N241 Unit 5 Neuro

Pupils that are fixed (nonreactive) and dilated are:

A poor prognosis sign

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

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

A physician orders a patient to take Benztropine (Cogentin). The patient has never taken this medication before and is due to take the first dose at 1000. What statement by the patient requires you to hold the dose and notify the physician? A. "I forgot to tell the doctor I take eye drops for my glaucoma." B. "I had a PET scan last week." C. "I take aspirin once day." D. "My hands are experiencing tremors at rest."

A. "I forgot to tell the doctor I take eye drops for my glaucoma." (This medication is contraindicated for patients with glaucoma)

You're maintaining an external ventricular drain. The ICP readings should be?* A. 5 to 15 mmHg B. 20 to 35 mmHg C. 60 to 100 mmHg D. 5 to 25 mmHg

A. 5 to 15 mmHg

The patient has a blood pressure of 130/88 and ICP reading of 12. What is the patient's cerebral perfusion pressure, and how do you interpret this as the nurse?* A. 90 mmHg, normal B. 62 mmHg, abnormal C. 36 mmHg, abnormal D. 56 mmHg, normal

A. 90 mmHg, normal

You're teaching a group of nursing students about Guillain-Barré Syndrome and how it can affect the autonomic nervous system. Which signs and symptoms verbalized by the students demonstrate they understood the autonomic involvement of this syndrome? Select all that apply:* A. Altered body temperature regulation B. Inability to move facial muscles C. Cardiac dysrhythmias D. Orthostatic hypotension E. Bladder distension

A. Altered body temperature regulation C. Cardiac dysrhythmias D. Orthostatic hypotension E. Bladder distension

A patient with Guillain-Barré Syndrome has a feeding tube for nutrition. Before starting the scheduled feeding, it is essential the nurse? Select all that apply:* A. Assesses for bowel sounds B. Keeps the head of bed less than 30' degrees C. Checks for gastric residual D. Weighs the patient

A. Assesses for bowel sounds C. Checks for gastric residual

A patient with multiple sclerosis has issues with completely emptying the bladder. The physician orders the patient to take ___________, which will help with bladder emptying. A. Bethanechol B. Oxybutynin C. Avonex D. Amantadine

A. Bethanechol

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

A. Bleeding

A patient is suspected of having multiple sclerosis. The neurologist orders various test. The patient's MRI results are back and show lesions on the cerebellum and optic nerve. What signs and symptoms below would correlate with this MRI finding in a patient with multiple sclerosis? A. Blurry vision B. Pain when moving eyes C. Dysarthria D. Balance and coordination issues E. "Pill rolling" of fingers and hands G. Heat intolerance H. Dark spots in vision I. Ptosis

A. Blurry vision B. Pain when moving eyes C. Dysarthria D. Balance and coordination issues H. Dark spots in vision

Select the main structures below that play a role with altering intracranial pressure:* A. Brain B. Neurons C. Cerebrospinal Fluid D. Blood E. Periosteum F. Dura mater

A. Brain C. Cerebrospinal Fluid D. Blood

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

A. Cerebral vasospasm

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

A. Cloudy, turbid CSF

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? A. Cotton-tipped applicator B. Glucometer C. Hammer D. Safety pin

A. Cotton-tipped applicator

A patient is being treated for increased intracranial pressure. Which activities below should the patient avoid performing?* A. Coughing B. Sneezing C. Talking D. Valsalva maneuver E. Vomiting F. Keeping the head of the bed between 30- 35 degrees

A. Coughing B. Sneezing D. Valsalva maneuver E. Vomiting

Select all the signs and symptoms that occur with increased ICP:* A. Decorticate posturing B. Tachycardia C. Decrease in pulse pressure D. Cheyne-stokes E. Hemiplegia F. Decerebrate posturing

A. Decorticate posturing D. Cheyne-stokes E. Hemiplegia F. Decerebrate posturing

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? A. Decreased coordination B. Increased sleeping during the night C. Increased touch sensation D. Nightly confusion

A. Decreased coordination

While providing discharge teaching to a patient prescribed Ropinirole (Requip), you make it priority to teach the patient about what side effect? A. Drowsiness B. Dry mouth C. Coughing D. Dark sweat or saliva

A. Drowsiness

A spouse of a husband who has Parkinson's Disease explains to you that her husband experiences episodes while walking where he freezes and can't move. She asks what can be done to help with these types of episodes to prevent injury. Select all the options that are correct: A. Have the husband try to change direction of movement by moving in the opposite direction when the freeze ups occur. B. Use a cane with a laser point while walking. C. Have the husband try to push through the freeze ups. D. Encourage the husband to consciously lift the legs while walking (as with marching).

A. Have the husband try to change direction of movement by moving in the opposite direction when the freeze ups occur. B. Use a cane with a laser point while walking. D. Encourage the husband to consciously lift the legs while walking (as with marching).

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

What is the BEST position for a patient experiencing autonomic dysreflexia?* A. High Fowler's with legs lowered B. Low Fowler's with legs lowered C. Semi-Fowler's with legs at heart level D. Prone

A. High Fowler's with legs lowered

Which of the following is contraindicated in a patient with increased ICP?* A. Lumbar puncture B. Midline position of the head C. Hyperosmotic diuretics D. Barbiturates medications

A. Lumbar puncture

You're assessing a patient's health history for risk factors associated with developing Guillain-Barré Syndrome. Select all the risk factors below:* A. Recent upper respiratory infection B. Patient's age: 3 years old C. Positive stool culture Campylobacter Jejuni D. Hyperthermia E. Epstein-Barr F. Diabetes G. Myasthenia Gravis

A. Recent upper respiratory infection C. Positive stool culture Campylobacter Jejuni E. Epstein-Barr

You're collecting vital signs on a patient with ICP. The patient has a Glascoma Scale rating of 4. How will you assess the patient's temperature?* A. Rectal B. Oral C. Axillary

A. Rectal

patient with Parkinson Disease is experiencing weight loss due to difficulty chewing and swallowing. Which meal option below is the best for this patient? A. Scrambled eggs with a side of cottage cheese B. Grilled cheese with apple slices C. Baked chicken with bacon slices D. Tacos with refried beans

A. Scrambled eggs with a side of cottage cheese

You're caring for a patient with Parkinson's Disease that has tremors. Select the option that is INCORRECT about tremors experienced in this disease: A. The tremors are most likely to occur with purposeful movements. B. A common term used to describe the tremors in the hands and fingers is called "pill-rolling". C. Tremors are one of the most common signs and symptoms in Parkinson's Disease. D. Tremors in this disease can occur in the hands, fingers, arms, legs and even the lips and tongue.

A. The tremors are most likely to occur with purposeful movements.

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

B. "Are you taking ibuprofen daily?"

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."

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? A. "I always take my medicine as directed." B. "I only eat little snacks so I don't gain weight." C. "I will make sure I drink enough water." D. "I make sure to get as much sleep as I used to."

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

You're providing diet education to a patient with Parkinson's Disease. Which statement below demonstrates the patient understood your teaching? Select all that apply: A. "I will limit foods high in fiber like fruits and vegetables in my diet." B. "I will be sure to drink 2 Liter of fluid per day." C. "It is very common for me to experience diarrhea with this disease." D. "I will avoid taking Carbidopa/Levodopa with a protein rich meal."

B. "I will be sure to drink 2 Liter of fluid per day." D. "I will avoid taking Carbidopa/Levodopa with a protein rich meal." (The patient should NOT take this medication with a protein rich meal because levodopa competes with protein in the small intestine (hence decreasing it absorption).)

You're educating a patient about treatment options for Guillain-Barré Syndrome. Which statement by the patient requires you to re-educate the patient about treatment?* A. "Treatments available for this syndrome do not cure the condition but helps speed up recovery time." B. "Plasmapheresis or immunoglobin therapies are treatment options available for this syndrome but are most effective when given within 4 weeks of the onset of symptoms." C. "When I start plasmapheresis treatment a machine will filter my blood to remove the antibodies from my plasma that are attacking the myelin sheath." D. "Immunoglobulin therapy is where IV immunoglobulin from a donor is given to a patient to stop the antibodies that are damaging the nerves.

B. "Plasmapheresis or immunoglobin therapies are treatment options available for this syndrome but are most effective when given within 4 weeks of the onset of symptoms." (Plasmapheresis and immunoglobin therapies are treatment options available for GBS, BUT they are only really effective when given within 2 weeks from the onset of symptoms (not 4 weeks).)

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."

You're providing education to a group of nursing students about ICP. You explain that when cerebral perfusion pressure falls too low the brain is not properly perfused and brain tissue dies. A student asks, "What is a normal cerebral perfusion pressure level?" Your response is:* A. 5-15 mmHg B. 60-100 mmHg C. 30-45 mmHg D. >160 mmHg

B. 60-100 mmHg

Which patient below is at MOST risk for developing a condition called autonomic dysreflexia? A. A 24-year-old male patient with a traumatic brain injury. B. A 15-year-old female patient with a spinal cord injury at C7. C. A 35-year-old male patient with a spinal cord injury at L6. D. A 42-year-old male patient recovering from a hemorrhagic stroke.

B. A 15-year-old female patient with a spinal cord injury at C7.

Which patient below is at MOST risk for increased intracranial pressure?* A. A patient who is experiencing severe hypotension. B. A patient who is admitted with a traumatic brain injury. C. A patient who recently experienced a myocardial infarction. D. A patient post-op from eye surgery.

B. A patient who is admitted with a traumatic brain injury.

A patient is taking Rasagiline "Azilect" for treatment of Parkinson's Disease. What foods do the patient want to limit in their diet? Select all that apply: A. Liver B. Aged Cheese C. Sweetbread D. Beer E. Fermented foods F. Shellfish

B. Aged Cheese D. Beer E. Fermented foods (The patient should avoid foods high in tyramine which can cause a hypertensive crisis. This includes: aged cheese, smoked/cured meats, fermented food, beer.)

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

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

While assessing a patient with Parkinson's Disease, you note the patient's arms slightly jerk as you passively move them toward the patient's body. This is known as: A. Lead Pipe Rigidity B. Cogwheel Rigidity C. Pronate Rigidity D. Flexor Rigidity

B. Cogwheel Rigidity

What assessment finding requires immediate intervention if found while a patient is receiving Mannitol?* A. An ICP of 10 mmHg B. Crackles throughout lung fields C. BP 110/72 D. Patient complains of dry mouth and thirst

B. Crackles throughout lung fields (Mannitol can cause fluid volume overload that leads to heart failure and pulmonary edema. Crackles in the lung fields represent pulmonary edema and requires immediate intervention.)

During the assessment of a patient with increased ICP, you note that the patient's arms are extended straight out and toes pointed downward. You will document this as:* A. Decorticate posturing B. Decerebrate posturing C. Flaccid posturing

B. Decerebrate posturing

You're providing an in-service to a group of new nurse graduates on the causes of autonomic dysreflexia. Select all the most common causes you will discuss during the in-service:* A. Hypoglycemia B. Distended bladder C. Sacral pressure injury D. Fecal impaction E. Urinary tract infection

B. Distended bladder C. Sacral pressure injury D. Fecal impaction E. Urinary tract infection

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

B. Glasgow Coma Score (GCS) 15 E. Pupil constriction to light

During your discharge teaching to a patient with multiple sclerosis, you educate the patient on how to avoid increasing symptoms and relapses. You tell the patient to avoid: A. Cold temperatures B. Infection C. Overexertion D. Salt F. Stress

B. Infection C. Overexertion F. Stress

You're developing a plan of care for a patient with multiple sclerosis who presents with Uhthoff's Sign. What interventions will you include in the patient's plan of care? Select all that apply: A. Avoid movements of the head and neck downward B. Keep room temperature cool C. Encourage patient to use warm packs and heating pads for symptoms D. Educate the patient on three ways to avoid overheating during exercise

B. Keep room temperature cool D. Educate the patient on three ways to avoid overheating during exercise

Your patient is back from having a lumbar puncture. Select all the correct nursing interventions for this patient?* A. Place the patient in lateral recumbent position. B. Keep the patient flat. C. Remind the patient to refrain from eating or drinking for 4 hours. D. Encourage the patient to consume liquids regularly.

B. Keep the patient flat. D. Encourage the patient to consume liquids regularly. (The patient will need to stay flat after the procedure for a prescribed amount of time to prevent a headache, and the nurse will need to encourage the patient to drink fluids regularly to help replace the fluid lost during the lumbar puncture.)

External ventricular drains monitor ICP and are inserted where?* A. Subarachnoid space B. Lateral Ventricle C. Epidural space D. Right Ventricle

B. Lateral Ventricle

You're performing a head-to-toe assessment on a patient with multiple sclerosis. When you ask the patient to move the head and neck downward the patient reports an "electric shock" sensation that travels down the body. You would report your finding to the doctor that the patient is experiencing: A. Romberg's Sign B. Lhermitte's Sign C. Uhthoff's Sign D. Homan's Sign

B. Lhermitte's Sign

You're providing free education to a local community group about the signs and symptoms of Parkinson's Disease. Select all the signs and symptoms a patient could experience with this disease: A. Increased Salivation B. Loss of smell C. Constipation D. Tremors with purposeful movement E. Shuffling of gait F. Freezing of extremities G. Euphoria H. Coordination issues

B. Loss of smell C. Constipation E. Shuffling of gait F. Freezing of extremities H. Coordination issues

A patient is receiving Mannitol for increased ICP. Which statement is INCORRECT about this medication?* A. Mannitol will remove water from the brain and place it in the blood to be removed from the body. B. Mannitol will cause water and electrolyte reabsorption in the renal tubules. C. When a patient receives Mannitol the nurse must monitor the patient for both fluid volume overload and depletion. D. Mannitol is not for patients who are experiencing anuria.

B. Mannitol will cause water and electrolyte reabsorption in the renal tubules. (Mannitol will PREVENT (not cause) water and electrolytes (specifically sodium and chloride) from being reabsorbed....hence it will leave the body as urine.)

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? A. Adult postoperative left craniotomy client whose hand grip is weaker on the right B. Middle-aged adult client who had a cerebral aneurysm clipping and is becoming increasingly confused C. Older adult client who had a carotid endarterectomy and is unable to state the day of the week D. Young adult client involved in a motor vehicle crash (MVC) who is yelling obscenities at the nursing staff

B. Middle-aged adult client who had a cerebral aneurysm clipping and is becoming increasingly confused (A change in level of consciousness is an early indication that central neurologic function has declined. The primary care provider must be notified immediately.)

In autonomic dysreflexia, the nurse would expect what finding below the site of the spinal cord injury?* A. Flushed lower body B. Pale and cool lower extremities C. Low blood pressure D. Absent reflexes

B. Pale and cool lower extremities

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? A. Dry mouth B. Slow heart rate C. Tingling feelings D. Warm sensation

B. Slow heart rate

A 25 year-old presents to the ER with unexplained paralysis from the hips downward. The patient explains that a few days ago her feet were feeling weird and she had trouble walking and now she is unable to move her lower extremities. The patient reports suffering an illness about 2 weeks ago, but has no other health history. The physician suspects Guillain-Barré Syndrome and orders some diagnostic tests. Which finding below during your assessment requires immediate nursing action?* A. The patient reports a headache. B. The patient has a weak cough. C. The patient has absent reflexes in the lower extremities. D. The patient reports paresthesia in the upper extremities.

B. The patient has a weak cough. (The syndrome tends to start in the lower extremities (with paresthesia that will progress to paralysis) and migrate upward. The respiratory system can be affected leading to respiratory failure. Therefore, the nurse should assess for any signs and symptoms that the respiratory system may be compromised (ex: weak cough, shortness of breath, dyspnea...patient says it is hard to breath etc.). The nurse should immediately report this to the MD because the patient may need mechanical ventilation.)

The Monro-Kellie hypothesis explains the compensatory relationship among the structures in the skull that play a role with intracranial pressure. Which of the following are NOT compensatory mechanisms performed by the body to decrease intracranial pressure naturally? Select all that apply:* A. Shifting cerebrospinal fluid to other areas of the brain and spinal cord B. Vasodilation of cerebral vessels C. Decreasing cerebrospinal fluid production D. Leaking proteins into the brain barrier

B. Vasodilation of cerebral vessels D. Leaking proteins into the brain barrier (Vasoconstriction (not dilation) decreases blood flow and helps lower ICP. Leaking of protein actually leads to more swelling of the brain tissue. Remember water is attracted to protein (oncotic pressure).)

Which finding below represents a positive Romberg Sign in a patient with multiple sclerosis? A. The patient report dark spots in the visual fields during the confrontation visual field test. B. When the patient closes the eyes and stands with their feet together they start to lose their balance and sway back and forth. C. The patient's sign and symptoms increase when expose to hot temperatures. D. The patient reports an electric shock feeling when the head and neck are moved downward.

B. When the patient closes the eyes and stands with their feet together they start to lose their balance and sway back and forth.

The patient's lumbar puncture results are back. Which finding below correlates with Guillain-Barré Syndrome?* A. high glucose with normal white blood cells B. high protein with normal white blood cells C. high protein with low white blood cells D. low protein with high white blood cells

B. high protein with normal white blood cells

Your patient is scheduled for a lumbar puncture to help diagnose multiple sclerosis. The patient wants clarification about what will be found in the cerebrospinal fluid during the lumbar puncture to confirm the diagnosis of MS. You explain that ____________ will be present in the fluid if MS is present. A. high amounts of IgM B. oligoclonal bands C. low amounts of WBC D. oblong red blood cells and glucose

B. oligoclonal bands

Pinpoint and nonresponsive pupils are indicative of:

Brainstem dysfunction at the pons.

According to question 16, the patient's blood pressure is 130/88. What is the patient's mean arterial pressure (MAP)?* A. 42 B. 74 C. 102 D. 88

C. 102

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

Which patient below with ICP is experiencing Cushing's Triad? A patient with the following:* A. BP 150/112, HR 110, RR 8 B. BP 90/60, HR 80, RR 22 C. BP 200/60, HR 50, RR 8 D. BP 80/40, HR 49, RR 12

C. BP 200/60, HR 50, RR 8

Which medications below can help treat muscle spasms in a patient with multiple sclerosis? Select all that apply: A. Propranolol B. Isoniazid C. Baclofen D. Diazepam E. Modafinil

C. Baclofen D. Diazepam

A patient with Parkinson's Disease has slow movements that affects their swallowing, facial expressions, and ability to coordinate movements. As the nurse you will document the patient has: A. Akinesia B. "Freeze up" tremors C. Bradykinesia D. Pill-rolling

C. Bradykinesia

You're patient with Parkinson's Disease has been taking Carbidopa/Levodopa for several years. The patient reports that his signs and symptoms actually become worse before the next dose of medication is due. As the nurse, you know what medication can be prescribed with this medication to help decrease this for happening? A. Anticholinergic (Benztropine) B. Dopamine agonists (Ropinirole) C. COMT Inhibitor (Entacapone) D: Beta blockers (Metoprolol)

C. COMT Inhibitor (Entacapone) (Entacapone "Comtan" (is a catechol-O-methyltransferase inhibitors) and is used with levodopa/carbidopa to prevent the "wearing off" of the drug before the next dose is due. It blocks the COMT enzyme that will break down the levodopa in the blood to allow it to last longer.)

A patient is receiving Interferon Beta for treatment of multiple sclerosis. As the nurse you will stress the importance of? A. Physical exercise to improve fatigue B. Low fat diet C. Hand hygiene and avoiding infection D. Reporting ideation of suicide

C. Hand hygiene and avoiding infection

A patient has a ventriculostomy. Which finding would you immediately report to the doctor?* A. Temperature 98.4 'F B. CPP 70 mmHg C. ICP 24 mmHg D. PaCO2 35

C. ICP 24 mmHg

Which tests below can be ordered to help the physician diagnose Guillain-Barré Syndrome? Select all that apply:* A. Edrophonium Test B. Sweat Test C. Lumbar puncture D. Electromyography E. Nerve Conduction Studies

C. Lumbar puncture D. Electromyography E. Nerve Conduction Studies

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? A. Allergy to penicillin B. History of bacterial meningitis C. Poor skin turgor and dry mucous membranes D. The client's dose of metformin (Glucophage) held today

C. Poor skin turgor and dry mucous membranes (This assessment indicates dehydration which places the client at risk for contrast induced nephropathy.)

You're performing a head-to-toe assessment on a patient with a spinal cord injury at T6. The patient is restless, sweaty, and extremely flushed. You assess the patient's blood pressure and heart rate. The patient's blood pressure is 140/98 and heart rate is 52. You look at the patient's chart and find that their baseline blood pressure is 106/76 and heart rate is 72. What action should the nurse take FIRST? A. Reassess the patient's blood pressure. B. Check the patient's blood glucose. C. Position the patient at 90 degrees and lower the legs. D. Provide cooling blankets for the patient.

C. Position the patient at 90 degrees and lower the legs.

After taking all the necessary steps for a patient who has developed autonomic dysreflexia, what should the nurse assess FIRST as a possible cause of this condition?A. Skin break down B. Blood glucose C. Possible bladder irritant D. Last bowel movement

C. Possible bladder irritant

A patient with increased ICP has the following vital signs: blood pressure 99/60, HR 65, Temperature 101.6 'F, respirations 14, oxygen saturation of 95%. ICP reading is 21 mmHg. Based on these findings you would?* A. Administered PRN dose of a vasopressor B. Administer 2 L of oxygen C. Remove extra blankets and give the patient a cool bath D. Perform suctioning

C. Remove extra blankets and give the patient a cool bath (It is important to monitor the patient for hyperthermia (a fever). A fever increases ICP and cerebral blood volume, and metabolic needs of the patient. The nurse can administer antipyretics per MD order, remove extra blankets, decrease room temperature, give a cool bath or use a cooling system. Remember it is important to prevent shivering (this also increases metabolic needs and ICP).)

A patient who experienced a cerebral hemorrhage is at risk for developing increased ICP. Which sign and symptom below is the EARLIEST indicator the patient is having this complication?* A. Bradycardia B. Decerebrate posturing C. Restlessness D. Unequal pupil size

C. Restlessness

A patient is prescribed to take Carbidopa/Levodopa (Sinemet). As the nurse you know that which statement is INCORRECT about this medication: A. It can take up to 3 weeks for the patient to notice a decrease in signs and symptoms when beginning treatment with this medication. B. Body fluids can turn a dark color and stain clothes. C. This medication is most commonly prescribed with a vitamin B6 supplement. D. Carbidopa helps to prevent Levodopa from being broken down in the blood before it enters the brain. Hence, levodopa is able to enter the brain.

C. This medication is most commonly prescribed with a vitamin B6 supplement.

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? A. Abducens (CN VI) B. Facial (CN VII) C. Trigeminal (CN V) D. Trochlear (CN IV)

C. Trigeminal (CN V)

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

C. V (trigeminal)

You're about to send a patient for a lumbar puncture to help rule out Guillain-Barré Syndrome. Before sending the patient you will have the patient?* A. Clean the back with antiseptic B. Drink contrast dye C. Void D. Wash their hair

C. Void

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

C. Young man with a spinal cord injury (Although each individual responds differently, young adults who experience a spinal cord injury and loss of independent movement are more likely to experience depression.)

A patient is experiencing hyperventilation and has a PaCO2 level of 52. The patient has an ICP of 20 mmHg. As the nurse you know that the PaCO2 level will?* A. cause vasoconstriction and decrease the ICP B. promote diuresis and decrease the ICP C. cause vasodilation and increase the ICP D. cause vasodilation and decrease the ICP

C. cause vasodilation and increase the ICP

As the nurse you know that Parkinson's Disease tends to affect the _____________ of the midbrain, which leads to the depletion of the neurotransmitter ________________. A. red nucleus, acetylcholine B. leminisci, norepinephrine C. substantia nigra, dopamine D. tectum nigra, dopamine

C. substantia nigra, dopamine

Criteria for notifying HCP of change in patient's condition? (3)

Changes in LOC, speech, alertness, sensation and movement. Acute change in Glasgow Coma Scale New onset or Uncontrolled Seizures

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

D. Client whose Glasgow Coma Scale (GCS) has changed from 15 to 13. (A decrease of 2 or more points in the Glasgow Coma Scale total is clinically significant and indicates a major change in neurologic status. This finding must be reported immediately to the primary health care provider (PHCP).)

While positioning a patient in bed with increased ICP, it important to avoid?* A. Midline positioning of the head B. Placing the HOB at 30-35 degrees C. Preventing flexion of the neck D. Flexion of the hips

D. Flexion of the hips (Avoid flexing the hips because this can increase intra-abdominal/thoracic pressure, which will increase ICP.)

The nurse is about to assess for bowel impaction in a patient who has developed autonomic dysreflexia. The nurse makes it priority to?* A. Avoid using lubricants B. Stimulate the bowel with rectal manipulation C. Slowly administer a saline solution prior to assessment D. Instill an anesthetic jelly prior to assessment

D. Instill an anesthetic jelly prior to assessment

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 the eye assessment of a patient with increased ICP, you need to assess the oculocephalic reflex. If the patient has brain stem damage what response will you find?* A. The eyes will roll down as the head is moved side to side. B. The eyes will move in the opposite direction as the head is moved side to side. C. The eyes will roll back as the head is moved side to side. D. The eyes will be in a fixed mid-line position as the head is moved side to side.

D. The eyes will be in a fixed mid-line position as the head is moved side to side.

The physician orders Nitropaste for a patient who has developed autonomic dysreflexia. Which finding would require the nurse to hold the ordered dose of Nitropaste 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. (A patient should not receive a dose of Nitropaste 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.)

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

What is Parkinson's Disease?

Disease of basal ganglia characterized by: Slowing down in the initiation and execution of movement. Increased muscle tone (rigidity) Tremors at rest Impaired Postural reflexes (instability) (Not enough Dopamine)

Two neurotransmitters involved in Parkinson's Disease

Dopamine and Acteylcholine

Multiple Sclerosis tends to affect men more than women and occurs during the ages of 50-70 years. TRUE or FALSE?

FALSE

Parkinson's Disease most commonly affects patients in young adulthood, and there is currently no cure for the disease. TRUE or FALSE?

FALSE

Patients with multiple sclerosis have different signs and symptoms because this disease can affect various areas of the peripheral nervous system. TRUE or FALSE?

FALSE (CENTRAL NERVOUS SYSTEM)

Guillain-Barré Syndrome occurs when the body's immune system attacks the myelin sheath on the nerves in the central nervous system. TRUE or FALSE?

FALSE (PERIPHERAL not Central)

Ovoid pupils which is regarded as the mid-stage between normal-size and dilated can indicate:

HERNIATION

Asymmetric pupils, loss of light reaction or unilateral or bilateral are treated as:

Herniation of the brain stem from ICP until proven different.

The earliest indicator of change is ____?

LOC!

Neuro Exams: If your patient can follow commands, the exam should include _____, ______, _______, _______, and _________.

LOC, Pupils, Cranial Nerves, Motor response and sensation

What are the 12 cranial nerves?

Olfactory Optic Oculomotor Trochlear Trigeminal Abducens Facial Acoustic (Vestibulocochelar) Glossopharyngeal Vagus Accessory Hypoglossal

Neuro Exams: If your patient cannot follow commands, you will only be able to assess _______, ________, and ________.

Pupils, eye opening, and motor response

FOUR Cardinal Signs of Parkinson's Disease

TRAP Tremors Rigidity Akinesia/Bradykinesia Postural Instability