Neuro Test 2 Ch 67, 69, 70

What is paresthesia?

A sensation of "pins and needles"

A patient has a cardioembolic stroke. What is the most common cardiac dysrhythmia that is observed on the monitor?

Atrial fibrillation

Describe the various classifications of brain tumors based on their pathophysiology:

Brain tumors are classified according to origin: those arising from the covering of the brain, those developing in or on the cranial nerves, those originating within brain tissue, and metastatic lesions originating elsewhere in the body

Describe how thrombolytic agents treat ischemic stroke.

By dissolving the blood clot that is blocking blood flow to the brain

Cervical disc herniation usually occurs at what interspaces?

C5 to C6 and C6 to C7

Explain how demyelination correlates with a diagnosis of MS:

Demyelination refers to the destruction of myelin, the fatty and protein material that surrounds nerve fibers in the brain and spinal cord. This destruction results in impaired transmission of nerve impulses.

What is Dyskinesia?

Impaired ability to execute voluntary movements

The majority of metastatic lesions to the brain occur from the areas of:

Lung, breast, lower gastrointestinal tract, pancreas, kidney, skin

What is micrographia?

Minute and illegible handwriting

What are the degenerative disorders of the central and peripheral nervous system?

Parkinson disease, Huntington disease, Alzheimer disease, amyotrophic lateral sclerosis, muscular dystrophies, degenerative disc disease, and postpolio syndrome

What are the four cardinal signs of Parkinson disease?

Tremor, rigidity, Bradykinesia, and postural instability

Neurological deficits associated with receptive aphasia

Unable to comprehend the spoken word

Neurological deficits associated with expressive aphasia

Unable to form words that are understandable

Neurological deficits associated with the loss of peripheral vision

Unaware of the borders of objects

The nurse is caring for a patient with Huntington disease in the long-term care facility. What most prominent symptom that correlates with this disease will the nurse document? a. Rapid, jerky, involuntary movements b. Slow, shuffling gait c. Dysphagia and dysphonia d. Dementia

a. Rapid, jerky, involuntary movements

A patient with Huntington disease is prescribed medication to reduce the chorea. What medication will the nurse gives that is the only drug approved for the treatment of the symptom? a. Tetrabenzine b. Carbamazepine c. Phenobarbital d. Diazepam

a. Tetrabenzine

A stroke is also called what? This emphasizes the urgency of its occurrence

brain attack

The main surgical procedure for managing transient ischemic attacks (TIAs) is:

carotid endarterectomy

A spinal cord tumor located within the spinal cord is classified as:

intramedullary

The primary cerebrovascular disorder in the United States is:

stroke

Cranial nerve associated with sinus tract tumor

V

Cranial nerve associated with trigeminal neuralgia

V

Cranial nerve associated with brain stem ischemia

VI

Cranial nerve associated with bell palsy

VII

Cranial nerve associated with herpes zoster

VII

Cranial nerve associated with meniere syndrome

VIII

Cranial nerve associated with GBS

X

A patient having a stroke is having difficulty forming words. What would the nurse document this finding as? a. Ataxia b. Arthralgia c. Dysphagia d. Dysarthria

c. Dysphagia

A patient diagnosed with MS 2 years ago has been admitted to the hospital with another relapse. The previous relapse followed a complete recovery with the exception of occasional vertigo. What type of MS does the nurse recognize this patient most likely has? a. Benign b. Primary progressive c. Relapsing-remitting (RR) d. Disabling

c. Relapsing-remitting (RR)

The nurse is volunteering for a Red Cross blood drive and is taking the history of potential donors. Which volunteer would the nurse know will not be allowed to donate blood? a. A donor with a history of hypertension with a blood pressure of 140/90 mmHg b. A donor who is taking medication for BPH c. A donor who moved to the United States from Canada d. A donor who was in college in England for 1 year

d. A donor who was in college in England for 1 year

The three common focal or localized symptoms of increased ICP are:

hemiparesis, seizures, mental status changes

The most common motor dysfunction of a stroke is:

hemiplegia

The most common cause of acute encephalitis in the United States is:

herpes simplex virus (HSV)

The most common cause of intracerebral hemorrhage is:

hypertension

The three diagnostic tests used to support diagnosis of Creutzfeldt-Jakob are:

immunologic assessment, electroencephalogram (EEG), magnetic resonance imaging (MRI)

What are two common characteristics of muscular dystrophies?

progressive muscle wasting and weakness, abnormal elevation in blood muscle enzymes

Potential complications of a hemorrhagic stroke include:

rebleeding or hematoma expansion, cerebral vasospasm, acute hydrocephalus, seizures

Classic clinical features of Guillain-Barre syndrome are:

areflexia and ascending weakness

The most common cause of cerebrovascular disease:

atherosclerosis

The nurse is caring for a patient with GBS in the intensive care unit and is assessing the patient for autonomic dysfunction. What intervention should be provided in order to determine the presence of autonomic dysfunction? a. Assess the respiratory rate and oxygen saturation b. Assess the blood pressure and heart rate c. Assess the peripheral pulses d. Listen to the bowel sounds

b. Assess the blood pressure and heart rate

Your adult child of a patient with Huntington disease asked the nurse what the risk is of inheriting the disease. What is the best response by the nurse? a. "The disease is hereditary and therefore there is no risk for you" b. "If one parent has the disorder, there is a 75% chance that you will inherit the disease" c. "If one parent has the disorder, there is a 50% chance that you will inherit the disease" d. "The disease is inherited and all offspring of a parent will develop the disease

c. "If one parent has the disorder, there is a 50% chance that you will inherit the disease"

When a patient is assessed and determined to have Parkinson's disease, what clinical manifestation is most commonly present?

Although symptoms are variable, a slow, unilateral resting tremor is present in the majority of patients at the time of diagnosis

Neurological deficits associated with homonymous hemianopsia

Difficulty judging distances

What is radiculopathy?

Disease of the spinal nerve root

Neurological deficits associated with diplopia

Double vision

What are two major collaborative problems for patients with a cervical discectomy?

Hematoma at the surgical site, causing cord compression; and neurologic deficit and recurrent or persistent pain after surgery

The nurse is assisting with giving a Tensilon test to a patient with ptosis. If the test is positive for myasthenia gravis what outcome does the nurse observe? a. 30 seconds after administration, the facial weakness in the ptosis will be relieved for approximately five minutes b. After administration of the medication, there will be no change in the status of the ptosis or facial weakness c. The patient will have recovery of symptoms for at least 24 hours after the administration of the Tensilon d. Eight hours after administration, the acetylcholinesterase Begins to regenerate the available acetylcholine and will relieve symptoms

a. 30 seconds after administration, the facial weakness in the ptosis will be relieved for approximately five minutes

An emergency department nurse understands that a 110 lbs recent stroke victim will receive at least the minimum dose of recombinant t-PA. What minimum dose will the patient receive? a. 50mg b. 60mg c. 85mg d. 100mg

a. 50mg

A college student goes to the infirmary with a fever, headache, and a stiff neck. The nurse suspects the student may have meningitis and has the student transferred to the hospital. If the diagnosis is confirmed, what should the nurse institute for those who have been in contact with the student? (Select all that apply). a. Administration of rifampin b. Administration of ciprofloxacin hydrochloride c. Administration of ceftriaxone sodium d. Administration of amoxicillin e. Administration of rofecoxib

a. Administration of rifampin b. Administration of ciprofloxacin hydrochloride c. Administration of ceftriaxone sodium

Describe the physiologic changes that result from the infiltration of tissue subsequent to the growth of a brain tumor:

A variety of physiologic changes can occur, such as increased ICP and cerebral edema, seizure activity and focal neurologic signs, hydrocephalus, and altered pituitary function

What is Dysphonia?

Abnormal voice quality caused by incoordination of speech muscles

What strategies can the nurse educate the patient with MS about to avoid the disabling effects of fatigue?

Avoiding hot temperatures, effective treatment of depression and anemia, and occupational and physical therapy may help control fatigue, additional strategies include a balance of rest and activities, good nutrition to avoid being overweight and obese, and a healthy lifestyle, including avoidance of alcohol and cigarette smoking.

Neurological deficits associated with dysphagia

Difficulty in swallowing

Neurological deficits associated with paresthesia

Difficulty in swallowing

What is the difference between primary and secondary brain tumors?

Primary brain tumors originate from cells within the brain. Secondary, or metastatic, brain tumors develop from structures outside the brain and are twice as common as primary brain tumors.

What is chorea?

Rapid, jerky, purposeless movements of extremities or facial muscles

What is Akathisia?

Restlessness and agitation

Neurological deficits associated with ataxia

Staggering, unsteady gait

What are the bacteria responsible for the majority of cases of bacterial meningitis in adults:

Streptococcus pneumoniae with Neisseria meningitides

What is the clinical feature unique to the patient with St. Louis encephalitis

Syndrome of inappropriate antidiuretic hormone (SIADH) with hyponatremia

Myasthenia gravis is considered an autoimmune disease in which antibodies are directed against:

acetylcholine receptors

The two medications of choice for acute encephalitis are:

acyclovir (Zovirax) and ganciclovir (Cytovene)

The primary pathology of multiple sclerosis is damage to the:

myelin sheath

The risk of coronary heart disease and stoke has decreased in women on the Dietary Approaches to Stop Hypertension (DASH) diet. What does this dietary regimen consist of?

The DASH diet is high in fruits and vegetables, moderate in low-fat dairy products, and low in animal protein (has a substantial amount of plant protein from legumes and nuts)

What is bradykinesia?

Very slow voluntary movements and speech

The nurse is performing an assessment for a patient in the clinic with Parkinson's disease. The nurse determines that the patients voice has changed since the last visit and there's no more difficult to understand. How should the nurse document the finding? a. Dysphagia b. Dysphonia c. Hypokinesia d. Micrographia

b. Dysphonia

A patient who has had a stroke begins having complications regarding spasticity in the lower extremity. What prescribed medication does the nurse give to help alleviate this problem? a. Diphenhydramin b. Lioresal c. Heparin d. Pregabalin

b. Lioresal

A patient is brought to the emergency department experiencing a possible stroke. What initial diagnostic test for a stroke, usually performed in the emergency department, would the nurse prepare the patient for? a. 12-lead electrocardiogram b. Carotid ultrasound study c. Noncontrast computed tomography d. Transcranial Doppler flow study

c. Noncontrast computed tomography

Describe the process of stereotactic biopsy and its benefits in the diagnosis of brain tumors:

Computer-assisted stereotactic (three-dimensional) biopsy is used to diagnose deep seated brain tumors and to provide a basis for treatment and prognosis. Stereotactic approaches involve the use of a three-dimensional frame that allows very precise localization of the tumor; a stereotactic frame and multiple imagining studies (x-rays, CT scans, or MRIs) are used to localize the tumor and verify its position. Brain-mapping technology helps determine how close diseased areas of the brain are to structures essential for normal brain function.

A patient with a brain tumor reports headaches that are worse in the morning. What explanation does the nurse give for the morning headaches? a. "You may have an increase in intracranial pressure" b. "You are most likely dehydrated" c. "You are probably experiencing migraine headaches" d. "The tumor is shrinking"

a. "You may have an increase in intracranial pressure"

The nurse recognizes that a patient is exhibiting symptoms associated with a TIA. After what period of time does the nurse determine these symptoms will subside? a. 1 hour b. 3 to 6 hours c. 12 hours d. 24 to 36 hours

a. 1 hour

A patient is diagnosed with an intracerebral tumor. The nurse is aware that the diagnosis may include which form(s) of tumor growth? (Select all that apply.) a. Astrocytoma b. Ependymoma c. Medulloblastoma d. Meningioma e. Acoustic neuroma

a. Astrocytoma b. Ependymoma c. Medulloblastoma

What clinical manifestation does the nurse recognize when a patient has had a right hemispheric stroke? a. Left visual field deficit b. Aphasia c. Sow, cautious behavior d. Altered intellectual ability

a. Left visual field deficit

A patient with myasthenia gravis is in the hospital for treatment of pneumonia. The patient informs the nurse that it is very important to take pyridostigmine bromide on time. The nurse gets busy and does not give the medication until after breakfast. What outcome will the patient have related to this late dose? a. The muscles will become fatigued and the patient will not be able to chew food or swallow pills b. There should not be a problem, since the medication was only delayed by about two hours c. The patient will go into cardiac arrest d. The patient will require a double dose prior to lunch

a. The muscles will become fatigued and the patient will not be able to chew food or swallow pills

A patient has been diagnosed with meningococcal meningitis at a community living home. When should prophylactic therapy begin for those who have had close contact with the patient? a. Within 24 hours after exposure b. Within 48 hours after exposure c. Within 72 hours after exposure d. Therapy is not necessary prophylactically and should only be used if the person develops symptoms

a. Within 24 hours after exposure

The nurse caring for a patient with bacterial meningitis is giving dexamethasone that has been prescribed as an adjunct to antibiotic therapy. When does the nurse determine is the appropriate time to give this medication? a. 1 hour after the antibiotic has been infused and daily for 7 days b. 15 to 20 minutes before the first dose of antibiotic and every 6 hours for the next 4 days c. 2 hours prior to the administration of antibiotics for 7 days d. It can be given every 6 hours for 10 days

b. 15 to 20 minutes before the first dose of antibiotic and every 6 hours for the next 4 days

A patient has had a large ischemic stroke and is hospitalized in the neurologic intensive care unit. What interventions will be provided for this patient to decrease intracranial pressure? (Select all that apply.) a. Giving mannitol b. Maintaining the partial pressure of carbon dioxide (PaCO2) within a range of 30 to 35 mmHg c. Giving heparin to induce anticoagulation d. Giving supplemental oxygen if the oxygen saturation is below 85% e. Elevating the head of the bed to 30 degrees

a. Giving mannitol b. Maintaining the partial pressure of carbon dioxide (PaCO2) within a range of 30 to 35 mmHg d. Giving supplemental oxygen if the oxygen saturation is below 85%

The nurse is caring for a patient admitted to the hospital with a brain abscess that developed from an untreated case of otitis media. What assessment data is a priority to alert the nurse to changes in intracranial pressure? a. Level of consciousness b. Peripheral pulses c. Sensory perception d. Crackles bilaterally

a. Level of consciousness

After having a stroke, a patient has cognitive deficits. What are the cognitive deficits the nurse recognizes the patient has as a result of the stroke? (Select all that apply.) a. Poor abstract reasoning b. Decreased attention span c. Short and long term memory loss d. Expressive aphasia e. Paresthesias

a. Poor abstract reasoning b. Decreased attention span c. Short and long term memory loss

A patient with bell palsy says to the nurse, "It doesn't hurt anymore to touch my face. How am I going to get muscle tone back so I don't look like this anymore?" What intervention should the nurse suggest to the patient? a. Suggest massaging the face several times daily, using a gentle upward motion, to maintain muscle tone b. Suggest applying cool compresses on the face several times a day to tighten the muscles c. Inform the patient that the muscle function will return as soon as the virus dissipates d. Tell the patient to smile every four hours

a. Suggest massaging the face several times daily, using a gentle upward motion, to maintain muscle tone

Name the most common type of ischemic stroke

Small, penetrating artery thrombotic stroke affect one or more vessels, and is the most common type of ischemic stroke

Hemorrhagic strokes are caused by bleeding into:

1. Brain tissue 2. Ventricles 3. Subarachnoid Space

Thrombolytic therapy with recombinant plasminogen activator (t-Pa) for ischemic stroke has significantly decreased poststroke symptoms. However, the treatment challenge is that the therapy has to be given within ____ hours.

4.5

What are the five chief complaints of amyotrophic lateral sclerosis (ALS)?

Fatigue, progressive muscle weakness, cramps, fasciculations (twitching), incoordination

Cranial nerve associated with optic neuritis

II

Cranial nerve associated with pituitary tumor

II

Disease-modifying therapies that are available to treat MS include:

Immunomodulating and immunosuppressive agents

The nurse is using a bedside risk scoring system for an adult patient with bacterial meningitis. Name five risks for an unfavorable outcome:

Risks for an unfavorable outcome include older age, a heart rate of greater than 120 bpm, decreased score on the Glasgow coma scale, cranial nerve palsies, and a positive Gram stain one hour after presentation to the hospital.

Cranial nerve associated with vagal body tumors

X

A patient had a carotid endarterectomy yesterday and when the nurse arrived in the room to perform an assessment, the patient states, "All of a sudden, I am having trouble moving my right side." What concern should the nurse have about this complaint? a. A thrombus formation at the site of the endarterectomy b. This is a normal occurrence after an endarterectomy and would not be a concern c. Bleeding from the endarterectomy side d. Surgical wound infection

a. A thrombus formation at the site of the endarterectomy

A patient that had a stroke is experiencing memory loss and impaired learning capacity. In which lobe does the nurse determine that brain damage has most likely occurred? a. Frontal b. Occipital c. Parietal d. Temporal

a. Frontal

The nurse is caring for a patient with MS who is having spasticity in the lower extremities that decreases physical movement. What interventions can the nurse provide to assist with relieving the spasms? (Select all that apply.) a. Have the patient take a hot tub bath to allow muscle relaxation b. Demonstrate daily muscle stretching exercises c. Apply warm compresses to the affected areas d. Allow the patient adequate time to perform exercises e. Assist with a rigorous exercise program to prevent contractures

b. Demonstrate daily muscle stretching exercises c. Apply warm compresses to the affected areas d. Allow the patient adequate time to perform exercises

A patient with Parkinson's disease is exhibiting bradykinesia, rigidity, and trimmers. The symptoms are directly related to what decreased neurotransmitter level? a. Acetylcholine b. Dopamine c. Serotonine d. Phenylalanine

b. Dopamine

A patient suspected of having GBS has had a lumbar puncture for cerebrospinal fluid evaluation. When reviewing the laboratory results, what does the nurse find that is diagnostic for this disease? a. Glucose in the CSF b. Elevated protein levels in the CSF c. Red blood cells present in the CSF d. White blood cells in the CSF

b. Elevated protein levels in the CSF

The nurse is caring for a patient with Parkinson's disease and is preparing to give medication. What does the nurse give to the patient that is considered the most effective drug currently given for the tremor of Parkinson's? a. Ropinirole b. Levodopa c. Amantadine d. Pergolide mesylate

b. Levodopa

A patient with ALS asks if the nurse has heard of a drug that will prolong the patient's life. What medication will the nurse inform the patient may prolong life by 3 to 6 months? a. Baclofen b. Riluzole c. Dantrolene sodium d. Diazepam

b. Riluzole

A patient having an acute stroke with no other significant medical disorders has a blood glucose level of 420 mg/dL. What significance does the hyperglycemia have for this patient? a. The patient has new onset diabetes b. This is significant for poor neurologic outcomes c. The patient has developed diabetes insipidus due to the location of the stroke d. The patient has liver failure

b. This is significant for poor neurologic outcomes

The nurse is caring for a patient in the emergency department with an onset of pain related to trigeminal neuralgia. What subjective data stated by the patient does the nurse determine triggered the paroxysms of pain? a. "I was sitting at home watching television" b. "I was putting my shoes on" c. "I was brushing my teeth" d. "I was taking a bath"

c. "I was brushing my teeth"

A patient is in the acute phase of an ischemic stroke. How long does the nurse know that this phase may last? a. Up to 2 weeks b. Up to 1 week c. 1 to 3 days d. Up to 24 hours

c. 1 to 3 days

A patient is exhibiting seizure like movements localized to one side of the body. What type of brain tumor does the nurse determine the patient most likely has? a. A cerebella tumor b. A frontal lobe tumor c. A motor cortex tumor d. An occipital lobe tumor

c. A motor cortex tumor

A patient with Parkinson's disease asked the nurse what can be done to prevent problems with bowel elimination. What intervention should the nurse include when developing the plan of care for this patient to assist with a regular stool pattern? a. Take psyllium daily b. Take a laxative whenever bloating is experienced c. Adopt a diet with moderate fiber intake d. Adopt a high-fiber diet

c. Adopt a diet with moderate fiber intake

During a Tensilon test to determine if a patient has myasthenia gravis, the patient reports cramping and becomes diaphoretic. Vital signs are blood pressure 130/78, heart rate 42 and respiration 18. What is the priority action by the nurse? a. Place the patient in the supine position b. Give diphenhydramine for the allergic reaction c. Give atropine to control the side effects of edrophonium d. Call the rapid response team because the patient is preparing to arrest

c. Give atropine to control the side effects of edrophonium

The nurse is giving the IV antiviral medication ganciclovir to the patient with herpes simplex virus (HSV)-1 encephalitis. What is the best way for the nurse to give the medication to avoid crystallization of the medication in the urine? a. Give the medication rapidly over 15 minutes with 100mL of NS b. Dilute the medication in 500mL of LR solution c. Give via slow IV over 1 hr d. Give in a drip over 4 hours

c. Give via slow IV over 1 hr

A patient is exhibiting classic signs of a hemorrhagic stroke. What report from the patient would be an indicator fo this type of stroke? a. Numbness of an arm or leg b. Double vision c. Severe headache d. Dizziness and tinnitus

c. Severe headache

A patient is diagnosed with ALS. The nurse understands that the symptoms of the disease will begin in what way? a. Ascending paralysis b. Numbness and tingling in the lower extremities c. Weakness starting in the muscles supplied by the cranial nerves d. Jerky, uncontrolled movements in the extremities

c. Weakness starting in the muscles supplied by the cranial nerves

An older adult patient exhibiting clinical manifestations of a brain tumor is admitted to the hospital for testing. What tumor types does the nurse recognize are commonly seen in the older adult? a. Anaplastic astrocytoma b. Cerebral metastasis from other sites c. Glioblastoma multiforme d. Medulloblastoma

d. Medulloblastoma

A patient with Parkinson's disease is experiencing an on-off syndrome. What does the nurse recognize that the patient's clinical symptoms will be? a. The patient will have unilateral resting tremors and then will have a period of no tremors present b. The patient will have a slow, shuffling gait and then will be able to move at a faster pace c. The patient will have a period when medication with levodopa but will be unnecessary d. Patient will have periods of near him ability, followed by a sudden return of effectiveness of the medication

d. Patient will have periods of near him ability, followed by a sudden return of effectiveness of the medication

The nurse is caring for a patient having a hemorrhagic stroke. What position in the bed will the nurse maintain this patient? a. High fowler's b. Prone c. Supine d. Semi-fowler's

d. Semi-fowler's

The patient is diagnosed with a spinal cord tumor and has had a course of radiation and chemotherapy. Two months after the completion of the radiation, the patient reports severe pain in the back. What does this indicate for the patient? a. Lumbar sacral strain b. The development of a skin ulcer from the radiation c. Hematoma formation d. Spinal metastasis

d. Spinal metastasis

When should the nurse plan the rehabilitation of a patient who is having an ischemic stroke? a. The day before the patient is discharged b. After the patient has passed the acute phase of the stroke c. After the nurse has received the discharge orders d. The day the patient has the stroke

d. The day the patient has the stroke

The majority of patients with myasthenia gravis exhibit the clinical signs of:

double vision, ptosis

As a cause of death in the United States stroke currently ranks:

fourth

The three most common systemic signs of increased intracranial pressure are:

headache, N/V, papilledema (70 to 75% occurrence)

The two categories of stroke:

ischemic and hemorrhagic

The infectious disorders of the nervous system are:

meningitis, brain abscesses, various types of encephalitis, Creutzfeldt-Jakob disease (CJD), variant CJD