Quiz: Chapter 21, The Neurologic System EAQ

The nurse is caring for a patient who suffered massive head trauma and suspects increased intracranial pressure from an automobile accident. Which cranial nerves are most appropriate to check at this time? 1 CN I and CN II 2 CN II and CN III 3 CN III and CN IV 4 CN IV and CN V

CN II and CN III

The nurse is caring for a patient following a cerebral angiography. Which nursing intervention(s) are necessary following this procedure? Select all that apply. 1 Monitoring neurologic status 2 Checking for return of the gag reflex 3 Obtaining regular electrocardiograms (ECGs) 4 Assessment of pulses distant to the puncture site 5 Assessing the catheter puncture site for bleeding

Monitoring neurologic status Assessment of pulses distant to the puncture site Assessing the catheter puncture site for bleeding Monitoring neurologic status, assessing pulses distant to the puncture site, assessing the catheter puncture site for bleeding, and obtaining regular ECGs are standard nursing responsibilities for patients after an angiogram in order to determine if the patient is demonstrating any signs of complications from the test. In addition, vital signs should be monitored and the patient should be assessed for dysphagia and respiratory distress, which could indicate internal bleeding in the neck.

Which cranial nerves affect the function of the eyes? Select all that apply. 1 CN II 2 CN III 3 CN IV 4 CN XI 5 CN VIII

1 CN II 2 CN III 3 CN IV Cranial nerves II, III, and IV affect the eyes. Cranial nerve XI affects shoulder movement and head rotation. Cranial nerve VIII affects hearing and balance.

The nurse is assessing the patient's patellar reflex. The patient asks what the purpose of this exam is. Which response by the nurse is correct? 1 "I am checking the conscious nerve response in your leg." 2 "This assessment determines your hand-eye coordination." 3 "Checking this reflex assesses involuntary muscular contractions." 4 "The patellar reflex demonstrates large voluntary muscle coordination."

"Checking this reflex assesses involuntary muscular contractions." A reflex is an action or movement that is built into the nervous system and does not need the intervention of conscious thought to take place. Checking reflexes does not assess hand-eye coordination or large voluntary muscle coordination.

During a neurologic assessment, the primary health care provider will test the functionality of the patient's facial nerve. What instructions should the nurse give to the patient? Select all that apply. 1 "Frown." 2 "Read a vision chart." 3 "Puff out your cheeks." 4 "Protrude your tongue." 5 "Move your tongue from side to side."

"Frown." "Puff out your cheeks."

The patient who is scheduled for an EEG asks the nurse about the test. Which response by the nurse is most accurate? 1 "It is an electroencephalogram, which means that electricity will be used to measure the activity of your brain cells." 2 "There is really no electricity involved; it just looks that way because they attach a lot of electric wires to your scalp." 3 "It is a recording of electrical output from your brain. You will not experience any pain at all during the test" 4 "There is nothing to worry about so long as you do exactly as you are told. The electroencephalogram technician has had a lot of experience in handling the electric wires and the machine."

"It is a recording of electrical output from your brain. You will not experience any pain at all during the test" An EEG measures the electrical impulses of the brain and is used to detect abnormal brain wave patterns that are indicative of specific diseases, such as seizure disorder, brain tumor, cerebrovascular accident (CVA), head trauma, and infection. The test can also be performed to determine cerebral death. The EEG does not measure the activity of brain cells. It is inappropriate to comment that no electricity is involved or to tell the patient there is nothing to worry about as long as the patient does exactly as told.

A patient who is to have computed tomography (CT scan) of the brain voices concern about the procedure. The LPN/LVN can best allay the patient's fears by making which statement? 1 "CT scans use only a small amount of radioactive material injected into your brain." 2 "The procedure is safe and painless; you will hear a clicking noise as the CT machine rotates." 3 "You will probably be given something to make you drowsy and deaden the pain during the CT scan." 4 "CT scanning is a new procedure, and since it involves the brain, I think the health care provider can answer your questions better than I can."

"The procedure is safe and painless; you will hear a clicking noise as the CT machine rotates." The CT scan is a noninvasive test that is used to examine the brain from many different angles, obtaining a series of cross-sectional images that provide views from three dimensions. Various clicking and whirring noises are heard as the machine rotates the scanner for different views. Radioactive material is not injected into the brain, there is no pain involved, and it is not a new procedure. There is no need to refer the patient's questions to the health care provider, the nurse is capable of explaining the procedure.

The nurse in the intensive care unit is measuring the pressure of the cerebrospinal fluid (CSF). Which statement accurately describes CSF? Select all that apply. 1 CSF circulates within the subarachnoid space. 2 CSF cushions and protects the brain and spinal cord. 3 CSF normal pressure is 90 to 150 cm water pressure (cm H2O). 4 CSF is reabsorbed by the arachnoid villi at the same rate at which it is formed. 5 CSF is formed continuously within the ventricles of the brain as a filtrate from the blood.

1 CSF circulates within the subarachnoid space. 2 CSF cushions and protects the brain and spinal cord. 4 CSF is reabsorbed by the arachnoid villi at the same rate at which it is formed. 5 CSF is formed continuously within the ventricles of the brain as a filtrate from the blood. The CSF circulates within the subarachnoid space, cushions and protects the brain and spinal cord, is reabsorbed by the arachnoid villi at the same rate at which it is formed, and is formed continuously within the ventricles of the brain. Normal CSF pressure is 70 to 125 cm water pressure (cm H2O), not 90 to 150.

What important functions does the hypothalamus have? Select all that apply. 1 Controls appetite 2 Controls respiration 3 Controls water balance 4 Controls body temperature 5 Controls movement of the body

1 Controls appetite 3 Controls water balance 4 Controls body temperature 5 The hypothalamus functions to control appetite, water balance, and body temperature. The pons and the medulla oblongata are involved with respiration. The cerebellum is responsible for the coordination of the movement of the body.

The LPN/LVN discusses ways to prevent a stroke with a patient. Which measures should the nurse include in her teaching? Select all that apply. 1 Proper treatment for hypertension 2 Adequate treatment of atherosclerosis 3 Avoiding the use of recreational drugs 4 Encouraging the use of seatbelts in vehicles 5 Keeping serum cholesterol levels under control

1 Proper treatment for hypertension 2 Adequate treatment of atherosclerosis 3 Avoiding the use of recreational drugs 5 Keeping serum cholesterol levels under control

The brainstem consists of what parts? Select all that apply. 1 Axon 2 Pons 3 Medulla 4 Midbrain

2 Pons 3 Medulla Midbrain The pons, the medulla, and the midbrain are parts of the brainstem. The axon is part of the neuron, and the cerebrum is part of the brain.

Which statements about the Glasgow coma scale are true? Select all that apply. 1 A score of 8 or less indicates coma level. 2 A score of 0 indicates a totally comatose patient. 3 A score of 3 indicates a totally comatose patient. 4 The optimal score is 15, which indicates a fully alert patient. 5 The optimal score is 100, which indicates a fully alert patient.

A score of 8 or less indicates coma level. A score of 3 indicates a totally comatose patient. The optimal score is 15, which indicates a fully alert patient.

The nurse is giving pretest instructions to the patient who is scheduled to have an electroencephalogram (EEG). What should the patient be instructed to avoid prior to the exam? Select all that apply. 1 Alcohol 2 Sleeping pills 3 Coffee and cola drinks 4 Antihypertensive medication 5 Milk and other high-calcium foods

Alcohol 2 Sleeping pills 3 Coffee and cola drink In addition to avoiding alcohol, sleeping pills, coffee, and cola drinks, the patient should be instructed to avoid any sedatives and any other products containing caffeine. Mild and other high-calcium foods are not restricted. The physician may also have the patient hold other medications, such as anticonvulsants. Additionally, the patient may be asked to stay up most of the night before the exam.

A patient who has experienced a stroke has difficulty expressing herself. What medical term is used to describe this? 1 Aphagia 2 Aphasia 3 Dysphagia 4 Dysarthria

Aphasia Aphasia is the medical term used to describe difficulty expressing one's self. Aphagia is the inability or refusal to swallow. Dysphagia is difficulty swallowing. Dysarthria is difficulty speaking.

A nurse has been assigned to a neurologic nursing unit and is considering the special needs of the patients. What are some common problems encountered during the care of patients with neurologic concerns? Select all that apply. Aphasia 2 Asystole 3 Confusion 4 Dysphagia 5 Impaired mobility

Aphasia 3 Confusion 4 Dysphagia 5 Impaired mobility Common neurologic patient care problems include aphasia, confusion, dysphagia, and impaired mobility. Asystole is a cardiac problem that occurs when there ceases to be any cardiac electrical activity.

A nurse is caring for a patient with suspected facial nerve injury. Which methods of assessment of facial nerve palsy does the nurse anticipate will be used by the primary health care provider? Select all that apply. 1 Ask the patient to close the eyes. 2 Prick the tip of the nose with a pin. 3 Ask the patient to puff out the cheeks. 4 Ask the patient to protrude the tongue. 5 Test the sense of taste on the posterior third of the tongue.

Ask the patient to close the eyes. Ask the patient to puff out the cheeks.

The nurse teaches the nursing student about how to care for a patient with aphasia. What information is it important to include? 1 Speak clearly and loudly. 2 Avoid speaking to the patient; speak to the interpreter. 3 Avoid speaking to the patient as if he or she is mentally incompetent. 4 If something needs to be repeated, say it in a different way to help comprehension.

Avoid speaking to the patient as if he or she is mentally incompetent. It is important to avoid speaking to an aphasic patient as if he or she is mentally incompetent. There is no need to speak loudly, unless the aphasic patient is hard of hearing. The patient should be spoken to, not about; the nurse may also need to speak to an interpreter. If something needs to be repeated, it is important to repeat it using exactly the same words.

The nurse teaches the nursing student about how to care for a patient with aphasia. What information is it important to include? 1 Speak clearly and loudly. 2 Avoid speaking to the patient; speak to the interpreter. 3 Avoid speaking to the patient as if he or she is mentally incompetent. I4 If something needs to be repeated, say it in a different way to help comprehension.

Avoid speaking to the patient as if he or she is mentally incompetent. It is important to avoid speaking to an aphasic patient as if he or she is mentally incompetent. There is no need to speak loudly, unless the aphasic patient is hard of hearing. The patient should be spoken to, not about; the nurse may also need to speak to an interpreter. If something needs to be repeated, it is important to repeat it using exactly the same words.

The functional unit of the nervous system consists of what parts? Select all that apply. 1 Axon 2 Cell body 3 Cerebrum 4 Dendrites 5 Brainstem

Axon 2 Cell body 4 Dendrites The functional unit of the nervous system is the neuron, which consists of a cell body, dendrites, and an axon. The cerebrum and the brainstem are parts of the brain.

A patient complains of poor peripheral vision. The nurse anticipates which cranial nerve (CN) will be evaluated by the primary health care provider? 1 CN I 2 CN II 3 CN III 4 CN VII

CN II

The student nurse is performing a neurologic assessment on a patient. When checking changes in the size of the pupils, which action by the student is most appropriate? 1 Darken the room and then shine a light into each eye from the side. 2 Shine the light in both eyes and compare the way in which the pupils constrict. 3 Use a drug to dilate the pupils and, after a few minutes, test their reaction to light. 4 Have the patient in a brightly lighted room and cover one eye while testing the other.

Darken the room and then shine a light into each eye from the side. The pupils should be examined in a room with low light as this will allow the pupils to be naturally dilated. The light source should then be directed into each eye from the side while the other eye is covered. It should be noted whether each pupil constricts and whether it does so briskly or sluggishly. It is not appropriate to shine the light into both eyes, use a drug to dilate the pupils, or have the patient sit in a brightly lit room.

The patient is assessed and charted as "adducted and flexed." What is this posturing called, and where does it indicate that damage to the brain has occurred? 1 Decorticate posturing; the cortex 2 Decerebrate posturing; the cortex 3 Decorticate posturing, the brainstem 4 Decerebrate posturing; the brainstem

Decorticate posturing; the cortex A patient who is adducted and flexed is demonstrating decorticate posturing, which indicates damage to the cortex.

The nurse is performing a "neuro check" on a patient who has demonstrated a decreased level of consciousness (LOC). What is the best way to assess the patient's neuromuscular status? 1 Measure the patient's vital signs. 2 Test the reaction of the patient's pupils to light. 3 Check the patient's response to the stimulus of pinching. 4 Determine whether the patient is able to move his legs and arms.

Determine whether the patient is able to move his legs and arms. When performing a neurologic check on a patient with decreased LOC, the nurse should determine if the patient can follow simple commands by asking him to move his extremities. If the patient is unable to follow simple commands, the nurse should test the patient's pupils and reaction to stimulation such as pinching.

Which neurotransmitters affect the central nervous system and the peripheral nervous system? Select all that apply. 1 Serotonin 2 Dopamine 3 Epinephrine 4 Acetylcholine 5 Norepinephrine

Dopamine 3 Epinephrine 4 Acetylcholine 5 Norepinephrine Dopamine, epinephrine, acetylcholine, and norepinephrine affect the central nervous system and the peripheral nervous system. Serotonin affects only the central nervous system.

A nurse is caring for a patient for whom the health care team suspects cerebral death. Which diagnostic procedure will confirm this? 1 Reflex test 2 Myelogram 3 Lumbar puncture 4 Electroencephalography

Electroencephalography Electroencephalography detects abnormal brain wave patterns. This assesses for abnormal brain wave patterns (or lack of brain waves), which would indicate cerebral death. A myelogram is an x-ray exam of the spinal cord and vertebral column performed after an injection of contrast medium into the subarachnoid space. Reflex tests help to assess the integrity of the nerve circuits and are performed to quickly confirm the integrity of the spinal cord or specific nerve root function. Lumbar puncture is used to aspirate cerebrospinal fluid.

The primary health care provider requests a skull x-ray for a patient. Which nursing intervention should the nurse perform to prepare the patient for the procedure? 1 Encourage fluids 2 Withhold the preceding meal 3 Instruct the patient to empty the bladder 4 Explain that the procedure is noninvasive

Explain that the procedure is noninvasive It is important to explain to the patient that a skull x-ray is a noninvasive procedure. This will help to reduce patient anxiety. Nursing preparations such as encouraging fluids, withholding the preceding meal, and emptying the bladder do not apply to a skull x-ray. These preparations are applied to procedures such as lumbar puncture, cerebral angiography, and positron emission tomography.

How does the nurse assess the hypoglossal cranial nerve? 1 Have the patient smell pickle juice 2 Have the patient shrug the shoulders 3 Have the patient stick the tongue out 4 Perform the Romberg test on the patient

Have the patient stick the tongue out A quick method to assess the hypoglossal cranial nerve is to have the patient stick the tongue out. Having a patient shrug the shoulders tests the spinal accessory nerve. Having the patient smell pickle juice assesses the olfactory nerve. Performing the Romberg test on the patient tests the vestibulocochlear nerve.

A patient has paralysis and a loss of sensation in an extremity. How is that documented? 1 Hemiplegia 2 Tetraplegia 3 Hemiparesis 4 Quadriplegia

Hemiplegia Hemiplegia is the paralysis and loss of sensation in an extremity. Tetraplegia and quadriplegia mean that four limbs are paralyzed. Hemiparesis is one-sided weakness.

patient has paralysis and a loss of sensation in an extremity. How is that documented? 1 Hemiplegia 2 Tetraplegia 3 Hemiparesis 4 Quadriplegi

Hemiplegia Hemiplegia is the paralysis and loss of sensation in an extremity. Tetraplegia and quadriplegia mean that four limbs are paralyzed. Hemiparesis is one-sided weakness.

A nurse is caring for a patient who has recently had a stroke. The patient is having trouble with articulating words. Which cranial nerve (CN) was affected by the stroke? 1 Vagus (CN X) 2 Facial (CN VII) 3 Acoustic (CN VIII) 4 Hypoglossal (CN XII)

Hypoglossal (CN XII)

A nurse is caring for an unconscious patient. When performing the patient's neurologic assessment, the nurse should keep in mind that which statements are true about pupillary response? Select all that apply. 1 If both pupils remain constricted, there is probably damage to the pons. 2 One pupil that remains fixed and dilated indicates increased intracranial pressure (ICP). 3 Pupils that remain dilated and fixed in the presence of a bright light indicate brain damage. 4 The size of the pupils are the same on every patient—there is no need to measure pupil size. 5 The pupils should be examined in a room with fluorescent lights, in which the pupils would usually be constricted.

If both pupils remain constricted, there is probably damage to the pons. One pupil that remains fixed and dilated indicates increased intracranial pressure (ICP).

The primary health care provider requests a cerebral angiography for a patient to detect a potential brain tumor. Which patient instruction is most appropriate to provide? 1 Ensure that the patient has an empty bladder. 2 Explain that the procedure is noninvasive. 3 Inform the patient that a contrast medium will be injected. 4 Tell the patient that full activity will be allowed after the procedure.

Inform the patient that a contrast medium will be injected. Cerebral angiography is a contrast-based test. The nurse should explain that a contrast medium will be injected by a small needle into the artery, making this procedure invasive. An empty bladder is not required with this test. The patient's activity will be restricted to bed rest for a specified amount of time after the procedure.

A patient with a seizure disorder will undergo electroencephalography. Which nursing intervention should the nurse perform to prepare the patient for the procedure? 1 Ensure that the patient has an empty bladder. 2 Ensure that the patient is not wearing metallic jewelry. 3 Assess the patient for contraindications to contrast media. 4 Inform the patient that there is no danger of electrical shock.

Inform the patient that there is no danger of electrical shock. In electroencephalography, the electrical activity of the brain is recorded by scalp electrodes to evaluate seizure disorders. It is a noninvasive procedure and does not pose any danger of electrical shock. An empty bladder is not required for the test because the electrodes are placed on the scalp. The patient may wear metal jewelry because metal does not interfere with the test procedure. Metal jewelry may interfere in tests in which electromagnetic rays are passed through the body—for example, x-rays. The procedure does not involve injecting contrast media; therefore assessing for contraindications to contrast media is not applicable.

Which brain disorders are related to infection? Select all that apply. 1 Meningitis 2 Bell palsy 3 Brain abscess 4 Myasthenia gravis 5 Parkinson disease

Meningitis Brain abscess Meningitis and brain abscess are related to a brain infection. Bell's palsy is related to a cranial nerve disorder. Myasthenia gravis is a neuromuscular disorder. Parkinson's disease is a degenerative disorder.

Which are considered neuromuscular disorders? Select all that apply. 1 Cerebral palsy 2 Multiple sclerosis 3 Huntington disease 4 Migraine, cluster headache 5 Amyotrophic lateral sclerosis

Multiple sclerosis Amyotrophic lateral sclerosis Multiple sclerosis and amyotrophic lateral sclerosis are considered neuromuscular disorders. Cerebral palsy and Huntington disease are genetic/developmental disorders. Migraine, cluster headache, is a cerebrovascular problem.

A patient who is taking phenytoin (Dilantin) has quick back-and-forth oscillation of the eyes. Which medical term is used to describe this? 1 Posturing 2 Nystagmus 3 Accommodation 4 Babinski reflex 3 Accommodation 4 Babinski reflex

Nystagmus Nystagmus is the back-and-forth oscillation of the eyes. Posturing is nonpurposeful movement in response to pain. Accommodation is the eye's ability to focus on far and near objects. Babinski reflex is associated with the toe's movement to response, and it is associated with assessment of the cerebral cortex.

If a patient has visual difficulty related to a nervous system disorder, what part of the cerebrum is likely affected? 1 Frontal 2 Parietal 3 Occipital 4 Temporal

Occipital

How does the nurse assess the vestibulocochlear cranial nerve? 1 Have the patient smell pickle juice. 2 Have the patient shrug the shoulders. 3 Have the patient stick the tongue out. 4 Perform the Romberg test on the patient.

Perform the Romberg test on the patient. Performing the Romberg test on the patient tests the vestibulocochlear nerve. A quick method to assess the hypoglossal cranial nerve is to have the patient stick the tongue out. Having a patient shrug the shoulders tests the spinal accessory nerve. Having the patient smell pickle juice assesses the olfactory nerve.

After a lumbar puncture, the nurse sends the cerebrospinal fluid for investigation. What findings are considered normal for cerebrospinal fluid? Select all that apply. Protein: 14 mg/dL 2 Glucose: 50 mg1/dL 3 Chloride: 155 mEq/L 4 Red blood cell count: 15 cells/μL 5 White blood cell count: 4 cells/ìL

Protein: 14 mg/dL 2 Glucose: 50 mg1/dL 5 White blood cell count: 4 cells/ìL

When increased intracranial pressure (ICP) is suspected, the nurse performs a complete neurologic assessment. What does the pupillary response indicate?

Pupil changes can be caused by pressure on the oculomotor nerve. Pupillary constriction or dilation, as well as size and equality of size and response, must be evaluated. Pupil dilation is not the first sign of increased ICP. Headache and level of consciousness changes are earlier signs.

If a patient had a brain injury near the medulla oblongata, what would be most affected? 1 Respiration 2 Coordination 3 Consciousness 4 Body temperature

Respiration

When assisting with a lumbar puncture, the LPN/LVN helps the patient maintain which position? 1 Knees slightly bent, with spinal column straight 2 Knee-chest, with the lower spine supported by pillows 3 Side-lying, with knees drawn up and spinal column curved 4 Semi-Fowler position, with the head bent downward onto the chest

Side-lying, with knees drawn up and spinal column curved To widen the intervertebral spaces for the lumbar puncture, the patient should be maintained in a position with back bowed, head flexed on chest, and knees drawn up to the abdomen. Straight spinal column, knee-chest, and semi-Fowler positions are not the correct positions for a lumbar puncture.

The nurse is assessing a fully alert patient who moves all extremities well. What score should the nurse give the patient on the Glasgow Coma Scale (GCS)? Record your answer using a whole number. _____

The highest GCS score is 15 for a fully alert person.

A patient has increased intracranial pressure (ICP). What will the nurse evaluate using the Glasgow Coma Scale (GCS)? Select all that apply. 1 The patient's ability to speak clearly 2 The patient's ability to swallow 3 The patient's digestion capacity 4 The patient's ability to obey commands 5 The patient's ability to open the eyes in response to a painful stimulus

The patient's ability to speak clearly The patient's ability to obey commands The patient's ability to open the eyes in response to a painful stimulus

The nurse carefully assesses the patient with the use of the Glasgow coma scale. What does the Glasgow coma scale determine? 1 The patient's ability to posture 2 The patient's level of consciousness 3 The patient's ability to problem solve

The patient's level of consciousness The Glasgow coma scale is a tool that is used to determine the patient's level of consciousness. Specific posturing occurs when there is damage to certain parts of the brain. The Glasgow coma scale does not assess the patient's ability to problem solve. Changes in blood pressure, particularly a rise in systolic pressure and widening (not narrowing) pulse pressure, may indicate an increase in intracranial pressure.

When rating a patient using the Glasgow Coma Scale, what would be appropriate for the LPN/LVN to ask the patient to do in order to test the patient's motor response? 1 Roll his eyes in a circle. 2 Take a deep breath and exhale. 3 Describe the view from his window. 4 Touch his nose with his left index finger.

Touch his nose with his left index finger. The Glasgow Coma Scale is a standardized scale used to determine a patient's neurologic status. It measures the patient's response in three different categories: eye opening, motor response, and verbal response. Determining if the patient can follow a simple command, such as touching his nose, would be an appropriate test of motor response.

The primary health care provider elicits the gag reflex on a patient. Which cranial nerve is being evaluated with this technique? Select all that apply. 1 Vagus nerve 2 Facial nerve 3 Olfactory nerve 4 Trochlear nerve 5 Glossopharyngeal nerve

Vagus nerve Glossopharyngeal nerve

What areas are monitored during a neurologic assessment? Select all that apply. 1 Vital signs 2 Homans sign 3 Pupil reaction 4 Motor reaction 5 Level of consciousness

Vital signs 3 Pupil reaction 4 Motor reaction 5 Level of consciousness

Which are preventative measures that nurses can teach patients to help prevent neurologic disorders? Select all that apply. 1 Wear helmets when biking 2 Refrain from recreational drug use 3 Never dive into water of unknown depth 4 Encourage to wear helmets when operating a car 5 Wear mask and helmet when spraying insecticides

Wear helmets when biking 2 Refrain from recreational drug use 3 Never dive into water of unknown depth

Which lobe of the cerebrum has likely been affected if the patient has personality changes? 1 Which lobe of the cerebrum has likely been affected if the patient has personality changes? 2 Parietal 3 Occipital 4 Temporal

frontal