Chapter 16: Disorders of Brain Function
A client has sustained a severe, diffuse brain injury that resulted in seriously compromised brain function. The client is at greatest risk for: Paraplegia Amnesia Brain death Confusion
Brain death
The nurse working in an emergency room is caring for a client who is exhibiting signs and symptoms of a stroke. What does the nurse anticipate that the physician's orders will include? Intravenous antibiotics CT scan MRI Pain medication
CT scan
When the suspected diagnosis is bacterial meningitis, what assessment techniques can assist in determining if meningeal irritation is present? Brudzinski sign and Chadwick sign Brudzinski sign and Kernig sign Chvostek sign and Goodell sign Kernig sign and Chadwick sign
Brudzinski sign and Kernig sign
The nurse is working in the emergency room. One client's presenting symptoms include the worst headache ever, nuchal rigidity, and nausea. Another client's presenting symptoms include fever, stiff back, and positive Kernig sign. Which client should the nurse assess first? Client with the worst headache, nuchal rigidity, and nausea Client with fever, stiff back, and positive Kernig sign
Client with the worst headache, nuchal rigidity, and nausea
A child is being seen in the emergency department (ED) after ingesting crayons with lead in them. He is disoriented and having seizures. The provider suspects he has which of the following? Meningioma Viral meningitis Encephalitis Bacterial meningitis
Encephalitis
A high school student sustained a concussion during a football game. The school nurse will educate the family about postconcussion syndrome and ask them to watch for and report which manifestations of its presence? Unilateral weakness and decreased coordination Recurrent nosebleeds and hypersomnia Headaches and poor concentration Neck pain and decreased neck range of motion
Headaches and poor concentration
Following a head injury, a client is diagnosed with intracranial epidural hematoma. During the initial assessment, the client suddenly becomes unconscious. What additional clinical manifestations correlate with this diagnosis? Diffuse venous bleeding from the nose Ipsilateral pupil dilation Ipsilateral hemiparesis Increased head circumference with hydrocephalus
Ipsilateral pupil dilation
A client's emergency magnetic resonance imaging (MRI) has been examined by the physician and tissue plasminogen activator (tPA) has been administered to the client. What was this client's most likely diagnosis? Ischemic stroke Encephalitis Subarachnoid hemorrhage Status epilepticus
Ischemic stroke
The nurse reading a client's lumbar puncture results notifies the physician of findings consistent with meningitis when which sign/symptom is noted? Decreased protein count Increased glucose Clear cerebrospinal fluid Large number of polymorphonuclear neutrophils
Large number of polymorphonulcear neutrophils
As a client explains to the nurse what occurred prior to the onset of seizure activity, the client describes perceiving a feeling or warning that the seizure would occur. The nurse documents the perceived warning as which of the following? Clonic Ictal Atonic Prodrome
Prodrome
The nurse taking a report on a client coming into the emergency room plans care for a client with brain dysfunction based on which symptom? Pupils that react to light Stupor Chest pain Wheezing
Stupor
The MRA scan of a client with a suspected stroke reports ruptured berry aneurysm. The nurse plans care for a client with: Encephalitis Lacunar infarct Thrombotic stroke Subarachnoid hemorrhage
Subarachnoid hemorrhage
The most common cause of an ischemic stroke is which of the following? Cardiogenic embolus Vasospasm Thrombosis Intracerebral arterial vasculitis
Thrombosis
A client who is being seen in the outpatient clinic reports a single episode of unilateral arm and leg weakness and blurred vision that lasted approximately 45 minutes. The client is most likely experiencing: Thrombotic stroke Lacunar infarct Transient ischemic attack (TIA) Cardiogenic embolic stroke
Transient ischemic attack (TIA)
A client is brought to the emergency department and is diagnosed with an ischemic stroke confirmed by CT scan. The most important treatment for this client would be to: monitor vital signs closely for improvement. administer analgesics for the relief of pain. administer IV tissue plasminogen activator (tPA). prepare the client for emergency surgery.
administer IV tissue plasminogen activator (tPA).
The chart of a client admitted because of seizures notes that the seizure activity began simultaneously in both cerebral hemispheres. The nurse should interpret this to mean that the client experienced: focal seizure without impairment of consciousness. generalized seizure. focal seizure with impairment of consciousness. unknown type of seizure.
generalized seizure.
A client is diagnosed to be in a persistent vegetative state. How can her care providers most accurately explain an aspect of her situation to her family? "Your daughter's condition is an unfortunate combination: total loss of consciousness but continuation of all other normal brain function." "If you or the care team notice any spontaneous eye opening, then we will change her treatment plan." "Your daughter has lost all her cognitive functions as well as all her basic reflexes." "Though she still goes through a cycle of sleeping and waking, her condition is unlikely to change."
"Though she still goes through a cycle of sleeping and waking, her condition is unlikely to change."
Global and focal brain injuries manifest differently. What is almost always a manifestation of a global brain injury? Change in behavior Loss of eye movement reflexes Altered level of consciousness Respiratory instability
Altered level of consciousness Explanation:In contrast to focal injury, which causes focal neurologic deficits without altered consciousness, global injury nearly always results in altered levels of consciousness ranging from inattention to stupor or coma. The other answers are manifestations of different types of brain injury, not a global injury.
A client's emergency room report includes the presence of a contrecoup injury. The nurse plans care for a client with which of the following? Closed head injury in the area of impact Open spinal cord injury with complete severing of neurons Closed head injury opposite the area of impact Infection resulting from exposed brain tissue
Closed head injury opposite the area of impact Explanation:In a contrecoup injury, the client experiences a rebound injury on the side of the brain opposite the site of external force.
The nurse assessing a client with a traumatic brain injury assesses for changes in which neurologic component? Select all that apply. Cognition Metabolic function Sensory function Level of consciousness Motor function
Cognition Level of consciousness Motor function Sensory function
A parent brought her 8-year-old child to the emergent care center to be examined following a fall off a playground set, resulting in a head injury. On discharge, the nurse explains to the parent that some symptoms may continue, including the inability to remember what happened before the fall. Which term best describes the diagnosis? Anterograde amnesia Retrograde amnesia Postconcussion syndrome Concussion syndrome
Retrograde amnesia
A client suffering a thrombotic stroke is brought into the emergency department by ambulance and the health care team is preparing to administer a synthetic tissue plasminogen activator for which purpose? Thrombolysis Hemostasis Thrombogenesis Hemolysis
Thrombolysis
The most common cause of ischemic stroke is: vasospasms. thrombosis. cryptogenesis. arterial vasculitis.
thrombosis.
A client is having difficulty with sleeping and has also been experiencing marital difficulties over the past couple of months. The client tells the nurse at the physician's office that all this started after he had a car accident earlier that year. What would be the most important question for the nurse to ask? "Did you go to the hospital following the accident?" "What is your normal routine before bedtime?" "How long have you been married?" "Did you sustain any injuries in the accident?"
"Did you sustain any injuries in the accident?" Postconcussion syndrome can interfere with daily living and also with relationships and can continue for months. The syndrome can include amnesia, insomnia, headache, difficulty concentrating, and irritability. In this situation, it would be very important to determine if the patient sustained a head injury to rule out postconcussion syndrome.
Excessive activity of the excitatory neurotransmitters and their receptor-mediated effects is the cause of which type of brain injury? Excitotoxic Hypoxic Increased intercranial volume and pressure Ischemic
Excitotoxic
A male client has smoked cigarettes for decades and currently drinks around 10 beers a day. His diet is high in fat and low in fiber. This morning he has arrived at the emergency department with weakness on his left side and an inability to speak. What is most likely causing his symptoms? A hemorrhagic stroke An ischemic stroke involving the anterior cerebral artery An ischemic stroke involving the middle cerebral artery A transient ischemic attack (TIA)
An ischemic stroke involving the middle cerebral artery Explanation:A stroke in the territory of the middle cerebral artery is the most common aphasia-producing stroke, causing this sign more commonly than a hemorrhagic stroke or a TIA. The middle cerebral artery feeds blood to the language centers. The posterior, basilar, and anterior arteries feed different regions of the brain and a stroke in these arteries would produce different symptoms.
A nurse is teaching a client newly diagnosed with a seizure disorder. Which statement is most important for the nurse to provide regarding antiepileptic medications? Pregnant women should reduce the dose of medication or discontinue until after delivery. Children can build up a tolerance to the medication quickly. Antiepileptic medications should never be discontinued abruptly. All antiepileptic medications should be taken with food.
Antiepileptic medications should never be discontinued abruptly. Consistency in taking seizure medications is essential to obtaining and maintaining therapeutic blood levels of the medication. Abrupt withdrawal can cause seizure recurrence. Monitoring and assessment of drug levels are important. Each prescribed drug will provide information regarding administration to provide client safety.
he spouse of a client admitted to the hospital after a motor vehicle accident reports to the nurse that the client has become very drowsy. The nurse should: contact the physician. assess the client for additional signs/symptoms of increased intracranial pressure. instruct the spouse not to let the client fall asleep until the physician has assessed the client. prepare the client for EEG testing.
assess the client for additional signs/symptoms of increased intracranial pressure.
The parents of an infant born with hydrocephalus are concerned about the size of the baby's head. The doctors are telling them that the infant needs the surgical placement of a shunt. The nurse caring for the infant in the neonatal intensive care unit explains that placement of a shunt will: not affect the size of the infant's head. increase intracranial pressure. reverse any neurologic deficits that are present. decrease the likelihood of further neurological deficits.
decrease the likelihood of further neurological deficits.
The nurse is assessing a client and notes the client is now displaying decerebrate posturing. The position would be documented as: prone position with arms placed above the head and legs elevated; deep tendon reflexes showing hyperreflexia. active range of motion with increased strength in the upper extremities when painful stimulation applied. rigidity of the arms with palms of the hands turned away from the body and with stiffly extended legs and plantar flexion of the feet. flexion of the arms, wrists, and fingers, with abduction of the upper extremities, internal rotation, and plantar flexion of the lower extremities.
rigidity of the arms with palms of the hands turned away from the body and with stiffly extended legs and plantar flexion of the feet.