chapter 36

There are 12 pairs of cranial nerves. Only three are sensory. Select the cranial nerve that is affected with decreased visual fields.

Cranial nerve II

The nurse is caring for a client with an upper motor neuron lesion. What clinical manifestations should the nurse anticipate when planning the client's neurologic assessment?

Loss of voluntary control of movement

A client is scheduled for a myelogram and the nurse explains to the client that this is an invasive procedure, which assesses for any lesions in the spinal cord. The nurse should explain that the preparation is similar to which of the following neurologic tests?

Lumbar puncture

A nurse is performing a neurologic assessment on the client and notes a positive Romberg test. This test for balance is related to which of the following cranial nerves?

VIII

A nurse is discussing a lumbar puncture with a nursing student who observed the procedure. The student noticed that the cerebrospinal fluid was blood tinged and asks what that means. The correct reply is which of the following?

"It can mean a traumatic puncture or a subarachnoid bleed."

Dendrites conduct impulses to the cell body and are called afferent

("to" or "toward")

Decorticate posturing

(decorticate rigidity)

neurotransmitters

(or neurohormones) accomplish the transmission of an impulse from one neuron to another (see Chap. 67). Neurotransmitters can either excite or inhibit neurons.

meninges

1) the dura mater, the tough, outermost covering; (2) the arachnoid, or middle membrane lying directly below the dura mater; and (3) the pia mater, a delicate layer that adheres to the brain and spinal cord. The subarachnoid space lies between the pia mater and the arachnoid membrane

The nurse is caring for a patient who was involved in a motor vehicle accident and sustained a head injury. When assessing deep tendon reflexes (DTR), the nurse observes diminished or hypoactive reflexes. How will the nurse document this finding

1+

cranial nerves

12 pairs of nerves that carry messages to and from the brain

A nurse is assessing reflexes in a client with hyperactive reflexes. When the client's foot is abruptly dorsiflexed, it continues to "beat" two to three times before settling into a resting position. How should the nurse document this finding?

Clonus

brain stem

Connects the brain and spinal cord

The nurse is assessing the pupils of a patient who has had a head injury. What does the nurse recognize as a parasympathetic effect?

Constricted pupils

Which lobe of the brain is responsible for spatial relationships?

Parietal

A patient has suffered cerebellar trauma after falling off of a ladder. The patient has been stabilized and is now receiving care on a neurological unit. When planning this patient's care, what nursing diagnosis is most likely to result from an injury to this part of the brain?

Risk for falls

The nurse is preparing a child for a cisternal puncture to extract cerebrospinal fluid (CSF) for neurological diagnosis. To perform cisternal puncture, which of the following areas on the child's body should be shaved?

The back of the neck

central nervous system (CNS) and the peripheral nervous system (PNS).

The nervous system is divided into two anatomic divisions:

A 72-year-old man has been brought to his primary care provider by his daughter, who claims that he has been experiencing uncharacteristic lapses in memory. What principle should underlie the nurse's assessment and management of this client?

Thorough assessment is necessary because changes in cognition are always considered to be pathologic.

Acetylcholinesterase

breaks down acetylcholine

choroid plexus

line the ventricles

occipital lobe function

vision

spinal cord

which is covered by the meninges, is a direct continuation of the medulla and is surrounded and protected by the vertebrae

Cerebral angiography (arteriography)

x-ray imaging of the arterial blood vessels in the brain after injection of contrast material

The nurse is caring for a patient who was involved in a motor vehicle accident and sustained a head injury. When assessing deep tendon reflexes (DTR), the nurse observes diminished or hypoactive reflexes. How will the nurse document this finding?

1+

spinal nerves

8 cervical, 12 thoracic, 5 lumbar, 5 sacral, and 1 coccygeal

pons

A brain structure that relays information from the cerebellum to the rest of the brain

cerebellum

A large structure of the hindbrain that controls fine motor skills.mucle movement

myelin sheath

A layer of fatty tissue segmentally encasing the fibers of many neurons; enables vastly greater transmission speed of neural impulses as the impulse hops from one node to the next.

The nurse is caring for a client who exhibits abnormal results of the Weber test and Rinne test. The nurse should suspect dysfunction involving what cranial nerve?

Acoustic

Dermatome C6

Area of skin supplied by a single spinal nerve

A client is currently being stimulated by the parasympathetic nervous system. What effect will this nervous stimulation have on the client's bladder?

Bladder contract

A patient who has suffered a stroke is unable to maintain respiration and is intubated and placed on mechanical ventilator support. What portion of the brain is most likely responsible for the inability to breathe?

Brain stem

Axons

Carry impulses away from the cell body

myelogram

X-ray record of the spinal cord

corpus callosum

a broad band of nerve fibers joining the two hemispheres of the brain.

Decerebrate posturing

posturing in which the neck is extended with jaw clenched; arms are pronated, extended, and close to the sides; legs are extended straight out; more ominous sign of brain stem damage. Most Severe.

echoencephalography (EchoEG)

procedure used to examine the brain using sound waves

parasympathetic nervous system

rest and digest Acetylcholine

parietal lobe function

sensory

cerebral cortex

surface of the cerebrum. It contains motor neurons, which are responsible for movement, and sensory neurons, which receive impulses from peripheral sensory neurons located throughout the body.

Acetylcholine (ACh)

sympathetic nervous system, and at nerve endings of skeletal muscles.

Electromyography (EMG)

the electrical recording of muscle activity

dura mater

thick, outermost layer of the meninges surrounding and protecting the brain and spinal cord

pia mater

thin, delicate inner membrane of the meningesventricles

Pupils

third cranial (oculomotor) nerve

Synapses

tiny gaps between dentrites and axons of different neurons

ventricles of the brain

canals in the brain that contain cerebrospinal fluid

cerebrum

cerebrum consists of two hemispheres connected by the corpus callosum, a band of white fibers that acts as a bridge for transmitting impulses between the left and right hemispheres

cauda equina

collection of spinal nerves below the end of the spinal cord

myelin

covers some axons in the CNS and PNS

pinal nerves have two roots

dorsal and ventral Dorsal nerve fibers are sensory, and ventral nerve fibers are motor.

frontal lobe function

involved in motor function: problem solving, memory, judgment, impulse control

lumbar puncture (spinal tap)

is performed to obtain samples of CSF from the subarachnoid space for laboratory examination and to measure CSF pressure pressure of 80 to 180 mm H2O;

Flaccidity

loss of muscle tone, limp

arachnoid mater

middle layer of the meninges

The family nurse practitioner is performing the physical examination of a client with a suspected neurologic disorder. In addition to assessing other parts of the body, the nurse should assess for neck rigidity. Which method should help the nurse assess for neck rigidity correctly?

moving the head and chin toward the chest

The basic structure of the nervous system is the nerve cell

neuron

The nurse is caring for a comatose client. The nurse knows she should assess the client's motor response. Which method may the nurse use to assess the motor response?

observing the client's response to painful stimulus

Extrapyramidal fibers

originate in the motor cortex and project to the cerebellum and basal ganglia. they do not cross over because they connect to motor neurons in the spinal cord

Pyramidal motor pathways

originate in the motor cortex of the cerebrum cross over at the level of the medulla & end in the brain stem & spinal cord

midbrain

pons and cerebellum with the two cerebral hemispheres.

In the divisions of the nervous system, the basic structure is the neuron. The function of the neuron is determined by the direction of impulse transmission. Which part of the neuron is responsible for conducting impulses to the cell body?

dendrites

The nurse is caring for a post-lumbar puncture client who is experiencing an intense headache. If the physician chooses aggressive treatment, which nursing action is anticipated?

drawing venous blood to perform a blood patch

Sympathetic Nervous System (SNS)

fight or flight neurotransmitters of the sympathetic nervous system, collectively known as catecholamines, are epinephrine, norepinephrine, and dopamine.

flaccidity is when the client makes no motor response to stimuli.

flaccid

Each hemisphere has four lobes:

frontal, parietal, temporal, and occipital

To assess a client's cranial nerve function, a nurse should assess:

gag reflex.

temporal lobe function

hearing and smell

Glasgow Coma Scale (GCS) score

An evaluation tool used to determine LOC, which evaluates and assigns point values (scores) for eye opening, verbal response, and motor response, which are then totaled; effective in helping predict patient outcomes

A patient had a lumbar puncture 3 days ago in the outpatient clinic and calls the nurse with complaints of a throbbing headache. What can the nurse educate the patient to do for relief of the discomfort? Select all that apply.

Force fluids (unless contraindicated). Get plenty of bed rest. Take some over-the-counter analgesics.

The neurologic nurse is testing the function of a client's cerebellum and basal ganglia. What action will most accurately test these structures?

Guide the client through the performance of rapid, alternating movements.

A patient is having a lumbar puncture and the physician has removed 20 mL of cerebrospinal fluid. What nursing intervention is a priority after the procedure?

Have the patient lie flat for 6 hours.

A client is having a "fight or flight response" after receiving bad news about his prognosis. What affect will this have on the client's sympathetic nervous system?

Increase in the secretion of sweat

medulla oblongata

Part of the brainstem that controls vital life-sustaining functions such as heartbeat, breathing, blood pressure, and digestion.

Neurilemma

additional external myelin sheath that is formed by Schwann cells and found only on axons in the peripheral nervous system

Axons in the central and peripheral nervous systems may, or may not, be myelinated. Those that are myelinated are called white nerve fibers; those that are not are called gray nerve fibers. What is the function of myelination?

insulate electrical conduction