NUR334 PrepU: Chapter 37 - Disorders of Brain Function

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?"

Following a collision while mountain biking, the diagnostic work up of a 22 year-old male has indicated the presence of an acute subdural hematoma. Which of the following pathophysiological processes most likely underlies his diagnosis?

Blood has accumulated between the man's dura and subarachnoid space.

A soccer player has been diagnosed with a brain contusion after being injured in a game. The best explanation of the injury by the nurse would be:

Bruising on the surface of the brain occurred.

The nurse observes a new nurse performing the test for Kernig's sign on a client. The new nurse performs the test by providing resistance to flexion of the knees while the client is lying with the hip flexed at a right angle. The nurse should explain to the new nurse that:

Resistance should be provided with the knee in a flexed position.

The most common cause of an ischemic stroke is which of the following?

Thrombosis.

Global and focal brain injuries manifest differently. What is almost always a manifestation of a global brain injury?

Altered level of consciousness.

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 26 year-old female is resting after a one-minute episode during which she lost consciousness while her muscles contracted and extremities extended. This was followed by rhythmic contraction and relaxation of her extremities. On regaining consciousness, she found herself to have been incontinent of urine. What has the woman most likely experienced?

A tonic-clonic seizure.

The family of an older adult reports increasing inability to perform basic activities of daily living. After evaluation, the client is diagnosed with Alzheimer's disease. What intervention will be implemented to slow cognitive decline?

Acetylcholinesterase inhibitors.

The nurse is caring for a client admitted to the emergency room with suspected meningitis. The nurse prepares to perform which nursing intervention upon physician orders, while diagnostic testing is being completed?

Administration of antibiotics.

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.

The nurse is working in the emergency room. One client's presenting symptoms include the worst headache ever, nuchal rigidity and nausea. Another client's presenting symptoms include fever, stiff back, and positive Kernig's sign. Which client should the nurse assess first?

Client with the worst headache, nuchal rigidity, and nausea.

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.

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.

Excessive activity of the excitatory neurotransmitters and their receptor-mediated effects is the cause of which type of brain injury?

Excitotoxic.

Generalized convulsive status epilepticus is a medical emergency caused by a tonic-clonic seizure that does not spontaneously end, or recurs in succession without recovery. What is the first-line drug of choice to treat status epilepticus?

Intravenous lorazepam.

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 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.

An adult client has been admitted to a rehabilitation center after hospital treatment for an ischemic stroke. Which aspect of the client's history would be considered to have contributed to his stroke?

The client's blood pressure has historically been in the range of 150s/90s.

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 spouse of a patient diagnosed with Alzheimer's disease asks the nurse why the patient often neglects to take a shower. The spouse states that the patient was always diligent with hygiene in the past; however, over the past few months that has not been the case. Which of the following is the nurse's best response?

"You should remind the patient to shower."

The nurse contacts the healthcare provider regarding a client's early signs of diminishing level of consciousness based on which manifestations? Select all that apply.

-Disorientation. -Blunted responsiveness. -Inattention.

A client arrives at the emergency department with symptoms of stroke. What evidence should the nurse gather to determine if the client is a candidate for thrombolytic therapy? Select all that apply.

-Time of symptom onset. -Blood pressure. -History of stroke.

A nurse is monitoring the intracranial pressure (ICP) of a client. The nurse would consider the client to have a normal reading when the results identify:

0 to 15 mm Hg.

A client is admitted for cardioembolic stroke. Which therapy to best prevent recurrence of embolic stroke should the nurse monitor for effectiveness?

Anticoagulation therapy.

What medication teaching should be done for a woman of childbearing age with a seizure disorder?

Antiseizure drugs increase the risk for congenital abnormalities.

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

Brain death.

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.

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 patient suffering global cerebral ischemia a week after a suicide attempt by hanging is in the intensive care unit receiving treatment. The parent asks the nurse why it is necessary to keep the patient paralyzed with medications and on the ventilator. The most appropriate response would be that these therapies do which of the following?

Decrease metabolic needs and increase oxygenation.

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.

Which of the following clients' signs and symptoms would allow a clinician to be most justified in ruling out stroke as a cause? An adult:

Has had a gradual onset of weakness, headache, and visual disturbances over the last two days.

The nurse is assessing a client and notes the client is now displaying decerebrate posturing. The position would be documented as:

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.

A nurse at a long-term care facility provides care for a client who has had recent transient ischemic attacks (TIAs). What significance should the nurse attach to the resident's TIAs?

TIAs, by definition, resolve rapidly, but they constitute an increased risk for stroke.

The nurse assessing a patient with a traumatic brain injury assesses for changes in which of the following? Select all that apply.

-Level of consciousness. -Sensory function. -Motor function. -Cognition.

A nurse on a neurology unit is assessing a female brain-injured client. The client is unresponsive to speech, and her pupils are dilated and do not react to light. She is breathing regularly but her respiratory rate is 45 breaths per minute. In response to a noxious stimulus, her arms and legs extend rigidly. What is her level of impairment?

Coma.

The parents of an infant born with hydrocephalus are concerned about the size of the baby's head. The doctors are telling them that the infant needs the surgical placement of a shunt. The nurse caring for the infant in the neonatal intensive care unit explains that placement of a shunt will do which of the following?

Decrease the likelihood of further neurological deficits.

The MRA scan of a client with a suspected stroke reports ruptured berry aneurysm. The nurse plans care for a client with which of the following?

Subarachnoid hemorrhage.

The two main categories of glial tumors include which of the following?

Astrocytic.

Intracranial aneurysms that rupture cause subarachnoid hemorrhage in the client. How is the diagnosis of intracranial aneurysms and subarachnoid hemorrhage made?

CT Scan.

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?

CT Scan.

A teenager, exposed to West Nile virus a few weeks ago while camping with friends, is admitted with headache, fever, and nuchal rigidity. The teenager is also displaying some lethargy and disorientation. The nurse knows which of the following medical diagnoses listed below may be associated with these clinical manifestations?

Encephalitis.

The nurse is planning an inservice on hypoxia versus ischemia in brain-injured clients. The nurse should include which of the following?

Hypoxia produces a generalized depressive effect on the brain.

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

Inadequate to meet the metabolic needs of the entire brain.