Med Surg III Neuro

A daughter calls 911 for her father that is pulseless and apneic. What is their GCS score? A. 3 B. 5 C. 8 D. 15

A. 3

The nurse is aware that the following is true regarding the administration of Methylprednisolone post spinal cord injury? A. Administration is controversial B. Administration is the standard of care C. Administration of Methylprednisolone should occur within the first 72 hours after the injury D. Administration of Methylprednisolone is given in low doses over the first 2 weeks post injury

A. Administration is controversial

What is a craniotomy? A. Bone flap where blood is removed B. A hole within a cerebral ventricle for drainage C. Biopsy of the brain D. Removal of a brain tumor

A. Bone flap where blood is removed

A patient is being given a medication that stimulates her parasympathetic system. Following administration of this medication, the nurse should anticipate what effect? A. Constricted pupils B. Dilated bronchioles C. Decreased peristaltic movement D. Relaxed muscular walls of the urinary bladder

A. Constricted pupils

Level of consciousness (LOC) can be assessed based on criteria in the Glasgow Coma Scale (GCS). Which of the following indicators are assessed in the GCS? Select all that apply. A. Eye Opening B. Intelligence C. Motor Response D. Verbal Response E. Muscle Strength

A. Eye Opening C. Motor Response D. Verbal Response

A patient is receiving treatment for a complete spinal cord injury at T4. As the nurse you know to educate the patient on the signs and symptoms of autonomic dysreflexia. What signs and symptoms will you educate the patient about? Select all that apply: A. Headache B. Low blood glucose C. Sweating D. Flushed below site of injury E. Pale and cool above site of injury F. Hypertension G. Slow heart rate H. Stuffy nose

A. Headache C. Sweating F. Hypertension G. Slow heart rate H. Stuffy nose The answers are A, C, F, G and H. All of these are signs and symptoms of autonomic dysreflexia. The patient will have flushing above site of injury due to vasodilation from parasympathetic activity BUT will be pale and cool below site of injury due to vasoconstriction occurring below the site of injury for the sympathetic response reflex.

A nurse is providing education to a community group about ischemic strokes. One group member asks if there are ways to reduce the risk for stroke. Which of the following is a risk factor that can be modified? A. Hypertension B. Advanced Age C. Male Gender D. African Heritage

A. Hypertension

The nurse is assessing a patient with a T5 SCI and notes his BP is 206/098, HR 52, and he has profuse diaphoresis. He requests pain medication for his headache. Which action should the nurse first take? A. Immediately elevate the HOB B. Assess the skin for areas of pressure C. Notify the physician D. Check the patient for impaction

A. Immediately elevate the HOB The patient is experiencing Autonomic Dysreflexia. HOB should immediately be elevated to decrease the blood pressure.

A patient is scheduled for a myelogram and the nurse explains to the patient that this is an invasive procedure, which assesses for any lesions in the spinal cord. The nurse should explain that the preparation is similar to which of the following neurologic tests? A. Lumbar Puncture B. MRI C. Cerebral Angiography D. EEG

A. Lumbar Puncture

A client is being admitted into the ED to rule out meningitis. The first action by the nurse should be? A. Place the patient in isolation for droplet precautions B. Start O2 at 2L/min, titrate for O2 saturation >90% C. Call the physician to obtain a CT of the head w/o contrast D. Prepare for Lumbar Puncture

A. Place the patient in isolation for droplet precautions Until ruled out, patient is highly infectious, placing the patient in isolation protects the patient, yourself, and the rest of the ED.

The patient in the ED has just had a diagnostic lumbar puncture. To reduce the incidence of a post-lumbar puncture headache, what is the nurses most appropriate action? A. Position the patient prone B. Position the patient supine with the head of bed flat C. Position the patient left side-lying D. Administer acetaminophen as ordered.

A. Position the patient prone

A patient has autonomic dysreflexia/hyperreflexia with a sudden increase in blood pressure. What position will the nurse immediately put the patient in to decrease the blood pressure? A. Sitting B. Supine C. Prone D. Side-Lying

A. Sitting

Which statements are TRUE about autonomic dysreflexia? Select all that apply: A. "Autonomic dysreflexia is an exaggerated reflex response by the parasympathetic nervous system that results in severe hypertension due to a spinal cord injury." B. "Autonomic dysreflexia causes a slow heart rate and severe hypertension." C. "Autonomic dysreflexia is less likely to occur in a patient who has experienced a lumbar injury." D. "The first-line of treatment for autonomic dysreflexia is an antihypertensive medication."

B. "Autonomic dysreflexia causes a slow heart rate and severe hypertension." C. "Autonomic dysreflexia is less likely to occur in a patient who has experienced a lumbar injury." The answers are B and C. Option A is false, it should say: Autonomic dysreflexia is an exaggerated reflex response by the SYMPATHETIC (NOT parasympathetic) nervous system that results in severe hypertension due to a spinal cord injury. Option D is false because medications are used only if the blood pressure is not decreasing, or the cause cannot be determined.

Which statement, if made by the patient, could indicate the patient is experiencing a hemorrhagic stroke? A. "I do not feel right at all" B. "I'm having the worst headache of my life" C. "Why has my vision suddenly changed?" D. "I feel nauseous and might vomit"

B. "I'm having the worst headache of my life"

What GCS score do you consider intubation? A. 3 B. 8 C. 14 D. 5

B. 8

What is a Ventriculostomy? A. Bone flap where blood is removed B. A hole within a cerebral ventricle for drainage C. Biopsy of the brain D. Removal of a brain tumor

B. A hole within a cerebral ventricle for drainage

A nurse is teaching the family of what to expect after a craniotomy of a patient with a recent hemorrhagic stroke. What should the family except after surgery? Select all that apply. A. A compete resolution of deficits B. A large turban dressing on the head C. Periorbital edema and ecchymosis D. Positioning the client on the nonoperative side E. An incision at the nape of the neck

B. A large turban dressing on the head C. Periorbital edema and ecchymosis D. Positioning the client on the nonoperative side

The nurse is performing a neurologic assessment of a patient whose injuries have rendered her unable to follow verbal commands. How should the nurse proceed with assessing the patients level of consciousness (LOC)? A. Assess the patients vital signs and correlate these with the patients baselines B. Assess the patients eye opening and response to stimuli C. Document that the patient currently lacks a level of consciousness D. Facilitate diagnostic testing in an effort to obtain objective data.

B. Assess the patients eye opening and response to stimuli

The nurse is planning the care of a patient with Parkinson's disease. The nurse should be aware that treatment will focus on what pathophysiological phenomenon? A. Premature degradation of acetylcholine B. Decreased availability of dopamine C. Insufficient synthesis of epinephrine D. Delayed reuptake of serotonin

B. Decreased availability of dopamine

A trauma patient in the ICU has been declared brain dead. What diagnostic test is used in making the determination of brain death? A. Magnetic resonance imaging (MRI) B. Electroencephalography (EEG) C. Electromyography (EMG) D. Computed tomography (CT)

B. Electroencephalography (EEG)

Which risk factor is the most serious to address for the prevention of a recurrent hemorrhagic stroke? A. Weight B. HTN C. Gender D. Age

B. HTN

A trauma patient has increased ICP. Which abnormal parameter goal is acceptable? A. Lower osmolarity B. High MAP C. Lower Diastolic BP D. Higher PCO2

B. High MAP Cerebral autoregulation maintains a constant cerebral vascular blood flow as long as the MAP is maintained in the range of 50-150 mm Hg. When autoregulation in the brain fails, perfusion becomes dependent solely on blood pressure and the MAP. If maintenance of the MAP is disrupted (such as in hemorrhage and hypovolemia), the body's compensatory mechanisms may not be able to sustain a sufficient CPP. With a brain injury that results in an increased ICP, a normal MAP may not be sufficient to maintain CPP.

A client is in a driving accident creating a spinal cord injury. The nurse caring for a client realizes that the client is at risk for which type of shock? A. Anaphylactic B. Neurogenic C. Septic D. Obstructive

B. Neurogenic

A client is just prescribed Levodopa for Parkinson's, the nurse includes in her teaching to take the drug with food to minimize GI upset but to avoid a certain food. What should the client avoid? A. Dairy Products B. Protein C. Fruit D. Veggies

B. Protein

A client scheduled for magnetic resonance imaging (MRI) has arrived at the radiology department. The nurse who prepares the client for the MRI should prioritize what action? A. Withholding stimulants 24-48 hours prior to exam B. Removing all metal-containing objects C. Instructing the client to void prior to the MRI D. Initiating an IV line for administration of contrast

B. Removing all metal-containing objects

A patient was diagnosed with a Left Hemisphere Ischemic Stroke. Which of the following assessment findings would the nurse expect to find with this type of stroke? Select all that apply. A. Left Homonymous Hemianopsia B. Right-sided paralysis C. Cautious behavior D. Left-sided weakness E. Lack of awareness of deficits

B. Right-sided paralysis C. Cautious behavior

Select all the TRUE statements about the pathophysiology of multiple sclerosis: A. The dendrites on the neuron are overstimulated leading to the destruction of the axon. B. The myelin sheath, which is made up of Schwann cells, is damaged along the axon. C. This disease affects the insulating structure found on the neuron in the central nervous system. D. The dopaminergic neurons in the part of the brain called substantia nigra have started to die.

B. The myelin sheath, which is made up of Schwann cells, is damaged along the axon. C. This disease affects the insulating structure found on the neuron in the central nervous system. In multiple sclerosis the myelin sheath (which is the insulating and protective structure made up of Schwann cells that protects the axon) is damaged. MS affects the CNS (central nervous system) and when the myelin sheath becomes damaged it leads to a decrease in nerve transmission.

A client is scheduled for a lumbar puncture. The nurse is preparing the client for the procedure. Which statement by the client indicates a need for further teaching by the nurse? A. "I may feel a sharp pain that shoots to my leg, but it should pass soon" B. "I will go to the bathroom and try to urinate before the procedure" C. "I will need to lie on my stomach during the procedure" D. "The physician will insert a needle between the bones in my lower spine"

C. "I will need to lie on my stomach during the procedure"

A patient with myasthenia gravis will be eating lunch at 1200. It is now 1000 and the patient is scheduled to take Pyridostigmine. At what time should you administer this medication so the patient will have the maximum benefit of this medication? A. As soon as possible B. 1 hour after the patient has eaten (at 1300) C. 1 hour before the patient eats (at 1100) D. At 1200 right before the patient eats

C. 1 hour before the patient eats (at 1100) Pyridostigmine is an anticholinesterase medication that will help improve muscle strength. It is important the patient has maximum muscle strength while eating for the chewing and swallowing process. Therefore, the medication should be given 1 hour before the patient eats because this medication peaks (has the maximum effect) at approximately 1 hour after administration. How does the medication improve muscle strength? It does this by preventing the breakdown of acetylcholine. Remember the nicotinic acetylcholine receptors are damaged and the patient needs as much acetylcholine as possible to prevent muscle weakness. Therefore, this medication will allow more acetylcholine to be used...hence improving muscle strength.

A client suffers a head injury. The nurse implements an assessment plan to monitor for potential subdural hematoma development. Which manifestation does the nurse anticipate seeing first? A. Decreased HR B. Bradycardia C. Alteration of LOC D. Slurred Speech

C. Alteration of LOC

Your patient, who has a spinal cord injury at T3, states they are experiencing a throbbing headache. What is your NEXT nursing action? A. Perform a bladder scan B. Perform a rectal digital examination C. Assess the patient's blood pressure D. Administer a PRN medication to alleviate pain and provide a dark, calm environment.

C. Assess the patient's blood pressure The answer is C. This is the nurse's NEXT action. The patient is at risk for developing autonomic dysreflexia because of their spinal cord injury at T3 (remember patients who have a SCI at T6 or higher are at MOST risk). If a patient with this type of injury states they have a headache, the nurse should NEXT assess the patient's blood pressure. If it is elevated, the nurse would take measures to check the bladder (a bladder issue is the most common cause of AD), bowel, and skin for breakdown.

What is mannitol used for? Select all that apply. A. Seizures B. Parkinson's C. Cerebral Edema D. Acute Ischemic Stroke E. Alzheimer's F. Increased Intracranial Pressure (ICP)

C. Cerebral Edema F. Increased Intracranial Pressure (ICP)

A patient suffering a stroke is having a difficult time swallowing. What would the nurse document this finding as? A. Ataxia B. Arthralgia C. Dysphagia D. Dysarthria

C. Dysphagia

The nurse is caring for a patient with an upper motor neuron lesion. What clinical manifestations should the nurse anticipate when planning the patients neurologic assessment? A. Decreased muscle tone B. Flaccid paralysis C. Loss of voluntary control of movement D. Slow reflexes

C. Loss of voluntary control of movement

A nurse is taking care of a client with Meningitis, the nurse is ensuring the client has a quiet environment and is positioning the client. How should the nurse position the client? Select all that apply. A. Prone B. Side-Lying C. Midline D. HOB 30 Degrees E. Trendelenburg F. Supine G. HOB 75 Degrees

C. Midline D. HOB 30 Degrees

Which interventions should the nurse implement to decrease the risk of DVT for a patient with an SCI? Select all that apply. A. Maintain knees in a flexed position B. Massage the calves twice daily C. Promote increased fluid intake D. Administer prescribed Warfarin E. Apply thigh-high elastic stockings

C. Promote increased fluid intake D. Administer prescribed Warfarin E. Apply thigh-high elastic stockings

A patient is being given a medication that stimulates her sympathetic system. Following administration of this medication, the nurse should anticipate what effect? A. Bronchoconstriction B. Salivation C. Pupil Dilation D. Pupil Constriction

C. Pupil Dilation

The nurse on the Neuro unit is quizzing the new nurse on the unit the potential complications of Meningitis. Which answers should the new nurse select? Select all that apply. A. Respiratory Failure B. Brain Tumor C. SIADH/DI D. Hypertensive Crisis E. Cerebral Aneurysms F. Headache G. Iron Overload H. Seizures I. Sepsis

C. SIADH E. Cerebral Aneurysms F. Headache H. Seizures I. Sepsis

An older adult client is being discharged home. The client lives alone and has atrophy of the olfactory organs. The nurse tells the client's family that it is essential that the client have what installed in the home? A. Grab Bars B. Nonslip Mats C. Baseboard Heaters D. A Smoke Detector

D. A Smoke Detector

What drug is used for an Acute Ischemic Stroke that converts plasminogen to plasmin by directly cleaving peptide bonds at two sites, causing fibrinolysis? A. Keppra B. Levodopa C. Mannitol D. Alteplase (tPa)

D. Alteplase (tPa)

The nurse is conducting a focused neurologic assessment. When assessing the patients cranial nerve function, the nurse would include which of the following assessments? A. Assessment of hand grip B. Assessment of orientation to person, time, and place C. Assessment of arm drift D. Assessment of gag reflex

D. Assessment of gag reflex

What would be an expected response to hyperventilating a patient? A. Cerebral blood vessels dilate B. Hypercarbia C. Hypoxia D. Cerebral blood vessels constrict

D. Cerebral blood vessels constrict

The nurse cares for a patient diagnosed with meningitis on the neuro/medical floor. Which sign or symptom would the nurse expect to observe? A. Shuffled Gait B. Pill Rolling C. Aura D. Nuchal Rigidity

D. Nuchal Rigidity

The nurse is admitting a patient to the unit who is diagnosed with a lower motor neuron lesion. What entry in the patients electronic record is most consistent with this diagnosis? A. Patient exhibits increased muscle tone B. Patient demonstrates normal muscle structure with no evidence of atrophy C. Patient demonstrates hyperactive deep tendon reflexes D. Patient demonstrates an absence of deep tendon reflexes

D. Patient demonstrates an absence of deep tendon reflexes

As the home health nurse, you are helping a patient with Parkinson's Disease get dressed. What item gathered by the patient to wear should NOT be worn? A. Velcro pants B. Pull over sweatshirt C. Non-slip socks D. Rubber sole shoes

D. Rubber sole shoes Rubber sole shoes can make walking difficulty, especially when the patient has a shuffling gait because these type of shoes tend to stick to the floor and can cause the patient to trip. It is best to wear low heel, smooth soles (not slick or hard).

During nursing report, you learn that the patient you will be caring for has Guillain-Barré Syndrome. As the nurse you know that this disease tends to present with: A. Signs and symptoms that are unilateral and descending that start in the lower extremities B. Signs and symptoms that are symmetrical and ascending that start in the upper extremities C. Signs and symptoms that are asymmetrical and ascending that start in the upper extremities D. Signs and symptoms that are symmetrical and ascending that start in the lower extremities

D. Signs and symptoms that are symmetrical and ascending that start in the lower extremities GBS signs and symptoms will most likely start in the lower extremities (ex: feet), be symmetrical, and will gradually spread upward (ascending) to the head. There are various forms of Guillain-Barré Syndrome. Acute inflammatory demyelinating polyradiculoneuropathy (AIDP) is the most common type in the U.S. and this is how this syndrome tends to present.

The physician orders Nitro paste for a patient who has developed autonomic dysreflexia. Which finding would require the nurse to hold the ordered dose of Nitro paste and notify the physician? A. The patient's blood pressure is 130/80. B. The patient reports a throbbing headache. C. The patient's lower extremities are pale and cool. D. The patient states they took Sildenafil 12 hours ago.

D. The patient states they took Sildenafil 12 hours ago. The answer is D. A patient should not receive a dose of Nitro paste if they have taken a phosphodiesterase inhibitor within the past 24 hours (Sildenafil or Tadalafil). This will cause major vasodilation and severe hypotension that will not respond to medication. Another medication should be used. All the other findings are expected with autonomic dysreflexia.

What is the difference between DysphaGia and DysphaSia?

Dysphagia = Difficulty Swallowing Dysphasia = Difficulty Speaking

A client just had a lumbar puncture to confirm diagnosis of Meningitis. The post-op nurse should monitor for what potential complication?

HA due to leakage of CSF, pain is aggravated while sitting, standing, or coughing and resolves after lying down.