Chapter 53: Care of the Patient with a Neurologic Disorder

.What Glasgow Coma Scale rating would a patient receive who opens the eyes spontaneously, but has incomprehensible speech and obeys commands for movement?

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The nurse is caring for a home health patient who had a spinal cord injury at C5 three years ago. The nurse bases the plan of care on the knowledge that the patient will be able to:

feed self with setup and adaptive equipment.

.Following a myelogram the nurse should include in the postprocedure care assessment for:

sensation in lower extremities.

What is the nurse assessing when asking the patient, "Who is the president of the United States?" during a level of consciousness assessment?

Fund of knowledge

.The newly admitted patient to the emergency room after a motorcycle accident has serosanguineous drainage coming from the nose. What is the most appropriate nursing response to this assessment?

Gently wipe nose with absorbent gauze

What should the nurse do when the child arrives on the floor with the diagnosis of bacterial meningitis?

Place the child in respiratory isolation

.A family member of a patient who has just suffered a tonic-clonic seizure is concerned about the patient's deep sleep. What is this behavior called?

Postictal period

.Why are the drugs neostigmine (Prostigmin) and pyridostigmine (Mestinon) helpful to the person with myasthenia gravis?

Promotes nerve impulse transmission

The newly admitted patient to the emergency room 30 minutes ago after a fall off a ladder has gradually decreased in consciousness and has slowly reacting pupils, a widening pulse pressure, and verbal responses that are slow and unintelligible. What is the most appropriate position for the patient?

Neck placed in a neutral position

What is the nurse aware of when assessing a person with a craniocerebral injury?

Signs and symptoms may not occur until several days after the trauma

A patient with a spinal cord injury at T1 complains of stuffiness of the nose and a headache. The nurse notes a flushing of the neck and "goose flesh." What should be the primary nursing intervention based on these assessments?

Sit upright and check blood pressure

The nurse explains that the two divisions of the autonomic nervous system work to maintain homeostasis. Place in order the autonomic events. (Separate letters by a comma and space as follows: A, B, C, D)

a. Parasympathetic nervous system dominates b. Extremely stressful or frightening event c. Blood pressure, heart rate, and adrenaline output decrease d. Sympathetic nervous system dominates e. Heart rate and blood pressure rise, secretion of adrenaline ANS: B, D, E, A, C

What is the reticular activating system (RAS) essential to? (Select all that apply.)

Concentration Wakefulness Attention Introspection ANS: A, B, D, F

.The nurse is aware that the drug t-PA (Activase), a tissue plasminogen activator, must be given in____hours of the onset of symptoms to have maximum benefit.

3 hours

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?

Proprioception

The nurse is aware that the characteristic gait of the person with Parkinson disease is a propulsive gait, which causes the patient to:

shuffle with arms flexed.

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:

from the left side.

A patient, age 45, is to have a myelogram to confirm the presence of a herniated intervertebral disk. Which nursing action should be planned with respect to this diagnostic test?

Obtain an allergy history before the test.

The nurse is aware that when assessing a patient by the FOUR score coma scale, the patient is assessed in four categories: eye response, brainstem reflexes, motor response, and respiration. How are these results reported?

As individual scores in each category

Which question is likely to elicit the most valid response from the patient who is being interviewed about a neurologic problem?

"Can you describe the sensations you are having?"

________________ is/are responsible for the transmission of impulses between synapses.

ANS: Neurotransmitters

The waxy substance that covers the neuron fibers and increases the rate of transmission of impulses is the ________.

ANS: myelin

.A ___________ is a diagnostic procedure used to identify lesions by observing the flow of radiopaque dye through the subarachnoid space.

ANS: myelogram

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

ANS: nystagmus

.The nurse explains that the triad of signs of Parkinson disease is: _______, _______ and _______

ANS: tremor, rigidity, bradykinesia

How would a nurse record the behavior when a patient with Alzheimer disease attempts to eat using a napkin rather than a fork?

Agnosia

.What does the nurse know about the stroke patient who has expressive aphasia?

Can understand the spoken word, but cannot speak

What is the cardinal sign of increased intracranial pressure in a brain injured patient?

Decrease in the level of consciousness

The nurse assures an anxious family member of a 92-year-old patient who is demonstrating signs of dementia that many causes of dementia are reversible and preventable. What is one example?

Hypotension

.What is the first sign of Bell's palsy?

Inability to wrinkle forehead and pucker lips on affected side

What are the effects of normal aging on the nervous system? (Select all that apply.)

Loss of neurons Reduction of cerebral blood flow Lipofuscin Decrease in oxygen use ANS: B, D, E, F

What is the basic problem that prompts most of the early signs of Alzheimer disease?

Memory loss that disrupts daily life

.What is the purpose of a "drug holiday" in the treatment of Parkinson disease?

Restart drugs at a lower dosage with favorable results

A patient is in which stage of Alzheimer disease when she demonstrates "sundowning"?

Second stage

Why is the patient with suspected Guillain-Barre Syndrome (GBS) hospitalized immediately?

The disease can rapidly progress into respiratory failure

Which symptom is specific to migraine headaches?

They are preceded by an aura

.How would the nurse instruct a patient with Parkinson disease to improve activity level?

To walk with hands clasped behind back to help balance

What is 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?

Vagus nerve

What are the three signs of Cushing response? (Select all that apply.)

Widened pulse pressure Bradycardia Increased systolic blood pressure ANS: C, D, E

A frantic family member is distressed about the flaccid paralysis of her son following a spinal cord injury several hours ago. What does the nurse know about this condition?

It is possibly a temporary condition and will clear.

.Which of the following techniques are necessary for safely feeding a hemiplegic patient? (Select all that apply.)

Checking the affected side of mouth for food accumulation Offering small bites of food Adding a thickening agent to liquids ANS: C, D, F

What are surgical navigational systems?

Computerized devices that guide the surgeon

A patient has recently suffered a stroke with left-sided weakness and has problems with choking, especially when drinking thin liquids. What nursing interventions would be most helpful in assisting this patient to swallow safely?

Tuck chin when swallowing

Which foods should the person who suffers from migraine headaches avoid? (Select all that apply.)

Yogurt Caffeine Marinated foods ANS: A, B, E

What are the two divisions of the nervous system?

Central and the peripheral