neuro questions patho exam 5
You are assigned Henry, an 82-year-old man with Alzheimer's Disease. After visiting with him, his daughter asks you what the cure is. What is your best response? "Living in a warm climate reverses symptoms and prevents progression of the disease. Move him somewhere like Arizona." "Yearly brain scans can identify where he is in the disease process and we can prescribe medications based on the scan results." "Some medications may be beneficial to relieve symptoms, but there is no true cure." "We can start giving him dopamine to prevent further demyelination of the cauda equina."
"Some medications may be beneficial to relieve symptoms, but there is no true cure." While there is no cure for Alzheimer's disease or a way to stop or slow its progression, it is important to emphasize that there are drug and non-drug options that may help treat symptoms.
The family of a multiple sclerosis client asks, "What psychological manifestations may we expect to see in our mother?" The health care provider informs them to expect which of the following? Select all that apply. A: Forgetfulness B: Delirium C: Hallucinations D: Depression E: Inattentiveness
A,D,E Psychological manifestations, such as mood swings, may represent an emotional reaction to the nature of the disease or, more likely, involvement of the white matter of the cerebral cortex. Depression, euphoria, inattentiveness, apathy, forgetfulness, and loss of memory may occur. Hallucinations and delirium are not usually associated as a manifestation of MS.
Which intracranial pressure (ICP) would the nurse consider a normal reading? 45 to 60 mm Hg 30 to 45 mm Hg 15 to 30 mm Hg 0 to 15 mm Hg
0 to 15 mm Hg The cranial cavity contains blood, cerebrospinal fluid, and brain tissue. Each of these three volumes contributes to ICP, which is normally maintained within a range of 0 to 15 mm Hg when measured in the lateral ventricles.
A 14-year-old girl has been thrown from the back of a pick-up truck. MRI shows complete cord injury at the level of C2. What is the main significance of an injury at this level of the spinal column? 1. Intercostal and abdominal musculature is affected; the ability to take a deep breath and cough is less impaired 2. Cannot breathe on own, needs ventilator assistance 3. Needs maintenance therapy to strengthen existing muscles for endurance and mobilization of secretions 4. Partial or full diaphragmatic function; ventilation is diminished because of the loss of intercostal muscle function, resulting in shallow breaths and a weak cough
2. Cannot breathe on own, needs ventilator assistance Cord injuries involving C1 to C3 result in a lack of respiratory effort, and affected clients require assisted ventilation. The other answers involve injuries farther down the spinal column.
The nurse is assessing a client and notes the client is now displaying decerebrate posturing. The position would be documented as: 1. active range of motion with increased strength in the upper extremities when painful stimulation applied. 2. prone position with arms placed above the head and legs elevated; deep tendon reflexes showing hyperreflexia. 3. 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. 4. flexion of the arms, wrists, and fingers, with abduction of the upper extremities, internal rotation, and plantar flexion of the lower extremities.
3. 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. Decerebrate (extensor) posturing results from increased muscle excitability. It is characterized by 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, would be a response of decorticate posturing. The other options are not specific to a diagnosis.
Which statement accurately reflects the typical person afflicted with multiple sclerosis (MS)? A 50-year-old man A 6-year-old girl A 25-year-old woman A 26-year-old man
A 25-year-old woman The age of onset is typically between 20 and 30 years, with women being affected twice as frequently as men.
Which of the following risk factors for stroke are NON-modifiable? (select all that apply) Age Hereditary/Genetics Obesity Sex Cigarette smoking Alcohol use Ethnicity
A,B,D,G
The nurse assessing a client with a traumatic brain injury assesses for changes in which neurologic component? Select all that apply. Sensory function Metabolic function Motor function Level of consciousness Cognition
A,C,D,E Brain injuries can cause changes in level of consciousness and alterations in cognition, motor, and sensory function; therefore, the nurse assessing a client with a traumatic brain injury should assess for changes in these areas.
Which assessment findings would confirm that a client with spinal cord injury has developed autonomic dysreflexia? Select all that apply A: Pallor B: cold, dark blue lower legs C: a pounding headache D: pulse rate 51 E: Skin covered with goose bumps above the level of injury F: Blood pressure of 182/99
A,C,D,F Autonomic dysreflexia is a syndrome in which there is a sudden onset of excessively high blood pressure. It is more common in people with spinal cord injuries that involve the thoracic nerves of the spine or above (T6 or above). When blood pressure increases it can cause all sorts of seemingly unrelated signs and symptoms. Symptoms vary by person but typically include high blood pressure, pounding headache, pallor/flushed face, sweating above the level of injury, goose bumps below the level of injury, nasal stuffiness, nausea, and a pulse slower than 60 beats per minute.`
The nurse is planning an inservice on hypoxia versus ischemia in brain-injured clients. The nurse should include which of the following? A: Hypoxia produces a generalized depressive effect on the brain. B: Ischemia does not interfere with delivery of glucose. C: Ischemia denotes a deprivation of oxygen with maintained perfusion. D: Hypoxia denotes an interruption in blood flow.
A: Hypoxia produces a generalized depressive effect on the brain. Hypoxia denotes a deprivation of oxygen with maintained blood flow (perfusion), whereas ischemia is a situation of greatly reduced or interrupted blood flow. Hypoxia produces a generalized depressant effect on the brain. Ischemia interferes with delivery of oxygen and glucose as well as the removal of metabolic wastes.
Aimee was diagnosed with multiple sclerosis (MS) at the age of 22. She has tremors associated with MS. As the nurse, how would you explain MS to Aimee?? Due to demyelination of neurons that occur in MS: A: communication being sent through the neurons is slowed B: dopamine levels are insufficient to act as chemical messengers in the body C: nerve damage results in complete paralysis D: nerve impulses shoot down the back constantly and make muscles hyperreactive
A: communication being sent through the neurons is slowed MS is an inflammatory demyelinating condition. This means it is caused by damage to myelin - a fatty material that insulates nerves, acting much like the covering of an electric wire. Myelin allows a nerve to transmit its impulses rapidly. It is the speed and efficiency with which these impulses are conducted that permits smooth, rapid and coordinated movements to be performed with little conscious effort. In MS, the loss of myelin (demyelination) is accompanied by a disruption in the ability of the nerves to conduct electrical impulses to and from the brain. This produces the various symptoms of MS. The sites where myelin is lost (plaques or lesions) appear as hardened (scar) areas: in multiple sclerosis these scars appear at different times and in different areas of the brain and spinal cord. The term multiple sclerosis means 'many scars'.
A man arrives in the ER with a severe head injury. Your priority assessment is what? Cerebrospinal fluid or blood leaking from the ears Assessing and maintaining the patency of the airway Neurologic status using the Glasgow Coma Scale A CT scan to identify the level of spinal cord injury
Assessing and maintaining the patency of the airway Remember your ABC's! Airway, breathing, circulation.
An older adult is brought to the emergency department after experiencing some confusion, slurred speech, and a weak arm. Now the client is back to acting normally. Suspecting a transient ischemic attack (TIA), the health care provider prescribes diagnostic testing looking for which cause of this episode? Aneurysm leakage Atherosclerotic lesions in cerebral vessels Minor residual deficits Diffuse cerebral electrical malfunctions
Atherosclerotic lesions in cerebral vessels The traditional definition of TIA as a neurologic deficit resolving within 24 hours was developed before the mechanisms of ischemic cell damage and the penumbra were known and before the newer, more advanced methods of neuroimaging became available. A more accurate definition now is a transient deficit without time limits, best described as a zone of penumbra without central infarction. TIAs are important because they may provide warning of impending stroke. The causes of TIAs are the same as those of ischemic stroke, and include atherosclerotic disease of cerebral vessels and emboli. The most common predisposing factors for cerebral hemorrhage are advancing age and hypertension; other causes include aneurysm rupture. Cerebral electrical malfunctions usually occur with seizure activity.
Aimee attends a support group for MS. All of the group members talk about their associated symptoms. Which symptoms do the support group members have in common? Select all that apply. A: a tremor that looks like pill-rolling B: mental acuity progressively declines C: shuffling gait and difficulty turning corners D: debilitating fatigue E: visual acuity progressively declines F: loss of sensation in the right leg
B,D,E fatigue, visual disturbances, and decline of mental acuity are symptoms associated with MS. Loss of sensation in just the right leg alone is not a common manifestation of MS. The pill-rolling tremor, shuffling gait, and difficulty turning corners are more associated with Parkinson's.
One day following SCI a patient asks about the extent of impairment that will result from the injury. What is your best response? A: "you will have complete function when spinal shock resolves" B: "the extent of your injury cannot be determined until the secondary injury to the cord is resolved." C: "Because long-term rehabilitation can affect the return of function, it will be years before we can determine the complete effect" D: "when your condition is more stable we will do an MRI to reveal the extent of damage
B: "the extent of your injury cannot be determined until the secondary injury to the cord is resolved." Until the edema and necrosis at the site of injury are resolved 72 hours or more after the injury, it is not possible to determine how much cord damage is present from the initial injury, how much secondary injury has occurred, or how much cord was damaged by edema that extended above and below the level of initial injury.
Warren, an 80-year-old male, has been diagnosed with a stroke that resulted in an infarct to the cerebellum. Which of the following clinical findings would be most closely associated with cerebellar insult? A: tremors, rigidity, and bradykinesia. B: Unsteady gait and difficulty speaking and swallowing C: difficulty starting a movement, stopping movement and maintaining rhythmic movements. D: flaccid loss of muscle tone
B: Unsteady gait and difficulty speaking and swallowing The cerebellum receives information from the sensory systems, the spinal cord, and other parts of the brain and then regulates motor movements. The cerebellum coordinates voluntary movements such as posture, balance, coordination, and speech, resulting in smooth and balanced muscular activity. Injury to the cerebellum interferes with motor movement and can result in unbalanced gait and speech difficulties.
Acceleration-deceleration (coup-contrecoup) movements of the head often result in polar injuries in which A: bleeding from venules immediately fills the subdural space. B: focal injuries occur in two places at opposite poles C: widespread neuronal damage occurs D: injury is specific to the site of initial impact.
B: focal injuries occur in two places at opposite poles A coup injury occurs on the brain directly under the point of impact. A contrecoup injury occurs on the opposite side of the brain from where the impact occurred. Coup and contrecoup injuries are a type of traumatic brain injury that results in the bruising of the brain.
After a skydiving accident Eugene is taken to the ER with a closed head injury. He is awake, but very lethargic. When you first take his vitals they are BP 120/80, HR 70, RR 20. Two hours later you reassess Eugene. Which assessment indicates deterioration? BP 130/80, HR 77, RR 18 BP 160/70, HR 43, RR 8 BP 110/60, HR 99, RR 22 BP 115/75 HR 65, RR 11
BP 160/70, HR 43, RR 8 Stage 3 of ICP: decompensation is imminent. The patient's response is characterized by systolic hypertension with a widening pulse pressure, bradycardia with a full and bounding pulse, and altered respirations. This is known as Cushing's triad and is a neurologic emergency.
Which cardinal assessment finding would lead the nurse to suspect a client has developed Parkinson disease? Lack of sweating Bradykinesia Paresthesia Hypotonia
Bradykinesia The cardinal symptoms of Parkinson disease are tremor, rigidity (hypertonicity), and bradykinesia (slowness of movement). Bradykinesia is characterized by slowness in initiating and performing movements and difficulty in sudden, unexpected stopping of voluntary movements. Because the basal ganglia also influence the autonomic nervous system, persons with Parkinson disease often have excessive and uncontrolled sweating, sebaceous gland secretion, and salivation. Paresthesia is characteristic of demyelinating disease such as multiple sclerosis, rather than Parkinson disease.
The nurse expects that loss of respiratory effort occurs with a spinal injury at which level? C1-3 T9-T12 S1-S5 C7-T1
C1-3 Cord injuries involving C1 to C3 result in a lack of respiratory effort, and affected people require assisted ventilation.
The nurse is caring for a client with a spinal cord injury. Assessment reveals shallow breath sounds with a very weak cough effort. The nurse correlates this with which level of injury on the spinal column? C2 T1 C5 T10
C5 Although a C3-to-C5 injury allows partial or full diaphragmatic function, ventilation is diminished because of the loss of intercostal muscle function, resulting in shallow breaths and a weak cough. Cord injuries involving C1 to C3 result in a lack of respiratory effort, and affected clients require assisted ventilation. The intercostal muscles, which function in elevating the rib cage and are needed for coughing and deep breathing, are innervated by spinal segments T1 through T7. The major muscles of expiration are the abdominal muscles, which receive their innervation from levels T6 to T12.
During assessment of a patient admitted for acute exacerbations of MS, what would you as the nurse expect to find? A: Tremors, dysphasia, and ptosis B: Bowel and bladder incontinence with loss of memory C: Motor impairment, visual disturbances, and paresthesia D: Excessive involuntary movements, hearing loss, and ataxia
C: Motor impairment, visual disturbances, and paresthesia Specific neurological dysfunction of MS is caused by destruction of myelin and replacement with glial scar tissue at specific areas in the nervous system. Motor, sensory, cerebellar, and emotional dysfunctions, including paresthesia, patchy blindness, blurred vision, radiating pain along the nerve, ataxia, and severe fatigue are the most common manifestations.
While there is no specific test to diagnose Alzheimer's, which of the following indications on a CT scan would help confirm a suspected diagnosis of Alzheimer's? A: Demyelination of neurons B: 98% obstruction of cerebellar artery C: Numerous beta-amyloid plaque deposits D: A large area of ischemia in the parietal lobe
C: Numerous beta-amyloid plaque deposits There is no specific test to diagnose Alzheimer's. Multiple labs and diagnostic tests are done to rule out other diseases before confirming a diagnosis of AD. If AD is suspected the presence of beta-amyloid plaque deposits revealed in a CT scan can help confirm.
Tina has been a lifelong horse rider. At the age of 16 she was thrown off the back of her horse, Jericho. She can move her arms, but she has lost all motor function below the lumbar region of her spinal cord. What is this called? A: Quadraplegia B: Tetraplegia C: Paraplegia D: Indoplegia
C: Paraplegia Paraplegia is loss of function in the lower extremities, and function remains in the upper extremities. Quadraplegia and Tetraplegia are different names for loss of function in all extremities.
A family brings their father to his primary care physician for a checkup. Since their last visit, they note their dad has developed a tremor in his hands and feet. He also rolls his fingers like he has a marble in his hand. The primary physician suspects the onset of Parkinson disease when he notes which abnormality in the client's gait? A: Hyperactive leg motions like he just can't stand still B: Difficulty putting weight on soles of feet and tends to walk on tiptoes C: Slow to start walking and has difficulty when asked to "stop" suddenly D: Takes large, exaggerated strides and swings arms/hands wildly
C: Slow to start walking and has difficulty when asked to "stop" suddenly The cardinal symptoms of Parkinson disease (PD) are tremor, rigidity (hypertonicity), and bradykinesia or slowness of movement. Bradykinesia is characterized by slowness in initiating and performing movements and difficulty in sudden, unexpected stopping of voluntary movements. Persons with the disease have difficulty initiating walking and difficulty turning. While walking, they may freeze in place and feel as if their feet are glued to the floor, especially when moving through a doorway or preparing to turn. When they walk, they lean forward to maintain their center of gravity and take small, shuffling steps without swinging their arms.
A patient is being evaluated for Alzheimer's disease (AD). The nurse explains to the patient's adult children that A: the most important risk factor for AD is a family history of the disorder. B: new drugs have been shown to reverse AD dramatically in some patients. C: a diagnosis of AD is made only after other causes of dementia are ruled out. D: the presence of brain atrophy detected by magnetic resonance imaging (MRI) will confirm the diagnosis of AD.
C: a diagnosis of AD is made only after other causes of dementia are ruled out.
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 Pain medication CT scan MRI
CT scan The nurse should anticipate that the client will be ordered a CT scan to rule out hemorrhagic stroke that would preclude the administration of tissue plasminogen activator (tPA).
intracranial aneurysms that rupture cause subarachnoid hemorrhage in the client. How is the diagnosis of intracranial aneurysms and subarachnoid hemorrhage made? CT scan MRI Venography Loss of cranial nerve reflexes
CT scan The diagnosis of subarachnoid hemorrhage and intracranial aneurysms is made by clinical presentation, CT scan, and angiography. An MRI is not necessary for the diagnosis of subarachnoid hemorrhage and intracranial aneurysm. Loss of cranial nerve reflexes is not diagnostic of subarachnoid hemorrhage and intracranial aneurysm, and neither is venography.
A nurse on a neurology unit is assessing a client with a brain injury. The client is unresponsive to speech, with dilated pupils that do not react to light. The client is breathing regularly with a respiratory rate is 45 breaths per minute. In response to a noxious stimulus, the client's arms and legs extend rigidly. What is the client's level of impairment? Coma Vegetative state Delirium Brain death
Coma The continuum of loss of consciousness is marked by the degree of client responsiveness to stimuli, in addition to the preservation of brain stem reflexes. Since this client still exhibits a pain response (the extended arms and legs indicate decerebrate posturing), even though her pupils are not responsive to light, she has sustained sufficient brain function that she fails to qualify as brain-dead or in a vegetative state.
Parkinson's patients are at a high risk of falling. What should you teach your patient to do to reduce risk of falls? Use a squatty potty Consciously lift the toes when stepping. Always use a wheelchair Use a walker or cane when you feel you need extra support
Consciously lift the toes when stepping. The shuffling gait with PD causes the patient to be off balance and at a high risk of falling. Teach the patient to use a wide stance with the feet apart, lift the toes, and look ahead to balance the gait. Canes and walkers may be difficult to maneuver, and may increase the risk of falls.
Manny is diagnosed with a subdural hematoma following a horse riding accident. Which of the following best describes a subdural hematoma? A: This was a coup-contrecoup injury B: A parietal lobe lesion is increasing the ICP to 26 mmHg C: Multiple blood vessels just burst open in the brain D: Blood is accumulating between the dura and subarachnoid space
D: Blood is accumulating between the dura and subarachnoid space A subdural hematoma is a type of bleeding in which a collection of blood—usually associated with a traumatic brain injury—gathers between the inner layer of the dura mater and the arachnoid mater of the meninges surrounding the brain. It usually results from tears in bridging veins that cross the subdural space.
After a rolling MVA George goes to the ER for a C4 spinal cord injury. His BP is 86/60 and heartrate is 44 beats per minute. The nurse determines that this pathophysiologic response is caused by A: Loss of sympathetic nervous system innervation resulting in demyelination of nerve fibers B: a permanent loss of sensation and motor activity above the level of injury C: loss of sympathetic nervous system D: innervation resulting in vasoconstriction loss of sympathetic nervous system innervation resulting in vasodilation
D: innervation resulting in vasoconstriction loss of sympathetic nervous system innervation resulting in vasodilation Neurogenic shock is a distributive type of shock resulting in low blood pressure, occasionally with a slowed heart rate, that is attributed to the disruption of the autonomic pathways within the spinal cord. It can occur after damage to the central nervous system, such as spinal cord injury and traumatic brain injury.
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? Extensor posturing Diencephalon posturing Decerebrate posturing Decorticate posturing
Decorticate posturing Decorticate (flexion) posturing is characterized by flexion of the arms, wrists, and fingers, with adduction of the upper extremities, internal rotation, and plantar flexion of the lower extremities. Diencephalon posturing does not exist.
The demyelination and degeneration of nerve fibers characteristic of multiple sclerosis (MS) is the result of which pathophysiologic event? Oligodendrocyte infection Atherosclerotic destruction Corticospinal injuries Decreased oligodendrocytes
Decreased oligodendrocytes Oligodendrocytes are a type of large glial cell found in the central nervous system. Oligodendrocytes produce the myelin sheath insulating neuronal axons (analogous to Schwann cells in the peripheral nervous system). Multiple sclerosis is an immune-mediated disorder that occurs in genetically susceptible individuals. The pathophysiology of MS involves the demyelination of nerve fibers in the white matter of the brain, spinal cord, and optic nerve. In the CNS, myelin is formed by the oligodendrocytes, chiefly those lying among the nerve fibers in the white matter. This function of the oligodendrocytes is equivalent to that of the Schwann cells in the peripheral nervous system. The properties of the myelin sheath—high electrical resistance and low capacitance—permit it to function as an electrical insulator. Demyelinated nerve fibers display a variety of conduction abnormalities, ranging from decreased conduction velocity to conduction blocks.
Regarding the pathophysiology of Parkinson disease, which statement is true? Failure of the cerebral cortex interferes with the use of acetylcholine. Degeneration of the nigrostriatal dopamine neurons occurs. The dopamine receptors increase from an alteration in neuronal basal ganglia. Acetylcholine levels rise and inhibit voluntary movement.
Degeneration of the nigrostriatal dopamine neurons occurs. The primary brain abnormality found in all persons diagnosed with Parkinson disease is degeneration of the nigrostriatal dopamine neurons. Acetylcholine has no bearing on Parkinson development. There is a decrease in dopamine rather than an increase.
Alzheimer disease is the most common cause of which of these? Malnutrition Dementia Fatigue Psychosis
Dementia Dementia is a general term for a decline in mental ability severe enough to interfere with daily life. Alzheimer's is the most common cause of dementia. Alzheimer's is a degenerative brain disease that is caused by complex brain changes following cell damage. It leads to dementia symptoms that gradually worsen over time. The most common early symptom of Alzheimer's is trouble remembering new information because the disease typically impacts the part of the brain associated with learning first. As Alzheimer's advances, symptoms get more severe and include disorientation, confusion and behavior changes. Eventually, speaking, swallowing and walking become difficult. There is no way to prevent, cure or even slow Alzheimer's disease.
A client's recent diagnosis of Parkinson disease has prompted the care provider to promptly begin pharmacologic therapy. The drugs prescribed will likely influence the client's levels of which substance? Serotonin Dopamine Adenosine Acetylcholine
Dopamine Although some antiparkinsonian drugs act by reducing the excessive influence of excitatory cholinergic neurons, most act by improving the function of the dopaminergic system. Serotonin and adenosine are not known to participate directly in the pathophysiology of Parkinson disease.
A client with Parkinson disease presents with bradykinesia and an altered gait. These symptoms arise in response to the progressive deterioration of which structure in the brain? Dopamine nigrostriatal system Serotonergic system Cerebellum Limbic system
Dopamine nigrostriatal system The destruction of the dopamine nigrostriatal system upsets the balance of the basal ganglia, resulting in uncontrolled and uncoordinated movement. The cortex is involved in higher processing, serotonin is involved in the limbic system, and the cerebellum is unrelated to Parkinson disease; cerebellar disorders, however, will cause Parkinsonism.
Teddy fell off a ladder and has an injury at the level of T2. Which finding is of most concern to the nurse? SpO2 of 93% Heart rate of 42 bpm Blood pressure of 88/60 Loss of motor and sensory function of arms and legs.
Heart rate of 42 bpm Neurogenic shock associated with SCI above T6 greatly decreases the effect of the sympathetic nervous system, so bradycardia and hypotension occur. A heart rate of 42bpm is not adequate to meet the oxygen needs of the body. While low, this BP is not critical. Motor and sensory losses are expected. SpO2 is adequate for now.
You are planning community education for prevention of spinal cord injuries. Who do you target for the education? Retired men Adolescent girls High school boys Elementary school classes
High school boys Young adult men aged 16-30, who are impulsive or risky, have the greatest risk of SCI. Sports, trauma, and violence are other common factors with this age group.
The average time from the onset of symptoms to death is how long? 20 years 10 years 4 years I don't know this feels like something that depends on the patient and their presentation of the illness so I should assess them further?
I don't know this feels like something that depends on the patient and their presentation of the illness so I should assess them further? The rate of progression for Alzheimer's disease varies widely. On average, people with Alzheimer's disease live between 3 and 11 years after diagnosis, but some survive 20 years or more. The degree of impairment at diagnosis can affect life expectancy.
A patient who has severe Alzheimer's disease (AD) is being admitted to the hospital for surgery. Which intervention will the nurse include in the plan of care? Encourage the patient to discuss events from the past. Maintain a consistent daily routine for the patient's care. Reorient the patient to the date and time every 2 to 3 hours. Provide the patient with current newspapers and magazines.
Maintain a consistent daily routine for the patient's care. Providing a consistent routine will decrease anxiety and confusion for the patient. Encouraging the patient to discuss the past may be frustrating due to memory deficits. Reorienting the patient to date and time is helpful, but does not address the anxiety and confusion that comes from being in a foreign environment.
Frank complains of a red/green color distortion. Which disease process do you suspect? Parkinson's Disease Coronavirus Multiple Sclerosis Anterior Cord Syndrome
Multiple Sclerosis It is well established that MS is associated with reduced high-contrast visual acuity, color vision, contrast sensitivity, and visual fields. It is commonly reported that MS preferentially damages red-green color vision.
Restoration of the integrity of myelin sheaths would likely result in a slowing or stopping of the progression of: Duchenne muscular dystrophy (DMD) Amyotrophic lateral sclerosis (ALS) Paralysis caused by Clostridium botulinum Multiple sclerosis (MS)
Multiple sclerosis (MS)] The pathophysiology of MS involves the demyelination of nerve fibers in the white matter of the brain, spinal cord, and optic nerve. As such, the restoration of myelin would have the potential to slow or stop the progression of the disease. Myelin is not attacked during the pathogenesis and progression of ALS, DMD, or botulism poisoning.
The nurse is caring for an older adult client with hemiplegia following a stroke. While planning the client's care, the nurse knows the client is at risk for developing which condition? Involuntary movements Muscular dystrophy Muscle atrophy Pseudohypertrophy
Muscle atrophy Muscle atrophy can occur with prolonged immobilization following a chronic illness. The client suffering from hemiplegia will have paralysis and immobility. Muscular dystrophy is a genetic disorder characterized by muscle necrosis and increased muscle size. Pseudohypertrophy is associated with muscular dystrophy. Involuntary movements are associated with extrapyramidal tract disorders. Stroke is a pyramidal tract disorder with extrapyramidal tract disorder.
A client comes to the clinic and informs the nurse that he believes he is suffering from Parkinson disease. What objective data assessed by the nurse would correlate with the client's concern? Select all that apply. Tachycardia Rigidity Tremor Rapid speech Bradykinesia
Rigidity Tremor Bradykinesia The cardinal manifestations of Parkinson disease are tremor, rigidity, and bradykinesia (slowness of movement). Tremor is the most visible manifestation of the disorder. The tremor affects the distal segments of the limbs, mainly the hands and feet; head, neck, face, lips, and tongue; or jaw.
A client diagnosed with Parkinson disease is displaying the following manifestations: tremor, rigidity, and slowness of movement. The nurse would interpret these as: Signs of clinical deterioration Signs of clinical improvement Manifestations of another disease process Normal manifestations of Parkinson disease
Normal manifestations of Parkinson disease The cardinal manifestations of Parkinson disease are tremor, rigidity, and bradykinesia (slowness of movement).
A client who has experienced a spinal cord injury still has use of the arms but has impaired motor and sensory function of the trunk, legs, and pelvic organs. Which term best describes how this injury is classified? Paraplegia Brown-Séquard syndrome Tetraplegia Quadriplegia
Paraplegia The loss of motor and sensory function in the trunk, legs, and pelvic organs while maintaining use of the arms is called paraplegia. Tetraplegia is the loss of function in all areas. Quadriplegia is the loss of function of all four limbs. Clients with Brown-Séquard syndrome suffer from ipsilateral upper motor neuron paralysis and loss of proprioception, as well as contralateral loss of pain and temperature sensation.
What disease results from the degeneration of the dopamine nigrostriatal system of the basal ganglia? Myasthenia gravis Parkinson disease Guillain-Barré syndrome Huntington disease
Parkinson disease
Which disease can result in symptoms that can occur when a brain tumor causes damage to the nigrostriatal pathway? Alzheimer disease Guillain-Barré syndrome Truncal ataxia Parkinson disease
Parkinson disease Symptoms of parkinsonism can occur when damage to the nigrostriatal pathway occurs in such conditions as cerebral vascular disease, brain tumors, repeated head trauma, or a degenerative neurologic disease.
When Tina fell off her horse and went to the ER for her spinal cord injury, you as her nurse knew the priority of assessment was: Patency of her airway Bleeding in the extremities Assessing GI functioning Assessing the color and amount of urine
Patency of her airway Remember your ABC's! Limbs, urine, and GI functioning do not matter if the person cannot breathe.
Nystagmus due to cerebellar dysfunction would most likely interfere with which activity? Reading Speech Fine motor skills Walking
Reading Nystagmus is a vision condition in which the eyes make repetitive, uncontrolled movements. These movements often result in reduced vision and depth perception and can affect balance and coordination. These involuntary eye movements can occur from side to side, up and down, or in a circular pattern. Conjugate readjustment of eye position due to cerebellar damage can make reading very difficult.
Which symptom is unique to amyotrophic lateral sclerosis (ALS) and is not observed in multiple sclerosis (MS)? Optic nerve dysfunction Fatigue Dysarthria Respiratory muscle impairment
Respiratory muscle impairment Dysphagia with recurrent aspiration and weakness of the respiratory muscles produce the most significant acute complication of ALS. MS does not typically include respiratory muscle impairment.
Which complication of spinal cord injury is the most preventable in a paraplegic client? Muscle atrophy Deep vein thrombosis Autonomic dysreflexia Skin breakdown
Skin breakdown The lack of sensory warning mechanisms and voluntary motor ability below the level of injury, coupled with circulatory changes, places the person with spinal cord injury at major risk for disruption of skin integrity. Significant factors associated with disruption of skin integrity are pressure, shearing forces, and localized trauma and irritation. Relieving pressure, allowing adequate circulation to the skin, and inspecting the skin are primary ways of maintaining skin integrity. Of all the complications after spinal cord injury, skin breakdown is the most preventable. Autonomic dysreflexia is a syndrome in which there is a sudden onset of excessively high blood pressure. It is more common in people with spinal cord injuries that involve the thoracic nerves of the spine or above (T6 or above
A client has been diagnosed with a cerebral aneurysm and placed under close observation before treatment commences. Which pathophysiologic condition has contributed to this client's diagnosis? Deficits in the autonomic control of blood pressure Impaired synthesis of clotting factors Increased levels of cerebrospinal fluid Weakness in the muscular wall of an artery
Weakness in the muscular wall of an artery Aneurysms are direct manifestations of a weakness that exists in the muscular wall of an arterial vessel. Hypertension is a significant risk factor, but autonomic contributions are not common. Levels of cerebrospinal fluid (CSF) and hypo- or hypercoagulability are not implicated in the pathogenesis of aneurysms.
Which of these is the strongest risk factor for developing Alzheimer's? Heredity Age Exposure to toxins Allergic reaction
age Although some studies have shown an association between certain modifiable lifestyle factors and a reduced risk for Alzheimer disease, the National Institutes of Health says that age is the strongest known risk factor where most people receive the diagnosis after age 60. An early onset familial form can also occur, although it is rare.
A 62-year-old male patient comes to the ER presenting with signs of a stroke. Which lab would you assess first? BUN and Cr blood glucose Serum potassium RBCs, WBCs, and platelets
blood glucose The most important test in emergency stroke evaluation is glucose (or blood sugar), because levels of blood glucose which are too high or too low can cause symptoms which may be mistaken for stroke (fatigue, visual changes, speech disturbances, trouble concentrating)
Loss of coordinated movement, muscle rigidity, and immobility without paralysis is likely due to damage to: extrapyramidal tracts. cranial nerves. peripheral neurons. pyramidal structures.
extrapyramidal tracts. The extrapyramidal tracts originate in the brainstem, carrying motor fibres to the spinal cord. They are responsible for the involuntary and automatic control of all musculature, such as muscle tone, balance, posture and locomotion. Disorders of the pyramidal tracts (e.g., stroke) are characterized by spasticity and paralysis, whereas those affecting the extrapyramidal tracts (e.g., Parkinson disease) result in involuntary movements, muscle rigidity, and immobility without paralysis.
