Neuro quiz (chapters 65, 67, & 70)

Corticosteroids are used in the treatment of brain tumors for which of the following clinical manifestations? Select all that apply.

Headache Altered level of consciousness Cerebral edema Corticosteroids are used during treatment to reduce cerebral edema and reduce side effects of treatment, such as nausea and vomiting. They are also helpful in relieving headache and alterations in level of consciousness. Antiseizure agents are used to treat seizures if they occur. Corticosteroids are not used for personality changes associated with brain tumors. (ch 70, p. 2057)

The nurse educator is reviewing the assessment of cranial nerves. What should the educator identify as the specific instances when cranial nerves should be assessed? Select all that apply.

In the presence of peripheral nervous system disease With brain stem pathology When level of consciousness is decreased Cranial nerves are assessed when the level of consciousness is decreased, with brain stem pathology, or in the presence of peripheral nervous system disease. Abnormalities in muscle tone and involuntary movements are less likely to prompt the assessment of cranial nerves since these nerves do not directly mediate most aspects of muscle tone and movement. (ch 65, p. 1922)

As a member of the stroke team, the nurse knows that thrombolytic therapy carries the potential for benefit and for harm. The nurse should be cognizant of what contraindications for thrombolytic therapy? Select all that apply.

Recent intracranial pathology Current anticoagulation therapy Symptom onset greater than 3 hours prior to admission Some of the absolute contraindications for thrombolytic therapy include symptom onset greater than 3 hours before admission, a patient who is anticoagulated (with an INR above 1.7), or a patient who has recently had any type of intracranial pathology (e.g., previous stroke, head injury, trauma). (ch 67, p. 1977)

Which of the following are clinical manifestations associated with increased intracranial pressure (ICP)? Select all that apply.

Seizures Nausea with or without vomiting Papilledema Headache Symptoms of increased intracranial pressure include headache, nausea with or without vomiting, and papilledema. Angina is not associated with increased ICP. (ch 70, p. 2054)

The nurse is assessing the client's pupils following a sports injury. Which of the following assessment findings indicates a neurologic concern? Select all that apply.

Unequal pupils Pinpoint pupils Absence of pupillary response Normal assessment findings include that the pupils are equal and reactive to light. Pupils that are unequal, pinpoint in nature, or fail to respond indicate a neurologic impairment. (ch 66, p. 1939)

A client with an incurable brain tumor is experiencing nausea and vomiting and has little interest in eating. His family states, "We don't know how to help him." Which of the following would be appropriate for the nurse to suggest to help improve the client's nutritional intake? Select all that apply.

Plan meals for times when the client is rested. Ensure that the client is free of pain for meals. Provide the client with foods that he likes. Suggestions to improve nutrition include making sure that the client is comfortable, free of pain, and rested. This may require family members to adjust meal times. Additionally, they should eliminate offensive sights, sounds, and odors. Therefore, placing the client near sites of meal preparation may be too overwhelming. If the client has difficulty with or shows disinterest in usual foods, the family should offer foods that the client prefers, rather than attempting to get the client to eat as previously. If the client shows marked deterioration, then some other form of nutritional support such as a feeding tube or parenteral nutrition may be indicated, but only if this measure is consistent with the client's choices for care. (ch 70, p. 2059-2060)

A 76-year-old male client is brought to the clinic by his daughter. The daughter states that her father has had two transient ischemic attacks (TIAs) in the past week. The physician orders carotid angiography and the report reveals that the carotid artery has been narrowed by atherosclerotic plaques. What treatment option does the nurse expect the physician to offer this client to increase blood flow to the brain? Select all that apply.

Balloon angioplasty of the carotid artery followed by stent placement Carotid endarterectomy If narrowing of the carotid artery by atherosclerotic plaques is the cause of the TIAs, a carotid endarterectomy (surgical removal of atherosclerotic plaque) could be performed. A balloon angioplasty of the carotid artery, a procedure similar to a percutaneous transluminal coronary artery angioplasty, may be performed alternatively to dilate the carotid artery and increase blood flow to the brain, followed by stent placement. Options B and C are not options to increase blood flow through the carotid artery to the brain. (ch 67, p. 1976)

A client has just been diagnosed with Parkinson's disease. The nurse is teaching the client and family about dietary issues related to this diagnosis. Which of the following are risks for this client? Select all that apply.

Dysphagia Constipation Choking Eating problems associated with Parkinson's disease include aspiration, choking, constipation, and dysphagia. Fluid overload and anorexia are not specifically related to Parkinson's disease. (ch 70, p. 2067)

The nurse is caring for a patient diagnosed with a subarachnoid hemorrhage resulting from a leaking aneurysm. The patient is awaiting surgery. Which of the following nursing interventions would be appropriate for the nurse to implement? Select all that apply.

Elevate the head of bed 30 degrees. Administer Colace per order. Provide a dimly lit environment. Cerebral aneurysm precautions are implemented for the patient with a diagnosis of an aneurysm to provide a nonstimulating environment, prevent increases in intracranial pressure (ICP), and prevent further bleeding. The patient is placed on immediate and absolute bed rest in a quiet, nonstressful environment, because activity, pain, and anxiety elevate blood pressure, which increases the risk for bleeding. Visitors, except for family, are restricted. Dim lighting is helpful because photophobia (visual intolerance of light) is common. The head of the bed is elevated 15 to 30 degrees to promote venous drainage and decrease ICP. No enemas are permitted, but stool softeners (Colace) and mild laxatives are prescribed. Both prevent constipation, which would cause an increase in ICP, as would enemas. (ch 67, p. 1991)

Nursing students are reviewing information about Parkinson's disease in preparation for class the next day. The students demonstrate an understanding of the material when they identify which of the following as a cardinal sign of this disorder? Select all that apply.

Tremor Rigidity Bradykinesia Postural instability Cardinal signs of Parkinson's disease are tremor, rigidity, bradykinesia, and postural instability. Although mental status changes can occur over the course of the disease, intellect is usually not affected. (ch 70, p. 2063)

A patient with an inoperable brain tumor has been told that he has a short life expectancy. On what aspects of assessment and care should the home health nurse focus? Select all that apply.

Administration of treatments Pain control Management of treatment complications Assistance with self-care Home care needs and interventions focus on four major areas: palliation of symptoms and pain control, assistance in self-care, control of treatment complications, and administration of specific forms of treatment, such as parenteral nutrition. Interpretation of diagnostic tests is normally beyond the purview of the nurse. (ch 70, p. 2060)