Ms 2 neurology *

1.What are the two divisions of the nervous system?

Central and the peripheral

What is the protective fluid of the central nervous system (CNS)?

Cerebrospinal fluid (CSF)

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

Concentration Wakefulness Attention Introspection

30. To reduce the risk for falls in the patient with Parkinson's disease, what should the nurse teach the patient to do?

Consciously lift the toes when stepping.

During the diagnosis and long-term management of a seizure disorder, what should the nurse recognize as one of the major needs of the patient?

Coping with the effects of negative social attitudes toward epilepsy

Which observation of the patient made by the nurse is most indicative of Parkinson's disease?

Difficulty rising from a chair and beginning to walk

7. How do generalized seizures differ from focal seizures?

Generalized seizures have bilateral synchronous epileptic discharges affecting the whole brain at onset of the seizure.

25.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

Following a lumbar puncture, what should the nurse assess the patient for?

Headache

Which CN is tested with tongue protrusion?

Hypoglossal (CN XII)

Which area of the brain regulates endocrine and autonomic nervous system (ANS) functions?

Hypothalamus

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

Inability to wrinkle forehead and pucker lips on affected side

Mitoxantrone (Novantrone) is being considered as treatment for a patient with progressive-relapsing MS. The nurse explains that a disadvantage of this drug compared with other drugs used for MS is what?

It has a lifetime dose limit because of cardiac toxicity.

A carotid endarterectomy is being considered as treatment for a patient who has had several TIAS. What should the nurse explain to the patient about this surgery?

It involves removing an atherosclerotic plaque in the carotid artery to prevent an impending stroke.

19.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.

3.The newly admitted patient to the emergency room 30 minutes ago after a fall off a ladder has gradually de- creased 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

islare responsible for the transmission of impulses between synapses.

Neurotransmitters

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

Obtain an allergy history before the test.

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

Place the child in respiratory isolation

32. What should the nurse do to prepare a patient for a lumbar puncture?

Position the patient in a lateral recumbent position with the hips, knees, and neck flexed.

10. A 28-year-old female patient has been diagnosed with occipital lobe damage after a car accident. What should nurse expect the patient to need help with?

Processing visual images

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?

Proprioception

During care of a patient in myasthenic crisis, maintenance of what is the nurse's first priority for the patient?

Respiratory function

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

Restart drugs at a lower dosage with favorable results

When providing care for a patient with ALS, the nurse recognizes what as one of the most distressing problems experienced by the patient?

Retention of cognitive function with total degeneration of motor function

17.What is the nurse aware of when assessing a person witha craniocerebral injury?

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

8 Which type of seizure occurs in children, is also known as a petit mal seizure, and consists of a staring spell that Jasts for a few seconds?

Typical absence

6. Which events cause increased ICP (select all that apply)?

Vasodilation d. Edema from initial brain insult Necrotic tissue edema

Which CN responds to the corneal reflex test?

c. Trigeminal (CN V)

3. How do spinal nerves of the peripheral nervous system (PNS) differ from cranial nerves (CNs)?

d. All spinal nerves contain both afferent sensory and efferent motor fibers whereas CNs contain one or both.

25. In the neurologic nursing assessment of the patient, he is unable to hear a ticking watch. What neurologic problem could be the cause of this finding?

d. The cochlear branch of the acoustic (CN VIII) nerve is damaged.

7. An early sign of increased ICP that the nurse should assess for is

decreasing level of consciousness (LOC).

18.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.

22. The nurse explains to a patient newly diagnosed with MS that the diagnosis is made primarily by

history and clinical manifestations.

A patient is admitted to the hospital with a left hemiplegia. To determine the size and location and to ascertain whether a stroke is ischemic or hemorrhagic, the nurse anticipates that the health care provider will request a

magnetic resonance imaging (MRI).

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

myelin

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

myelogram

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

nystagmus

The autonomic and the somatic are the division of the

peripheral nervous system.

27. A patient with a tremor is being evaluated for Parkinson's disease. The nurse explains to the patient that Parkinson's disease can be confirmed by

relief of symptoms with administration of dopaminergic agents.

"Sundowning" is seen in the AD patient in the

second stage of the disease.

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

sensation in lower extremities.

21.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.

42.The nurse explains that the triad of signs of Parkinson disease is:

tremor, rigidity, bradykinesia

23.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

What is the cranial nerve that supplies most of the organs in the thoracic and abdominal cavities and also carries notor fibers to glands that produce digestive juices and other secretions

Vagus nerve

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

Widened pulse pressure Bradycardia Increased systolic blood pressure,

18. How is cranial nerve (CN) III, originating in the midbrain, assessed by the nurse for an early indication of pressure on the brainstem?

Test pupillary reaction to light

4.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?"

11. A patient admitted to the hospital following a generalized tonic-clonic seizure asks the nurse what caused the seizure. What is the best response by the nurse?

"In seizures, some type of trigger causes sudden, abnormal bursts of electrical brain activity."

25. A patient with newly diagnosed MS has been hospitalized for evaluation and initial treatment of the disease. Following discharge teaching, the nurse realizes that additional instruction is needed when the patient says what?

"When I begin to feel better, I should stop taking the prednisone to prevent side effects."

20. A 38-year-old woman has newly diagnosed multiple sclerosis (MS) and asks the nurse what going to happen to her. What is the best response by the nurse?

"You will have either periods of attacks and remissions or progression of nerve damage over time."

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

12

What factors should be considered when taking the history of a patient with a neurologic problem

Avoid suggesting symptoms. Mental status must be accurately assessed to ensure that the reported history is factual. neurologic The mode of onset and course of illness are especially important aspects of the nursing

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

Can understand the spoken word, but cannot speak

Which CNs are involved with oblique eye movements (select all that apply)?

Abducens (CN VI) Trochlear (CN IV) Oculomotor (CN III)

18. During neurologic assessment of the older adult, what should the nurse expect to find?

Absent deep tendon reflexes

31. A patient with myasthenia gravis is admitted to the hospital with respiratory insufficiency and severe weakness. When is a diagnosis of cholinergic crisis made?

Administration of edrophonium (Tensilon) increases muscle weakness.

12.How would a nurse record the behavior when a patient with Alzheimer disease attempts to eat using a nap- kin rather than a fork?

Agnosia

A patient is diagnosed with cluster headaches. The nurse knows that which characteristics are associated with this type of headache (select all that apply)?

Alcohol is the only dietary trigger c. Abrupt onset lasting 5 to 180 minutes Severe, sharp. penetrating head pain May be accompanied by unilateral ptosis or lacrimation

16. Following a generalized tonic-clonic seizure, the patient is tired and sleepy. What care should the nurse provide?

Allow the patient to sleep as long as he feels sleepy.

Which of the following descriptions are characteristic of encephalitis (select all that apply)?

Almost always has a viral cause Is an inflammation of the brain May be transmitted by insect vectors

39. A patient is admitted to the hospital with possible bacterial meningitis. During the initial assessment, the nurse questions the patient about a recent history of what?

An upper respiratory infection

14. How are the metabolic and nutritional needs of the patient with increased ICP best met?

Balanced, essential nutrition in a form that the patient can toleratet

Which components are able to change to adapt to small increases in intracranial pressure (ICP) (select all that apply)?

Blood Cerebrospinal fluid (CSF) Brain tissue

The nurse teaches the patient taking antiseizure drugs that this method is most commonly used to measure compliance and monitor for toxicity.

Blood testing for drug levels

The incidence of ischemic stroke in patients with TIAS and other risk factors is reduced with the administration of which medication?

Daily low-dose aspirin

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

Decrease in the level of consciousness

The nurse finds a patient in bed having a generalized tonic-clonic seizure. During the seizure activity, what actions should the nurse take (select all that apply)?

Loosen restrictive clothing. Tum the patient to the side. Protect the patient's head from injury.

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

Loss of neurons Reduction of cerebral blood flowt Lipofuscin Decrease in oxygen use

When a patient is admitted to the ED following a head injury, what should be the nurse's first priority in management of the patient once a patent airway is confirmed?

Maintain cervical spine precautions.

In providing care for patients with chronic, progressive neurologic disease, what is the major goal of treatment that the nurse works toward?

Maximize neurologic functioning for as long as possible.

20.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

What methods are used to assess the facial (CN VII) nerve (select all that apply)?

Smile, frown, and close eyes Corneal reflex test Salt and sugar discrimination

What happens at the synapse?

The presynaptic terminal submits a nerve impulse through the synaptic cleft to the receptor site on the postsynaptic cell.

13.Which symptom is specific to migraine headaches?

They are preceded by an aura

What is the most important method of diagnosing functional headaches?

Thorough history of the headache

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

To walk with hands clasped behind back to help balance

Which type of seizure is most likely to cause death for the patient?

Tonic-clonic status epilepticus

when drinking thin liquids. What nursing interventions would be most helpful in assisting this patient to swal- 9.A patient has recently suffered a stroke with left-sided weakness and has problems with choking, especially low safely?

Tuck chin when swallowing

What are the key manifestations of bacterial meningitis?

High fever, nuchal rigidity, and severe headache

Which chronic neurologic disorder involves a deficiency of the neurotransmitters acetylcholine and y-aminobutyric acid (GABA) in the basal ganglia and extrapyramidal system?

Huntington's disease

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

Hypotension

What is the function of the dendrite?

Carries impulses to the nerve cell body

35. What is the neurologic diagnostic test that has the highest risk of complications and requires frequent monitoring of neurologic and vital signs following the procedure?

Cerebral angiography

37.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

5. What is a nursing intervention that is appropriate for the patient with a nursing diagnosis of anxiety related to lack of knowledge of the etiology and treatment of headache?

Help the patient to examine lifestyle patterns and precipitating factors.

21. The nurse is monitoring a patient for increased ICP following a head injury. What are manifestations of increased ICP (select all that apply)?

Fever Right pupil dilated greater than left pupil Decorticate posturing to painful stimulus Oriented to name only

The patient is admitted to the emergency department having difficulty with respiratory, vasomotor, and cardiac function. Which portion of the brain is affected to cause these manifestations?

Medulla

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

Memory loss that disrupts daily life

1. Which type of headache is suspected when the headaches are unilateral and throbbing, preceded by a prodrome of photophobia, and associated with a family history of this type of headache?

Migraine

Vigorous control of fever in the patient with meningitis is required to prevent complications of increased cerebral edema, seizure frequency, neurologic damage, and fluid loss. What nursing care should be included?

Monitor LOC related to increased brain metabolism.

During assessment of a patient admitted to the hospital with an acute exacerbation of MS, what should the nurse expect to find?

Motor impairment, visual disturbances, and paresthesias

26. The classic triad of manifestations associated with Parkinson's disease is tremor, rigidity, and bradykinesia. What is consequence related to rigidity?

Muscle soreness and pain

Place in order the autonomic events. (Separate letters by a comma and space as follows: 45.The nurse explains that the two divisions of the autonomic nervous system work to maintain homeostasis.

Parasympathetic nervous system dominates Extremely stressful or frightening event Blood pressure, heart rate, and adrenaline output decrease Sympathetic nervous system dominates Heart rate and blood pressure rise, secretion of adrenaline

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

Promotes nerve impulse transmission

26. During an assessment of the motor system, the nurse finds that the patient has a staggering gait and an abnormal swing. What should the nurse use this information to do?

Protect the patient from injury caused by falls.

The patient has a lack of comprehension of both verbal and written language. Which type of communication difficulty does this patient have?

Receptive aphasia

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

Second stage

When assessing the body functions of a patient with increased ICP, what should the nurse assess first?

Circulatory and respiratory status

15.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

11.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

4. What drug therapy is included for acute migraine and cluster headaches that appears to alter the pathophysiologicr process for these headaches?

Specific serotonin receptor agonists such as sumatriptan (Imitrex)

When teaching a patient with a seizure disorder about the medication regimen, what is it most important for the nurse to emphasize?

Stopping the medication abruptly may increase the intensity and frequency of seizures.

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

The disease can rapidly progress into respiratory failure

Bell's palsy?

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.

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

Yogurt Caffeine Marinated foods

24.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.