Chapter 20 Patho

The emergency room doctor suspects a client may have bacterial meningitis. The most important diagnostic test to perform would be:

Lumbar puncture

Which one of the following is the most common primary intracranial tumor in adults?

Neurogliomas or neoplasms of astrocytic origin

Hypoxic injury will result in which of the following effects on the brain?

Neuronal cell injury and death

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?

Prodrome

Tonic-clonic status epilepticus

is a medical emergency and, if not promptly treated, may lead to respiratory failure and death

most frequent sign of brain dysfunction

is an altered level of consciousness such as stupor

The parent of an infant who developed hydrocephalus while in utero is very concerned that the child will have significant intellectual dysfunction. The best response to the parent would be which of the following?

"Because the skull sutures are not fused there may be no brain damage."

A patient is having difficulty with sleeping and has also been experiencing marital difficulties over the past couple of months. The patient tells the nurse at the physician's office that all this started after he had a car accident earlier that year. Which of the following would be the most important question for the nurse to ask?

"Did you sustain any injuries in the accident?"

The spouse of a patient who has been in a long-term care facility for a few months due to a brain injury causing a vegetative state asks the nurse why the patient is still being fed through the gastrostomy tube. Which of the following is the nurse's best response?

"To avoid aspiration into the lungs."

A nurse is teaching a client newly diagnosed with a seizure disorder about medications. The most important information for the nurse to provide would be:

Antiepileptic medications should never be discontinued abruptly.

The nurse explaining the causes of congenital hydrocephalus to the mother of a child born with hydrocephalus includes which of the following?

Aquedectal stenosis

The nurse is caring for a client with a brain tumor when the client begins to vomit. Which intervention should the nurse do first?

Assess for other signs/symptoms of increased intracranial pressure

A teenager has been in a car accident and experienced acceleration-deceleration head injury. Initially, the client was stable but then started to develop neurological signs/symptoms. The nurse caring for this client should be assessing for which type of possible complication?

Brain contusions and hematomas

A client has sustained a severe, diffuse brain injury that resulted in seriously compromised brain function. The client is at greatest risk for:

Brain death

Manifestations of brain tumors are focal disturbances in brain function and increased ICP. What causes the focal disturbances manifested by brain tumors?

Brain edema and disturbances in blood flow

When the suspected diagnosis is bacterial meningitis, what assessment techniques can assist in determining if meningeal irritation is present?

Brudzinski sign and Kernig sign

An elderly male client has been brought to the emergency department after experiencing stroke-like symptoms a few hours ago, and has been subsequently diagnosed with an ischemic stroke. The care team is eager to restore cerebral perfusion despite the likely death of the brain cells directly affected by the stroke. What is the rationale for the care team's emphasis on restoring circulation?

Cells of the penumbra may be saved from hypoxic damage if blood flow is promptly restored.

The intracranial volume that is most capable of compensating for increasing intracranial pressure is the:

Cerebrospinal fluid

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 opposite the area of impact

The nurse is caring for a 31-year-old trauma victim admitted to the neurologic intensive care unit. While doing the initial assessment, the nurse finds that the client is flexing the arms, wrists, and fingers. There is adduction of the upper extremities with internal rotation and plantar flexion of the lower extremities. How would the nurse describe this in the notes?

Decorticate posturing

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?

Encephalitis

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 which of the following?

Generalized seizure

A client has developed global ischemia of the brain. The nurse determines this is:

Inadequate to meet the metabolic needs of the entire brain

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

A patient admitted to the emergency department with a change in mental status and a history of AIDS and primary central nervous system (CNS) lymphoma becomes extremely combative with the medical personnel. A family member is very upset with the patient's behavior. The nurse explains that these behaviors are most likely caused by which of the following?

Recurrence of primary CNS lymphoma

The nursing assistant reports to the registered nurse that a client with a brain tumor has a blood pressure of 180/100 and a pulse of 50. Which of the following is the correct nursing intervention?

Report to physician the client's signs of increased intracranial pressure.

A client has started having uncontrolled seizures that are not responding to usual medications. Nursing working with the client must pay special attention to which of the following priority aspects of this clients care? Assessment of:

Respiratory status and oxygen saturation

The nurse is explaining how vasogenic brain edema occurs to a client's family. The most appropriate information for the nurse to provide would be:

The blood-brain barrier is disrupted, allowing fluid to escape into the extracellular fluid.

A patient 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 of the following purposes?

Thrombolysis

The significant other 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:

assess the client for additional signs/symptoms of increased intracranial pressure.

Postconcussion syndrome

can interfere with daily living and also with relationships that can continue for months which include amnesia, insomnia, headache, difficulty concentrating, and irritability

most common causes of congenital hydrocephalus includes

congenital aqueductal stenosis, believed to be caused by ependymitis

The health care provider is concerned that a client may be at risk for problems with cerebral blood flow. The most important data to assess would be:

decreased level of oxygen

The nurse taking a report on a client coming into the emergency room plans care for a client with brain dysfunction based on which of the following symptoms?

stupor

The most common cause of ischemic stroke is:

thrombosis

The nurse assessing a patient with a traumatic brain injury assesses for changes in which of the following?

• Cognition • Level of consciousness • Motor function • Sensory function

The nurse contacts the physician regarding a client's early signs of diminishing level of consciousness based on which of the following?

• Inattention • Disorientation • Blunted responsiveness

Initial increases in intracranial pressure (ICP)

are largely buffered by a translocation of cerebrospinal fluid (CSF) to the spinal subarachnoid space and increased reabsorption of CSF