Ch 54: Care of the Patient with a Neurologic Disorder

34. The avoidance of decreases the risk for lung cancer.

ANS: cigarette smoking The avoidance of cigarette smoking has been found to decrease the incidence of lung cancer.

35. A is a diagnostic procedure used to identify lesions by observing the flow of radiopaque dye through the subarachnoid space and is similar to a lumbar puncture.

ANS: myelogram Myelogram is commonly used to identify lesions in the intradural or extradural compartments of the spinal canal.

17. A patient, age 23, has a comminuted fracture of T6-T7. She has a spinal cord injury resulting in paraplegia. She manifests signs and symptoms of autonomic dysreflexia, which is frequently triggered by a. bladder distention. b. nausea. c. food allergies. d. electrolyte imbalance.

ANS: A Autonomic dysreflexia occurs as a result of abnormal cardiovascular response to stimulation of the sympathetic division of the autonomic nervous system as a result of stimulation of the bladder, large intestine, or other visceral organs. The most common cause of this condition includes a distended bladder or fecal impaction.

8. A patient, age 45, is to have a myelogram to confirm the presence of a herniated intervertebral disk. Which nursing action should be planned for her with respect to this diagnostic test? a. Obtain an allergy history before the test. b. Ambulate the patient when she is returned to her room after the test. c. Warn her that paralysis could result from injection of the contrast medium. d. Keep her NPO for 6 to 8 hours after the test.

ANS: A Before the dye is injected, patients must be asked whether they have any allergies, specifically whether they have had any anaphylactic or hypotensive episodes from other dyes.

10. A patient's neurological status deteriorates over hours, and a craniotomy is performed to evacuate the hematoma. Which nursing intervention is indicated to help decrease the threat of increased intracranial pressure? a. Elevate the head of the bed 30 degrees. b. Cluster nursing interventions to provide uninterrupted periods of rest. c. Teach him to cough and deep breathe to prevent the necessity for suctioning. d. Teach him to hold his breath and bear down while repositioning in bed.

ANS: A Elevate the head of the bed to 30 to 45 degrees to promote venous return.

14. Before the patient undergoes computed tomographic (CT) scanning with a contrast medium, the nurse should a. verify that the patient is not allergic to seafood or iodine. b. explain that the patient will have to change position frequently during the procedure. c. maintain a safe distance from the patient to reduce the exposure to radiation. d. verify that the patient has no metal objects such as an implant or a pacemaker.

ANS: A It is important for the nurse to document and report to the physician any history of allergy to iodine and seafood because iodine is present in the contrast medium.

3. A patient has a head injury and is presenting with signs and symptoms of increased intracranial pressure. Which nursing intervention would be helpful in reducing this pressure? a. Place the neck in a neutral position to promote venous drainage. b. Suction hourly to stimulate the cough reflex. c. Add extra blankets to keep the patient warm. d. Turn the patient frequently to prevent skin impairment.

ANS: A Place the neck in a neutral position (not flexed or extended) to promote venous drainage.

31. In assessing a patient with suspected Bell's palsy, what clinical manifestations might be present? a. Inability to wrinkle forehead and pucker lips b. Inability to touch nose with finger with eyes closed c. Symmetric facial expressions d. Excruciating lightninglike shock in lips

ANS: A Unilateral weakness of the facial muscles usually occurs, resulting in a flaccidity of the affected side of the face with inability to wrinkle the forehead, close the eyelid, pucker the lips, smile, frown, whistle, or retract the mouth on that side. The face appears asymmetric.

38. Which foods may worsen headaches? (Select all that apply.) a. Yogurt b. Caffeine c. Beef d. Pears e. Marinated foods f. Milk

ANS: A, B, E Some foods may cause or worsen headaches. Foods that may provoke headaches include vinegar, chocolate, yogurt, alcohol, fermented or marinated foods, ripened cheese, cured sandwich meat, caffeine, and pork.

25. Which body system would the nurse choose to closely monitor in a patient diagnosed with Guillain-Barré syndrome? a. CNS b. GI c. Respiratory d. Cardiovascular

ANS: C The patient's condition can rapidly deteriorate into paralysis that affects the respiratory muscles. Close monitoring of respiratory function is important and necessary.

27. A lumbar puncture is performed to obtain which specimen? a. Serum b. Cerebral spinal fluid (CSF) c. Urine d. Arterial blood gases

ANS: B A lumbar puncture is done to obtain CSF for examination, to relieve pressure, or to introduce dye or medication.

12. A patient has been diagnosed with organic brain pathology. He is presenting with signs and symptoms of total or partial loss of the ability to recognize familiar objects or people through sensory stimulation. This condition is called a. apraxia. b. agnosia. c. aphasia. d. dysphagia.

ANS: B Agnosia is a total or partial loss of the ability to recognize familiar objects or people through sensory stimuli as a result of organic brain damage.

23. An 83-year-old patient has had a stroke. He is right-handed and has a history of hypertension and "little" strokes. He presents with right hemiplegia. To afford him the best visual field, the nurse should approach him a. from the right side. b. from the left side. c. from the center. d. from either side.

ANS: B Another perceptual problem is hemianopia, which is characterized by defective vision or blindness in half of the visual field. If the patient has hemianopia, which is common, the patient should be approached from the nonparalyzed side for care.

18. A patient, age 52, is brought to the emergency department by ambulance after she hit her head on her bathroom sink and fell unconscious to the floor. Which assessment should the nurse perform first? a. History of health problems b. Patency of airway c. Neurological status d. Status of bodily functions

ANS: B Nursing diagnosis and interventions for the patient with a severe head injury may include Ineffective breathing pattern related to neuromuscular impairment. Nursing interventions will be to maintain a patent airway.

22. A patient, age 27, has been admitted to the neurological department because of seizures of unknown cause. The nurse should take precautions by a. placing the patient in protective restraints. b. being certain padded side rails are present. c. suggesting that the family monitor the patient. d. placing the patient with one-on-one nursing service.

ANS: B Padded side rails may be used, especially if seizures often occur during sleep.

20. A patient, age 69, is being evaluated by a neurologist for signs of muscle rigidity, masklike face (area from forehead to chin), and propulsive gait. These signs are often characteristic of a. multiple sclerosis. b. Parkinsonism. c. Alzheimer's disease. d. epilepsy.

ANS: B Parkinsonism is a syndrome that consists of a slowing down in the initiation and execution of movement (bradykinesia), increased muscle tone (rigidity), tremor, and impaired postural reflexes.

7. As the result of a stroke, a patient has difficulty discerning the position of his body without looking at it. In the nurse's documentation, which would best describe the patient's inability to assess spatial position of his body? a. Agnosia b. Proprioception c. Apraxia d. Sensation

ANS: B Patients may experience a loss of proprioception with a stroke. This may include apraxia and agnosia (a total or partial loss of the ability to recognize familiar objects or people).

15. The Glasgow coma scale is a screening tool used to assess level of consciousness in three major areas. They are a. verbal, sensation, motor. b. eye, motor, verbal. c. verbal, pain, reflexes. d. eye, pain, verbal.

ANS: B The Glasgow coma scale was developed in 1974 and consists of three parts of the neurological assessment: eye opening, best motor response, and best verbal response.

9. A patient has recently suffered a stroke with left-sided weakness. She has problems with choking, especially when she drinks thin liquids. What nursing interventions would be most helpful in assisting this patient to swallow safely? a. Having her avoid all liquids b. Instructing her to tuck her chin when swallowing c. Giving her sips of water with each bite d. Having her turn her head to the left

ANS: B The patient should sit at a 90-degree angle with the head up and chin slightly tucked.

32. The earliest sign of increased intracranial pressure is a. headache. b. dilated pupil. c. decreasing level of consciousness. d. diplopia (double vision).

ANS: C A decreasing level of consciousness is the earliest sign of increased intracranial pressure.

6. The patient, injured in an automobile accident, is being evaluated in the emergency department for possible head injury. Which test should not be done if there is an indication of increased intracranial pressure? a. CT scan b. MRI scan c. Lumbar puncture d. Electroencephalogram

ANS: C A lumbar puncture is contraindicated in patients who might have increased intracranial pressure, because the withdrawal of fluid may cause the medulla oblongata to herniate downward into the foramen magnum.

30. The best nursing intervention for restlessness in a patient with a head injury is a. sedation with an available narcotic. b. restraints to prevent injury. c. assessing for pain or distended bladder. d. encouraging verbalization of the problem.

ANS: C Behavioral problems associated with a lack of judgment and restlessness may also occur. Restlessness in the head-injured patient may be caused by the need for a change of position, pain, or the need to empty the bladder.

4. When obtaining a health history from a patient with a neurological problem, the nurse is likely to elicit the most valid response from the patient with which question? a. "Do you have any sensations of pins and needles in your feet?" b. "Does the pain radiate from your back into your legs?" c. "Can you describe the sensations you are having in your head?" d. "Do you ever have any nausea or dizziness?"

ANS: C For patients with suspected neurological conditions, the presence of many symptoms or subjective data may be significant.

16. When the seriousness of craniocerebral trauma is assessed, it is important to remember that a. heavy scalp bleeding indicates serious trauma. b. open injuries are always more serious than closed injuries. c. signs and symptoms may not occur until several days after the trauma. d. trauma to the frontal lobe is more significant than to any other area.

ANS: C If a patient who has been conscious for several days after head injury loses consciousness or develops neurological signs and symptoms, a subdural hematoma should be suspected.

33. A therapeutic measure to reduce increased intracranial pressure is a. suction the patient every 2 hours. b. place in a semiprone position. c. reduce fluid intake. d. keep the patient flat in bed.

ANS: C Restrict fluid intake. Elevate the head of the bed 30 to 45 degrees to promote venous return. Prevent hip flexion to prevent an increase in intra-abdominal and intrathoracic pressure. Perform suctioning only as necessary.

24. If a patient with a head injury has drainage from the nose or ears, which nursing intervention would be appropriate? a. Cleanse ear or nose with a soft cotton-tipped swab. b. Gently suction the nasal cavity. c. Allow the patient to wipe the nose or ears, but not blow the nose or place anything in the external ear. d. Place a pressure dressing over the ear.

ANS: C The patient's ear and nose are checked carefully for signs of blood and serous drainage, which indicate that the meninges are torn and spinal fluid is escaping. No attempt should be made to clean out the orifice.

39. The three components of Cushing's response are: (Select all that apply.) a. Increased pulse rate b. Increased blood pressure c. Widened pulse pressure d. Bradycardia e. Increased systolic blood pressure f. Uncontrolled thermoregulation

ANS: C, D, E A widened pulse pressure, increased systolic blood pressure, and bradycardia are together called Cushing's response. It is considered an important diagnostic sign of late-stage brain herniation.

40. Important nursing measures needed when feeding a hemiplegic patient include: (Select all that apply.) a. Mixing liquids and solid foods together b. Taking the patient's dentures out to prevent choking c. Checking the affected side of mouth for food accumulation d. Offering small bites of food e. Elevating the patient to no more than 30 degrees f. Adding a thickening agent to liquids

ANS: C, D, F Important nursing measures include avoiding foods that cause choking, checking the affected side of the mouth for accumulation of food and resultant poor hygiene, not mixing liquids and solid foods, and encouraging the patient to take small bites.

5. A patient has been injured in a motorcycle accident and is presenting with signs and symptoms of increased intracranial pressure. What is the most significant sign or symptom of increased intracranial pressure? a. Pupil changes b. Ipsilateral paralysis c. Vomiting d. Decrease in the level of consciousness

ANS: D Collection of objective data includes a change in level of consciousness. A change in the level of consciousness is the earliest sign of increased intracranial pressure.

28. In the aging process, older adults are able to a. react to events immediately. b. master new material quickly. c. remember information from the immediate present (short-term memory). d. learn new skills.

ANS: D Most older people possess the ability to learn, but the speed of learning is slowed. Short-term memory is more affected by aging than is long-term memory.

11. A patient has a history of tonic-clonic seizures. She was admitted to the neurological unit after having had three tonic-clonic seizures in the past 2 days. Her husband reported that she had been sleeping for long periods after each seizure. The nurse explains to him that this rest period after a tonic-clonic seizure is called a a. convalescent period. b. post-status epilepticus period. c. post-tonic-clonic period. d. postictal period.

ANS: D Seizures are followed by a rest period of variable length, called a postictal period.

19. A 39-year-old mother of four has a 6-year history of multiple sclerosis. During planning, the nurse remembers this is a degenerative neurological disease that a. occurs most often in tropical climates. b. occurs most often in the older adult. c. has classic signs and symptoms that are readily recognized. d. results from demyelination of the nerve sheath.

ANS: D In patients with multiple sclerosis, multiple foci of demyelination are distributed randomly in the white matter of the brain stem, spinal cord, optic nerves, and cerebrum.

21. When planning care for a patient with aphasia, the nurse should a. talk loudly so he or she can hear. b. refrain from giving explanations about procedures because the patient cannot understand them anyway. c. provide as much environmental stimuli as possible to prevent feelings of isolation. d. consider the type of aphasia that the patient has and adapt communication methods accordingly.

ANS: D Many stroke patients have communication problems, including dysarthria and aphasia. The nurse should wait for the patient to communicate, rather than prompting or finishing the sentence before the patient has a chance to find the appropriate word.

13. A patient has been complaining of headaches. If the headaches are migraine, the nurse would expect to assess that the headaches: a. They are observed during times of stress. b. They become worse toward evening. c. They have their onset when the person is in his or her twenties or thirties. d. They may cause unusual smells or sounds for the patient before the pain begins.

ANS: D Migraine headaches are unusual in that there are prodromal (early signs and symptoms of a developing condition or disease) signs and symptoms that occur before the acute attack.

1. The name of this area of the brain means "bridge." It is the origin of cranial nerves V through VIII and is responsible for sending impulses to the structures inferior and superior to it. It also contains a respiratory center that complements the part of the brain stem located inferior to it. It is called the a. medulla oblongata. b. diencephalon. c. cerebellum. d. pons.

ANS: D The pons connects the midbrain to the medulla oblongata. The word pons means "bridge." It is the origin of cranial nerves V and VIII.

2. The cranial nerve that supplies most of the organs in the thoracic and abdominal cavities and also carries motor fibers to glands that produce digestive juices and other secretions is the a. somatic motor nerve. b. visceral sensory nerve. c. abducens nerve. d. vagus nerve.

ANS: D The vagus nerve extends from the throat, larynx, and organs in the thoracic and abdominal cavities. It is responsible for sensations and will accelerate peristalsis when stimulated.

37. Involuntary rhythmic movement of the eyes, with oscillations that may be horizontal, vertical, or mixed movements, is called .

ANS: nystagmus