced mobility, skin breakdown, and lack of social contact, although potential problems in this population, are more frequently observed in the long-term setting and not the top priority.

A client is admitted with an exacerbation of Guillain-Barré syndrome (GBS), presenting with dyspnea. Which intervention does the nurse perform first? Calls the Rapid Response Team (RRT) to intubate Instructs the client on how to cough effectively Raises the head of the bed to 45 degrees Suctions the client

Raises the head of the bed to 45 degrees The head of the client's bed should be raised to 45 degrees because this allows for increased lung expansion, which improves the client's ability to breathe. Intubation is indicated only if dyspnea is severe or oxygen saturation does not respond to oxygen therapy. Close monitoring of respiratory status is indicated because of the acute stages of GBS. Instructing the client on how to cough effectively is not the priority in this case. The client should be suctioned only if needed to avoid vagal stimulation.

When assessing memory, what 2 categories are important?

Recent and remote (short term and long term)

Loss of __________ __________ is an early sign of neuro dysfunction

Recent memory

Alzheimer's pathophysiology

Reduced ACh, beta amyloid plaques, tau protein tangles, degeneration of neurons and impaired neuron to neuron transmission Early: hippocampus/memory Late: cerebral cortex/speech/reasoning

Contraindication of cerebral angiogram

Renal failure patients Patients with elevated BUN/creatinine Patients with acute kidney injury Patients allergic to iodine, shellfish, contrast

If anything is off in the neuro exam...

Report it to the provider right away

parasympathetic nervous system functions

Rest and digest: pupils constrict and accommodate for near vision, HR slow, bronchioles constrict, increased gastric secretions, increased urination and defecation

Cerebellar function tests

Romberg test Heel to knee and down shn

A client with dementia and Alzheimer's disease is discharged to home. The client's daughter says, "He wanders so much, I am afraid he'll slip away from me." What resource does the nurse suggest? Alzheimer's Wandering Association Lost Family Members Tracking Association National Alzheimer's Group Safe Return Program

Safe Return Program The discharge nurse suggests the Safe Return Program to the daughter of a client who wanders at home. The Safe Return Program, a national, government-funded program of the Alzheimer's Association assists in the identification and safe, timely return of those with dementia who wander off and become lost.The Alzheimer's Wandering Association, National Alzheimer's Group, and Lost Family Members Tracking Association do not exist.

Priority interventions for AD

Safety Prevent injury, wandering, falls Behavior management Assistance with ADL and mobility

Definition of obtunded LOC

Similar to lethargic in which patient has lessened interest in environment; slow response to simulation; tends to sleep more than normal; appears drowsy in between sleep states

A client receiving propranolol (Inderal) as a preventative for migraine headaches is experiencing side effects after taking the drug. Which side effect is of greatest concern to the nurse? Dry mouth Slow heart rate Tingling feelings Warm sensation

Slow HR The side effect that is the greatest concern for a client taking propranolol for migraine headaches is a slow heart rate. Beta blockers such as propranolol (Inderal) may be prescribed as a preventive medication for migraines. Propranolol causes blood vessels to relax and improves blood flow although the exact mechanism of action in migraines is unclear. The client would be taught how to monitor his or her heart rate and appropriately report any deviations to the primary care provider.Dry mouth is typically associated with tricyclic antidepressants such as nortriptyline. Skin flushing, tingling feelings, and a warm sensation are common side effects with triptan medications and are not indications to avoid using this group of drugs. Nortriptyline may be used as a preventive medication. Triptans are utilized as abortive medications after a migraine begins.

2 branches of peripheral nervous system

Somatic (voluntary) and autonomic (involuntary)

What is an example of one circumstance in which you would perform neuro checks more frequently?

TPA administration (observing for hemorrhage)

Bell's Palsy

Temporary paralysis of the seventh cranial nerve that causes paralysis only on the affected side of the face. Also causes loss of taste. Causes: peripheral involvement of 7th cranial nerve: vascular ischemia, virus, edema, inflammatory reaction nursing considerations: protect head from cold drafts analgesics isometric exercises massage warm packs body image support corneal abrasion risks tx: electrical stimulation analgesics steroids

Which statement correctly illustrates the commonality between Guillain-Barré syndrome (GBS) and myasthenia gravis (MG)? The client's respiratory status and muscle function are affected by both diseases. Both diseases are autoimmune diseases with ocular symptoms. Both diseases exhibit exacerbations and remissions of their signs and symptoms. Demyelination of neurons is a cause of both diseases.

The client's respiratory status and muscle function are affected by both diseases. The client's respiratory status and muscle function are affected by both diseases.Both GBS and MG affect respiratory status and muscle function. Only MG is an autoimmune disease with ocular symptoms, and is characterized by exacerbations and remissions, whereas GBS has three acute stages. GBS causes demyelination of the peripheral neurons.

Nursing considerations for cranial nerve disorders

Treat symptoms Comfort measures Occasional surgical intervention

The nurse is assessing a client with a neurologic condition who is reporting difficulty chewing when eating. The nurse suspects that which cranial nerve has been affected? Abducens (CN VI) Facial (CN VII) Trigeminal (CN V) Trochlear (CN IV)

Trigeminal (CN V) The trigeminal nerve affects the muscles of mastication.

3 cranial nerve disorders discussed in class

Trigeminal neuralgia Bell's Palsy Acoustic Neuroma

In what age is babinski reflex normal?

Under 2 years

Which cranial nerve allows a person to feel a light breeze on the face? I (olfactory) III (oculomotor) V (trigeminal) VII (facial)

V (trigeminal)

The nurse has received report on a group of clients. Which client requires the nurse's attention first? Adult who is lethargic after a generalized tonic-clonic seizure Young adult who has experienced four tonic-clonic seizures within the past 30 minutes Middle-aged adult with absence seizures who is staring at a wall and does not respond to questions Older adult with a seizure disorder who has a temperature of 101.9° F (38.8° C)

Young adult who has experienced four tonic-clonic seizures within the past 30 minutes After receiving report on a group of clients, the nurse first needs to attend to the young adult client who is experiencing repeated seizures over the course of 30 minutes. This client is in status epilepticus, which is a medical emergency and requires immediate intervention.The adult client who is lethargic and the middle-aged adult client with absence seizures do not require immediate attention. A fever of 101.9° F (38.8° C), although high, does not require immediate attention.

Which client diagnosed with neurologic injury is typically at highest risk for depression? Older man with a mild stroke Older woman with a seizure Young man with a spinal cord injury Young woman with a minor closed head injury

Young man with a spinal cord injury

NT of parasympathetic nervous system

acetylcholine

Sun downing syndrome

agitation or confusion peaks in evening due to environmental factors that have changed as well as circadian rhythms

Opposing NT for PSNS

catecholamines (epi, norepi, dopamine)

Trigeminal Neuralgia

characterized by severe lightning-like pain due to an inflammation of the fifth cranial nerve (infection or pressure) nursing considerations: -avoid stimulus that increases the attacks treatment options: -tegretol and analgesics (no ETOH with meds) -alcohol injection to nerve -microvascular surgery pt. education: -avoid eye rub -chew on opposition site of face

Lumbar puncture

insertion of a needle into the subarachnoid space between the third and fourth or fourth and fifth lumbar vertebrae to: -withdraw CSF for diagnosis -Relieve pressure -Inject dye or medication

trigeminal dissection

no motor or sensory function on unilateral side

Disease course: AD vs. VaD

o AD: steady decline of cognitive function and mobility, ADL function is impaired, die from complications Vascular dementia: a step-wise progression; it significantly gets worse after each vascular event; symptoms may improve as collateral circulation improves blood flow to area

Dementia vs. delirium

o Delirium o Rapid onset o Acute o Inadequate cognition or acute fluctuation in confusion o Causes: infection, dehydration, drugs and alcohol, toxins, post-surgical o Reversible—treat the underlying cause o Re-orientation to reality is recommended and provide them with safe environment o Dementia o Slow onset o Chronic!! o Progressive decline o Cause: neurodegeneration in brain o Irreversible—treat signs and symptoms o Tx can slow disease but not eradicate o Re-orientation is not recommended in late stages: acknowledge feelings, don't argue, provide safe environment, observe for delusions or hallucinations

pre-MRI nursing interventions

o Explain procedure o Pre-medicate for claustrophobia o Patient must take off ANYTHING METAL o Pens, stethoscope, phone, jewelry o MRI screening form: performed with patient --Pacemaker, implants, cochlear implants, anything metal in body? --If they have any of these (pacemakers, AICD [automatic internal cardiac defibrillator] they cannot have MRI o No post-interventions required

EEG nursing interventions

o Hold any caffeine, sedatives, stimulants (is patient or drug producing effect) o Done at bedside o Patient has to stay super still o Use paste to keep electrodes stuck on head—clean off after done o Decrease environmental stimuli: dim lights, make it quiet, avoid visitors o Make hyperventilate the patient because it can induce seizure activity and that's what they want to see o No propofol, Ativan, etc.

Dementia

o Memory o Orientation o Attention o Language o Judgment o Reasoning

Priority interventions with vascular dementia

o Prevent further vascular events and ID risk factors o Manage risk factors o Diabetes: get BG under control o Stroke: anti-coagulants

Vascular disorder dementia

o caused by an ischemic event in the brain that causes infarction—causes loss of cognitive function -CV disease, ischemic lesions, or hemorrhagic brain lesions --> decreased blood supply to the brain -can be caused by single stroke or multiple strokes

Definition of stuporous LOC

only vigorous and repeated stimuli will arouse the individual (sternal rub, trap pinch, etc.) when left undisturbed, the patient will immediately lapse back to sleep into state of unresponsiveness

Definition of lethargic LOC

patient is drowsy but easily aroused

Lewy body dementia

progressive decline; visual hallucinations; changes in alertness or attention; rigid muscles; slow movement; depression

parasympathetic nervous system

relaxes the body calming effect "rest and digest"

Comatose

state of unconsciousness from which a patient cannot be aroused quantified by Glasgow Coma Scale score of 3-8

2 branches of autonomic nervous system

sympathetic and parasympathetic

Label these 1-4 who you would see first to last: A. 65-year-old who is scheduled for surgery the next day B. 68-year-old who has chronic protein-calorie malnutrition C. 70-year-old who has a history of gout and is reporting joint pain D. 72-year-old who was admitted to the unit with postoperative delirium

· 1) D—risk for injury is priority · 2) C—something that you can treat right now · 3) A—assess for abnormal S/S, V/S, labs, NPO · 4) B—issue is chronic and not much will change

Supportive care for patients with AD

· Active listening · Encourage Support Groups · Respite Care · Maintain own social contacts and leisure activities · Caregiver role strain · Discuss legal/financial support

AD Medications

· Antiseizure medications (prescribed only if a seizure occurs but not placed on these medications to prevent seizures) o Kepra, Valproic acid · Cholinesterase inhibitors: Slow the onset of cognitive decline (do not cure in any way) o Aricept, Razadine, Exolon · Antipsychotic: Reduce psychosis, agitation, or aggression. o Zyprexa, Seroquel, Abilify o Haldol and Thorazine are used less commonly d/t side effects (prolong QT interval à can cause lethal arryhtmias) · Antidepressants: Reduce symptoms · Sedatives: Aid with sleep

Alzheimer's Disease (AD)

· Chronic and Progressive · Memory Loss, altered judgment, visual spatial perception, personality change. · Risk factors: o Age o Gender o Family History o Head Injury · Time of onset to death usually ranges of 3-10 years · Accounts for 60% of dementia occurring over 65 years of age · So many different causes and risk factors

decorticate vs decerebrate posturing

· Decorticate: arms to the core o Abnormal motor movement seen in patient with lesions that interrupt spinal pathways o BETTER · Decerebrate: toes down and hands flail out o Abnormal motor movement with rigidity; associated with dysfunction of the brainstem o Seen in patient with GCS of like 3, but not dead o WORSE o Cer = SERious

AD Nursing Diagnoses

· Self-Care Deficit · Disturbed Sleep Pattern o Keep patients awake and active during the day which promotes restful sleep at night · Impaired verbal communication · Impaired cognitive function · Risk for injury · Agitation