NURS202

Uhthoff's sign

- A temporary worsening of vision and other neurological functions commonly seen in clients who have or are predisposed to MS, just after exertion or in situations where they are exposed to heat

alexia or dyslexia

difficulty reading

dysphagia

difficulty swallowing or chewing

acalculia

difficulty with math calculations

agraphia

difficulty writing

Parkinson's disease treatment

dopaminergics can slow disease progression, most effective in the first 3-5 years

diplopia

double vision

myasthenia gravis (MG) nursing care

education should focus on fatigue management and managing medication administration to optimize function

transcranial doppler ultrasonography indications

evaluation of cerebral vasospasm or narrowing of arteries

first phase of migraine

1. aura lasting minutes to an hour 2. well-defined transient focal neurological dysfunction 3. pain preceded by - flashing lights, lines spots, shimmering or zigzag lights 4. variety of neurologic changes - numbness tingling of lips or tongue, acute confusional state, aphasia, vertigo, unilateral weakness, drowsiness

What to report to physician.

1. decrease of 2 or more points in GCS 2. pinpoint, dilated, non reactive pupils. 3. abnormal flexion or extension of extremities 4. sudden or subtle changes in mental status

second phase of migraine

1. headache with nausea vomiting 2. pain beginning in temple, increases in intensity and becomes throbbing within 1 hour

three categories of migraine

1. migraine with aura (classic) 2. migraine without aura 3. atypical migraine

third phase of migraine

1. pain changes from throbbing to dull 2. headache, nausea, vomiting last 4-72 hours 3. visual migraine = aura without pain

Which of the following would the nurse include as a priority when planning teaching for the patient diagnosed with ALS? A. Advanced directives B. Bowel and bladder diversions C. Vision protection D. Treatment for dyskinesia

A. Advanced directives 3-5 years to live from diagnosis

The nurse is admitting a client diagnosed with multiple sclerosis. Which clinical manifestation should the nurse assess? Select all that apply. A. Muscle flaccidity B. Lethargy C. Dysmetria D. Fatigue E. Dysphagia

A. Muscle flaccidity C. Dysmetria D. Fatigue E. Dysphagia

A nurse is caring for a client who just experienced a generalized seizure. Which of the following actions should the nurse perform first? A. keep the client in a side-lying position B. document the duration of the seizure C. reorient the client to the environment D. provide client hygiene

A. keep the client in a side-lying position

decerebration

extension of the arms and legs, pronation of the arms, and plantar flexion. bad brain damage

ptosis

eyelid drooping

AVPU

Alert, Verbal, Pain, Unresponsive

complete spinal injury

All function is lost below the damaged spinal cord.

positive Romberg exam

eyes closed and swaying

hypotonia

flaccid paralysis inability to overcome forces of gravity

A 21 year old male presents to clinic for extremely painful headaches. Pain is felt above the left eye and described as a 9 out of 10. Headaches are short; most episodes last for 30-45 minutes, and always on the left side. He notices that during an episode, his left eye will become red and watery, and his nose will run on the left side. He was up to three episodes per day. During a headache he will become agitated and restless, and will pace, groan, and hit the wall or floor with his fist. He is very concerned that he may have a brain tumor, meningitis, or some other serious condition. His headaches are most likely which of the following types? A. Migraine with aura B. Cluster headache C. Tension headache D. Migraine with aura

B. Cluster headache

Patient is diagnosed with a left hemisphere stroke. Which manifestations would the nurse expect? A. constant smiling B. Intellectual impairment C. deficits in the right visual field D. Disorientation to, time, place, and person E. inability to discriminate words and letters

B. Intellectual impairment C. deficits in the right visual field E. inability to discriminate words and letters

You're performing a head-tote 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. Rhomberg's sign B. Lhermitte's sign C. Uhthoff's sign D. Homan's sign

B. Lhermitte's sign

A nurse is caring for a client who has AD and falls frequently. Which of the following actions should the nurse take first to keep the client safe? A. keep the call light near the client B. Place the client in a room close to the nurses' station C. Encourage the client to ask for assistance D. Remind the client to walk with someone for support

B. Place the client in a room close to the nurses' station

you're educating a patient about treatment options for Guillan-Barre 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 the recovery time B. Plasmapheresis or immunoglobulin 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 immunoglobulin therapies are treatment options available for this syndrome but are most effective when given within 4 weeks of the onset of symptoms. Within 2 weeks not 4

Which ability should nurse Rebecca expect from a client in the mild stage of dementia of the Alzheimer's type? A. Remembering the daily schedule B. Recalling past events C. Coping the anxiety D. Solving problems of daily living

B. Recalling past events

Thrombotic stroke

occurs secondary to the development of a blood clot on an atherosclerotic plaque in a cerebral artery that gradually shuts off the artery and causes ischemia distal to the occlusion

A patient is just admitted to the hospital following a spinal cord injury at the level of T4. A priority nursing care for the patient is monitoring for A. return of reflex B. bradycardia with hypoxemia C. effects of sensory deprivation D. fluctuations in body temperature

B. bradycardia with hypoxemia signs of neurogenic shock. T6 or higher

The patient's wife must leave her husband's bedside for 2 hours to run errands. Which nursing action is appropriate to contribute to patient safety while she is gone? A. Apply restraints B. maintain the bed in a low position C. sit with the patient until his wife returns D. place the call light in the patient's right hand

B. maintain the bed in a low position

which type of headache is suspected when the headaches are unilateral and throbbing, preceded by a prodrome of photophobia, and associated with a family history of this type of headache? A. cluster B. migraine C. caffeine withdrawal D. Sinus

B. migraine frequently unilateral and usually throbbing. usually have a family history. prodrome is also present

Which diagnostic test is used to confirm the diagnosis of ALS? A. electromyogram (EMG) B. muscle biopsy C. Serum creatinine kinase (CK) D. Pulmonary function test

B. muscle biopsy

A patient with a spinal cord injury at C5-C6 reports a sudden severe headache. the patient is flushed. vital signs include a blood pressure of 190/100 mmHg and heart rate of 52 beats/min. What is the priority nursing intervention? A. notify the health care provider B. place the patient in a sitting position C. check the patient for fecal implication D. check the urinary catheter for kinks or obstruction

B. place the patient in a sitting position

The family of a patient with Alzheimer's disease reports increasing symptoms of paranoia in the patient. Which nursing response is most appropriate? A. there is often an underlying psychiatric condition with AD B. some patients with dementia may experience paranoia, delusions, and even hallucinations C. this is a sign of rapid progression of the AD D. inform the patient that their feelings are not real

B. some patients with dementia may experience paranoia, delusions, and even hallucinations

A patient is scheduled for a magnetic resonance imaging (MRI) scan for suspected lung cancer. Which of the following is a contraindication to the study for this patient? A. The patient is allergic to shellfish B. The patient has a pacemaker C. The patient suffers from claustrophobia D. The patient takes antipsychotic medication

B. the patient has a pacemaker implanted pacemaker will interfere with the magnetic field

Autonomic dysreflexia

occurs secondary to the stimulation of the sympathetic nervous system and inadequate compensatory response by the parasympathetic nervous system

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 C. 1 hour before the patient eats D. at 1200 right before the patient eats

C. 1 hour before the patient eats

The spouse of a patient brought to the ED states that 6 hours ago her husband began having difficulty finding words. The patient has since become progressively worse. He has right hemiparesis. Upon assessing the patient, you note that he is lying flat in a supine position and has been incontinent of urine. A. Provide perineal care B. Assess gag reflex C. Elevate head of the bed. D. perform a linen and gown change

C. Elevate head of the bed. airway must be protected

After teaching a patient about management of migraine headaches, the nurse determines that the teaching has been effective when the patient says, A. I will take the topamax as soon as any headache start B. I should avoid taking aspirin and sumatriptan at the same time C. I will try to lie down someplace dark and quiet when the headache begins D. A glass of wine might help me relax and prevent headaches from developing

C. I will try to lie down someplace dark and quiet when the headache begins

The client diagnosed with an acute exacerbation of multiple sclerosis is placed on high-dose intravenous injections of corticosteroid medication. Which nursing intervention should be implemented? A. Discuss discontinuing the proton pump inhibitor with the HCP. B. Hold the medication until after all cultures have been obtained C. Monitor the client's serum blood glucose levels frequently D. Provide supplemental dietary sodium with the client's meals

C. Monitor the client's serum blood glucose levels frequently steroid interfere with glucose metabolism

the nurse is caring for an older adult client who is usually alert and oriented. When the patient exhibits a change in mental status, for which cause does the nurse initially assess? A. infection B. Use of sedatives C. Oxygen insufficiency D. Electrolyte imbalance

C. Oxygen insufficiency ABCs worry about airway first

hemorrhagic stroke

occurs when vessel integrity is interrupted and bleeding occurs in the brain tissue

which assessment data would indicate to the nurse that the client would be at risk for a hemorrhagic stroke? A. a blood glucose of 480 mg/dl B. A right sided carotid bruit C. a blood pressure of 220/120 mmHg D. The presence of bronchogenic carcinoma

C. a blood pressure of 220/120 mmHg

You're educating a patient about the pathophysiology of myasthenia gravis. While explaining the involvement of the thymus gland, the patient asks you where the thymus gland is located. You state it is located? A. behind the thyroid gland B. within the adrenal glands C. behind the sternum in between the lungs D. anterior to the hypothalamus

C. behind the sternum in between the lungs

The patient needs assistance with feeding, but can swallow well. To whome should the nurse delegate this responsibility? A. Hospital volunteer B. licensed practical nurse C. certified nursing assistant D. Student nurse doing first patient care experience

C. certified nursing assistant

A nurse is assessing a client. Which of the following findings indicated that the client has experienced a left hemispheric stroke? A. impulse control difficulty B. poor judgement C. inability to recognize familiar objects D. loss of depth perception

C. inability to recognize familiar objects

During assessment of a patient with a spinal cord injury at the level of T2 at the rehabilitation center, which finding would concern the nurse the most? A. a heart rate of 92 B. a reddened area over the patient's coccyx C. marked perspiration on the patient's face and arms D. A light inspiratory wheeze on auscultation of the lungs

C. marked perspiration on the patient's face and arms symptoms of autonomic dysreflexia

when caring for a patient with Parkinson disease, the nurse understands that progressive difficulty with which factor is a primary expected outcome? A. nutrition B. elimination C. motor ability D. effective communication

C. motor ability

You are taking care of a patient with a head injury. You use the Glasgow coma scale and the patient score 9. When the GCS is at this number, what would you expect? A. Patient is alert and oriented B. Patient is comatose C. Patient minimally responsive D. Patient is severely agitated

C. patient is minimally responsive GCS score of 15 is alert, 8 is comatose.

the nurse is assessing a patient with Parkinson disease. The nurse notes that the patient has resistance to passive movement of the lower extremities with mildly restrictive movement. Which documentation is most appropriate? A. Rigidity B. Cogwheel C. Plastic D. Lead pipe

C. plastic

A 78 year old client is admitted to the emergency department with numbness and weakness of the left arm and slurred speech. Which nursing intervention is priority? A. prepare to administer recombinant tissue plasminogen activator B. discuss the precipitating factors that caused the symptoms C. schedule for A STAT computer tomography scan of the head D. notify the speech pathologist for an emergency consult

C. schedule for A STAT computer tomography scan of the head

a nurse is completing discharge teaching to a client who has seizures and received a vagal nerve simulator to decrease seizure activity. Which of the following statements should the nurse include in the teaching? A. it is safe to use microwaves that are 1,200 watts or less B. you should avoid the use of CT scans with contrast C. you should place a magnet over the implantable device when you feel an aura occurring D. it is recommended that you use ultrasound diathermy for pain management

C. you should place a magnet over the implantable device when you feel an aura occurring

hemiplegia

paralysis increased muscle activity

left cerebral hemisphere

Controls Right Body Logical, Math, Calculations, Organized traits

right cerebral hemisphere

Controls left body Creative, Visual, facial recognition, visual, and musical traits

Alzheimer's disease (AD) nursing care

patient safety is priority

myasthenia gravis (MG) treatment

treatment includes cholinesterase inhibitors and managing muscle fatigue

aniscoria

unequal pupil size

X-ray indications

used to determine boney fractures, curvatures, bone erosion, bone dislocation, and calcification of tissue

During nursing report, you learn that the patient you will be caring for has Guillain-Barre 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 descending that start in the upper extremities D. Signs and symptoms that are unilateral and descending that start in the lower extremities

D. Signs and symptoms that are symmetrical and ascending that start in the lower extremities

The client is being evaluated to rule out ALS. Which signs/symptoms would the nurse note to confirm the diagnosis? A. Muscle atrophy and flaccidity B. Fatigue and malnutrition C. Slurred speech and dysphagia D. Weakness and paralysis

D. Weakness and paralysis

A nurse is caring for a client who has Parkinson's disease and is starting to display bradykinesia. Which of the following is an appropriate action by the nurse? A. teach the client to walk more quickly when ambulating B. complete passive range-of-motion exercises daily C. place the client on a low-protein, low calorie diet D. give the client extra time to perform activities

D. give the client extra time to perform activities

a female client is admitted to the hospital with diagnosis of Guillain-Barre syndrome. the nurse inquires during the nursing admission interview if the client has history of? A. Seizures or trauma to the brain B. Family history of Guillain-Barre syndrome C. Meningitis during the last 5 years D. Respiratory or gastrointestinal infection during the previous month

D. respiratory or gastrointestinal infection during the previous month

the neurologist is conducting a tension test at the bedside of a patient who is. experiencing unexplained muscle weakness, double vision, difficulty breathing, and ptosis. Which findings after the administration of edrophonium would represent the patient has myasthenia gravis? A. The patient experiences worsening of the muscle weakness B. the patient experiences wheezing along with facial flushing C. the patient reports a tingling sensation in the eyelids and sudden ringing in the ears D. The patient experiences improved strength

D. the patient experiences improved strength

Multiple Sclerosis (MS) treatment

DMTs can reduce the occurrence of relapses, corticosteroids are given to treat relapse

Arteriovenous malformation

a cluster of abnormally formed blood vessels, any one of these vessel can rupture, also causing bleeding into the brain

spinal shock

a complication of spinal cord injury caused by inflammation. total loss of all reflexive and autonomic function below the level of injury, temporarily.

Hyperflexion

a sudden and forceful acceleration of the head forward

consciousness

ability to be aware of the environment, an object, and oneself

amyotrophic lateral sclerosis (ALS) nursing care

advanced directives and end of life planning a priority

seizures

an abnormal, sudden,, excessive, uncontrolled electrical discharge of neurons within the brain that may results in a change in level is consciousness, motor or sensory ability, and/or behavior

decortication

arms, wrists, and fingers are flexed with internal rotation, and plantar flexion of the feet

Guillain-Barre Syndrome (GBS)

ascending muscle weakness can progress to paralysis

cerebral angiography indications

assess blood flow from and to the brain identify aneurisms define vascularity of tumors inject medications that treat clots administer chemotherapy

myasthenia gravis (MG)

autoimmune disease has periods of exacerbation and remission and is characterized by the segmental demyelination of nerve fibers in the brain and spinal cord

hemianopsia

blindness in half of visual field

fixed and dilated pupil

brain death

cluster headaches

brief, intense, unilateral pain generally occurring in spring and fall without warning cause and mechanism unknown more common in men ages 20-50

embolic stroke

caused by an embolus traveling from another part of the body to a cerebral artery

Ischemic stroke

caused by occlusion of a cerebral or carotid artery by either a thrombus or an embolus

Multiple Sclerosis (MS)

chronic progressive degenerative disorder of central nervous system. characterized by segmental demyelination of nerve fibers of brain and spinal cord. Myelin sheet.

epilepsy

chronic recurring abnormal brain electrical activity resulting in two or more seizures

penetrating trauma

classified by speed of object causing the injury

migraine headache

clinical syndrome characterized by recurrent episodic attacks of head pain that serve no protective purpose

migraine headaches

clinical syndrome characterized by recurrent episodic attacks of head pain that serve no protective purpose; reason or cause is unclear

magnetic resonance imaging scan indications

determine tumor size, blood vessel location, detect abnormalities, needle guide biopsy

evoked potentials indications

diagnose brain death and used to confirm MS and some brain tumors

anomia

difficulty finding words

lumbar puncture indications

detect presence of disease ie: MS, meningitis, infection reduce CSF pressure administer chemotherapy or medication

PET and SPECT scan indications

determine tumor activity and or response to treatment determine the presence of dementia

the nurse is ordered to administer lorazepam to a patient experiencing status epilepticus. As a precautionary measure, the nurse will also have what reversal agent on standby? A. narcan B. flumazenil C. calcium chloride D. idarucizumab

flumazenil

amyotrophic lateral sclerosis (ALS) treatment

focuses on symptom management, Riluzole may slow progression

assessment of cerebral function

gait and equilibrium.

ataxia

gait disturbance

hyperextension

head is suddenly accelerated then decelerated

unclassified migraine

headache does not fulfill all of criteria to be classified as a migraine

Neurogenic shock

hypotension, bradycardia, SCI above T5

electroencephalography indications

identify and determine seizure activity, can also be used for detecting sleep disorders and behavioral changes

Cerebral Computed Tomography (CT) Scan indications

identify infarctions, tumors, detect abnormalities, monitor response to treatment, guide needle for biopsies

Electromiography indications

identify muscle and nerve disorders

c3 to c5 injury

inability to breathe

apraxia

inability to perform previous learned skills

aphasia

inability to speak/comprehend language

Guillain-Barre Syndrome (GBS)

inflammatory disease that causes ascending paralysis often follows a viral illness and results in the destruction of the myelin sheath by synthesized T cells

spinal cord injury (SCI)

involve the loss of motor function, sensory function, reflexes, and control of elimination

contrast dye contraindications

kidney function iodine/shellfish allergy

photophobia

light sensitivity, intolerance of light

Akinesia

loss of ability to move your muscle voluntarily

amnesia

loss of memory

Magnetoencephalography (MEG) indications

measures magnetic field in the brain

cognition

mental process involved in gaining knowledge and comprehension

migraine without aura (common migraine)

migraine begins without aura pain aggravated by physical activity pain unilateral, pulsing 1 of the following symptoms is present: nausea/vomiting, photophobia, phonophobia lasts 4-72 hours occurs early morning, during periods of stress, premenstrual tension/fluid retention

status migrainous

migraines that lasts longer than 72 hours

Guillain-Barre Syndrome (GBS) nursing care priority

monitor respiratory status. assessment and ABGs

Parkinson's disease

neuro degenerative disease results from a lack of dopamine in the brain resulting in slow and rigid movements

amyotrophic lateral sclerosis (ALS)

neuro degenerative disease results from the degeneration and demyelination of motor neurons in the spinal cord, which results in paralysis and weakness of the muscle

Alzheimer's disease (AD)

neuro degenerative disease that has seven stages and is characterized by a progressive decline in cognitive functions

migrainous infarction

neurologic symptoms not completely reversible within 7 days. scheme infarct noted on neuroimaging

Parkinson's disease nursing intervention

nursing care focuses on helping client to maintain functional status as long as possible

Axial loading

occurs as a results of vertical compression to the spine

Alzheimer's disease (AD)

progressive memory loss and personality changes

amyotrophic lateral sclerosis (ALS)

progressive muscle weakness and atrophy

myasthenia gravis (MG)

progressive muscle weakness that worsens with repetition and improves with rest, facial manifestations common

PERRLA

pupils equal, round, reactive to light and accommodation

status epilepticus

repeated activity within a 30-min time frame or a single prolonged seizure lasting more than 5 minutes

Excessive rotation

results from excessive rotation of the beyond normal range

proprioception

sense of body position

photophobia

sensitivity to light

phonophobia

sensitivity to sound

Parkinson's disease

slowness in movement, muscle rigidity, and tremors

bradykinesia

slowness of movement

dysarthria

slurred speech

incomplete spinal injury

some function is preserved. Only a portion of the spinal cord may be injured. Prognosis for return of function is better because of preservation of axonal function.

hypertonia

spastic paralysis inability to overcome forces of gravity

atypical migraine

status migrainous migrainous infarction unclassified

abortive therapy

stop the Pain of a migraine during aura phase or soon after start of headache

Transient Ischemic Attack (TIA)

warning sign of impending stroke. temporary neurologic dysfunction resulting from brief interruption in cerebral blood flow

hemiparesis

weakness on one side of the body