Porth Pathophysiology Chapter 36 & 37 Combined
Diagnosis of Carpal Tunnel:
Tinned sign--the development of tingling sensation radiating into the palm of the hand that is elicited by light percussion over the median nerve of the wrist.
tension-type
most common type of headache
primary (somatosensory) cortex
most of surface concerns fingers, lips & tongue
nociception
pain or itch
A patients emergency magnetic resonance imaging (MRI) has been examined by the physician and tPA has been administered to the patient. What was this patients most likely diagnosis?
Ischemic stroke
The emergency room doctor suspects a client may have bacterial meningitis. The most important diagnostic test to perform would be: a) Lumbar puncture b) Sputum culture c) CT of the head d) Blood cultures
Lumbar puncture The diagnosis of bacterial meningitis is confirmed with abnormal CSF findings. Lumbar puncture findings, which are necessary for accurate diagnosis, include a cloudy and purulent CSF under increased pressure. The other options do not confirm the diagnosis.
Restoration of the integrity of myelin sheaths would likely result in a slowing or stopping of the progression of:
Multiple Sclerosis (MS)
Results of Peripheral Neuropathy:
Muscle weakness, with or without atrophy and sensory changes.
Disorder of transmission at the neuromuscular junction that affects communication between the motor neuron and the innervated muscle cell:
Myasthenia Gravis
pain transmission
PAG region also interacts with pontile noradrenergic neurons and the medullary nucleus raphe magnus (serotonin acts as NT) to block what?
Signs and Symptoms of Carpal Tunnel:
Pain, paresthesia, and numbness of the thumb and first two and one half digits of the hand; pain in the wrist and hand; decreased grip.
Any primary disorder of the peripheral nerves:
Peripheral Neuropathy
A patients recent computed tomography (CT) scan has revealed the presence of hydrocephalus. Which of the following treatment measures is most likely to resolve this health problem?
Placement of a shunt
trigger points
localized points on skin or mucous membranes that produce immediate intense pain when stimulated by light tactile stimulation
postherpetic neuralgia
localized recurrent infection by the varicella virus that has remained latent in the dorsal root ganglia since the initial attack of chickenpox
special somatic (afferent neurons)
located in muscles, tendons & joints
headache
many factors may precipitate a ________ including: foods/food additives (MSG, aged cheese, chocolate), missed meals, menstral periods (estrogen levels), certain medications
pain tolerance
maximum duration & intensity of pain that a person can endure
Headaches
may be primary or secondary
phantom limb pain
may be the result of regenerating nerve tissue being trapped within scar tissue at the amputation site or the spontaneous firing of spinal cord neurons that have lost their sensory input from the amputated limb
tension-type
may result from oromandibular dysfunction, stress, anxiety, depression, overuse of analgesics or caffeine
myelinated
mechanical or thermal stimuli
primary (headache)
migraine, cluster, tension-type
PAG (periaqueductal gray) region
modulates ascending pain impulses by producing a state of analgesia = endogenous analgesia center
migraine headache
more common in women, may have a hereditary linkage
proprioception
movement of limbs & joints
gate control theory
neural gating mechanism exists at the segmental spinal cord level to account for interactions between pain and the other sensations
substance P
neurotransmitter from C fibers -slow release
tension-type
not sufficiently severe to interfere with daily activities
neuralgia
occurs along the distribution of a cranial or spinal nerve
endorphins
opiod peptides that serve as endogenous
complex regional pain syndrome
pain & mobility problems that are more severe than the injury warrants
allodynia
pain after non-noxious stimulus
specificity theory
pain is a separate sensory modality evoked by specific receptors that transit information to the forebrain where pain is experienced
pattern theory
pain receptors share endings or pathways with the other senses but that different patterns of activity by the same neurons signal painful or nonpainful stimuli
allodynia
pain that follows a non-noxious stimulus to apparently normal skin
cutaneous
pain that is bright, sharp, burning pain with origin in skin or subcutaneous tissues
visceral (splanchnic)
pain that is diffuse, poorly-defined pain that results from stretching, distention, or ischemia of tissues in a body organ
acute
pain that is form from tissue damage; characterized by ANS responses (e.g., nausea)
deep
pain that isdiffuse, throbbing pain that originates in muscles, bones, & tendons & radiates to the surrounding tissues
referred
pain that originates in a visceral organ but is perceived elsewhere in the body wall that is innervated by neurons entering the same segment of the nervous system
Disorders of the pyramidal tracts, such as a stroke, are characterized by:
paralysis
Coup and contrecoup cerebral contusion caused by blunt head trauma against a fixed object results in:
permanent brain tissue damage
chronic
persistent pain that may be accompanied by loss of appetite, depression, sleep disturbances & other debilitating responses
Common manifestations of acute meningococcal meningitis, a highly contagious and lethal form of meningitis, include:
petechiae
Proprioception
position sense
pain
possesses an urgent, primitive quality
A patient has wrist inflammation causing compression of the median nerve in the carpal tunnel. Manifestations of this syndrome include:
precision grip weakness
More complex patterns of movements, such as throwing a ball or picking up a fork, are controlled by the ______ cortex in the frontal lobe.
premotor
TMJ (temporomandibular joint pain)
presents as facial muscle pain, headache, neck ache or earache
central axon
projects to the CNS
As the nurse is performing a physical assessment of a client, the client begins to have seizure activity including loss of consciousness and limb jerking. The nurse's first priority is to: a) preserve brain functioning. b) treat underlying disease. c) protect the patient from injury. d) stop the seizure.
protect the patient from injury. The first priority for the nurse when a client begins to experience seizure activity is to protect the client from injury during the seizure. -Stopping or preventing the seizure, preserving brain functioning and/or treating underlying disease are important goals of treatment but secondary to protecting the client from injury.
first-order neurons
receptor → CNS
complex regional pain syndrome
reflex sympathetic dystrophy
complex regional pain syndrome
regional post-traumatic pain problem affecting one or more limbs
tactile sensation
relays information about touch, pressure & vibration
dorsal column (medial lemniscal pathway)
relays precise information regarding spatial orientation
prostaglandins
released from inflamed tissues enhance the sensitivity of pain endings but they don't directly stimulate them
Hypoxic injury will result in which of the following effects on the brain? a) Can be focal or global with only one part of the brain being underperfused or all of the brain being compromised b) Depends on the brain's compensatory mechanisms and the extent of the swelling c) Neuronal cell injury and death d) Clouding of consciousness, bilaterally small pupils (approximately 2 mm in diameter) with a full range of constriction, and motor responses to pain that are purposeful or semipurposeful (localizing) and often asymmetric
Neuronal cell injury and death Neuronal cell injury and death is directly caused by hypoxic injury. The others are specific to several other brain injury types.
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? a) Wheezing b) Chest pain c) Stupor d) Pupils that react to light
Stupor The most frequent sign of brain dysfunction is an altered level of consciousness such as stupor. Pupils that react to light, wheezing and chest pain are not symptoms of brain function.
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? a) Encephalitis b) Subarachnoid hemorrhage c) Thrombotic stroke
Subarachnoid hemorrhage The rupture of a berry aneurysm leads to a subarachnoid hemorrhage.
sensory unit
cell body of dorsal root ganglion neuron + its receptor + its central axon
An elderly patient has been brought to his primary care provider by his wife who is concerned about his recent decrease in coordination. Upon assessment, his primary care provider notes that the patients gait is wide-based, unsteady, and lacking in fluidity, although his muscle tone appears normal. This patient requires further assessment for which of the following health problems?
cerebellar disorders
The intracranial volume that is most capable of compensating for increasing intracranial pressure is the:
cerebrospinal fluid
unmyelinated
chemical or chronic mechanical/thermal stimuli
The moderate stage of the progressive degenerative Alzheimer-type dementia is manifested by behaviors that include:
confusion
hyperpathia
continued stimulation causes pain
Merkels disks
continuous determination of touch against the skin
aspirin (& NSAIDs)
control pain because they block enzyme needed for PG synthesis
special somatic (afferent neurons)
convey information on position & movement of body
general somatic (afferent neurons)
convey sensations of pain, touch & temperature
general visceral (afferent neurons)
convey sense of fullness & discomfort
dorsal column (medial lemniscal pathway)
crosses at base of medulla
medial lemniscus
crosses at medulla & reaches thalamus on opposite side of brain where sensation began
The demyelination and degeneration of nerve fibers characteristic of multiple sclerosis is the result of:
decreased oligodendrocytes
Hair follicle end organs
detect impending touch on skin surface
Pacinian corpuscles
detect tissue vibration
free nerve endings
detect touch & pressure
The patient has a traumatic complete spinal cord transection at the C5 level. Intact motor and somatosensory function will include ______ control.
diaphragm
Thermal sensation
discriminated by cold, warmth, & pain receptors
dyesthesia
distortions of somesthetic sensation
dyesthesia
distortions of somesthetic sensation (usually associated with a partial loss of sensory innervation)
A patients recent diagnosis of Parkinson disease has prompted his care provider to promptly begin pharmacologic therapy. The drugs that are selected will likely influence the patients levels of:
dopamine
tension-type
dull, aching, diffuse, nondescript headaches occurring in a hatband distribution around the head
NTs
endogenous analgesic mechanisms involve three families of opioid peptides that can function as ____ 1.enkephalins 2.endorphins 3.dynorphins
cluster headache
episodic occurrences
paresthesias
example: -pins-and-needles sensation following compression of a peripheral nerve
glutamate
excitatory NT in spinal cord
fast-conducting (neospinothalamic tract)
experienced as bright, sharp or stabbing pain
pain tolerance
extremely variable & depends on person's culture & previous experiences
trigeminal neuralgia
facial tics or grimaces characterized by stabbing, paroxysmal attacks of pain
myelinated
fast pain
dorsal column (medial lemniscal pathway)
fast-conducting
C pain
fibers release both glutamate & substance P
Meissner corpuscles
found in nonhairy skin regions (lips, fingertips) -highly-developed sense of touch
somatosensory
four major modalities of _______ experience: 1. discriminative touch 2.proprioception 3.temperature 4.nociception
A client begins to exhibit signs and symptoms of a stroke at a community health fair. Emergency care for the client includes: a) going to an urgent care center. b) seeing his/her physician. c) going to the nearest stroke center. d) going to the nearest emergency room.
going to the nearest stroke center. Salvaging brain tissue, preventing secondary stroke, and minimizing long-term disability are the treatment goals for an acute ischemic stroke. The care of patients with stroke has shifted away from the "nearest hospital" to certified stroke centers. These are hospitals that have been certified by some external agency, most commonly the state or Joint Commission on Accreditation of Healthcare Organizations, the federal agency overseeing all facilities that care for Medicare patients.
primary (somatosensory) cortex
has a spatial orientation, the sensory homunculus
pain
theories include: specificity theory, pattern theory, gate control theory
nociceptive
these action potentials are transmitted through myelinated Aδ & unmyelinated C fibers
Carpal Tunnel Treatments (2):
1. Avoid movements that causes pain. 2. Splinting and anti-inflammatory medication.
Mononeuropathies (4):
1. Caused by localized conditions such as trauma, compression, or infections that affect a single spinal nerve, plexus, or peripheral nerve trunk. 2. Fractured bones may lacerate or compress nerves. 3. Excessively tight tourniquets may injure nerves directly or produce ischemic injury. 4. Infections such as herpes zoster may affect a single segmental afferent nerve distribution.
Following his annual influenza vaccination, a patient begins to feel achy, like he has developed the flu. An hour later, the patient is rushed to the emergency department. Diagnosis of Guillain-Barré syndrome was made based on which of the following assessment findings? Choose all that apply.
1.Rapid deterioration of respiratory status 2. Flaccid paralysis of limbs 3. Pale, cool, dry skin
second
______-order neurons in spinal cord process information & transmit it to reticular formation & thalamus
third
______-order neurons project pain information to somatosensory cortex where perception & subjective meaning of pain take place
phantom limb pain
a neurologic pain that follows amputation of a limb
analgesia
absence of pain
analgesia
absence of pain on noxious stimulation or relief of pain without loss of consciousness
cluster headache
accompanied by conjunctival injection (redness) or lacrimation (tearing), ipsilateral nasal congestion, eyelid edema, or forehead/facial sweating
astereogenesis
*Dorsal Column Medial Lemniscal Pathway* if medial lemniscal pathway is functional but somatosensory cortex is damaged, you can describe object but not recognize the specific object type
The nurse caring for a client with a newly diagnosed intracranial tumor anticipates that the neoplasm will be which of the following? a) Oligodendroglioma b) Meningioma c) Astrocytic neoplasms d) Metastatic carcinoma
Astrocytic neoplasms Collectively, astrocytic neoplasms are the most common type of primary brain tumor in adults; therefore the nurse anticipates that this is the cause of te client's intracranial tumor.
When the suspected diagnosis is bacterial meningitis, what assessment techniques can assist in determining if meningeal irritation is present? a) Kernig sign and Chadwick sign b) Chvostek sign and Guedel sign c) Brudzinski sign and Chadwick sign d) Brudzinski sign and Kernig sign
Brudzinski sign and Kernig sign Two assessment techniques can help determine whether meningeal irritation is present. Kernig sign is resistance to extension of the knee while the person is lying with the hip flexed at a right angle. Brudzinski sign is elicited when flexion of the neck induces flexion of the hip and knee. The other answers are incorrect.
somatosensory
Central processing of _________ information perception involves: -awareness of stimuli -localization & discrimination of its characteristics -interpretation of its meaning
pain
can be classified according to location, referral, & duration
cluster headache
hypothalamus is believed to play a key role in this pathology
muscle spasm (guarding)
protective reflex rigidity to guard affected body part
proprioceptive receptors
provide information on stationary & dynamic (kinesthesia) aspects of movement
unmyelinated
slow-wave pain
slower conducting (paleospinothalamic tract)
transmits diffuse, dull, aching, & unpleasant sensations to brainstem
A patient has an abrupt onset of mental slowing and depression. Which of the following conditions in the patient's history would indicate vascular dementia as a cause of these changes? Select all that apply. a) Cigarette smoking b) Peptic ulcer c) Diabetes insipidus d) Cardiac dysrhythmias e) Cerebrovascular accident
• Cerebrovascular accident • Cardiac dysrhythmias • Cigarette smoking The hallmarks of vascular dementia are mental slowing and depression. They usually occur as a result of brain injury from hemorrhage or occlusion. Common disorders associated with this diagnosis are cerebrovascular accident, cardiac dysrhythmias, cigarette smoking, hypertension, hyperlipidemia, diabetes mellitus, and autoimmune disorders.
The nurse assessing a patient with a traumatic brain injury assesses for changes in which of the following? Select all that apply. a) Sensory function b) Level of consciousness c) Metabolic function d) Motor function e) Cognition
• Cognition • Level of consciousness • Motor function • Sensory function Brain injuries can cause changes in level of consciousness and alterations in cognition, motor, and sensory function; therefore, the nurse assessing a patient with a traumatic brain injury should assess for changes in these areas.
A patient who experienced a traumatic head injury from a severe blow to the back of his head now lives with numerous function deficits, including an inability to maintain steady posture while he is in a standing position, although he is steadier when walking. Which of the following disorders most likely resulted from his injury?
A vestibulocerebellar disorder
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? a) "The cranial sutures are fused and decrease brain damage." b) "Infants never have symptoms from hydrocephalus." c) "Because the skull sutures are not fused there may be no brain damage." d) "Unfortunately, there usually is significant brain dysfunction."
"Because the skull sutures are not fused there may be no brain damage." When hydrocephalus develops in utero, before the cranial sutures have fused, the head can swell and decrease intracranial pressure, thereby decreasing the amount of brain tissue that is compressed.
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? a) "What is your normal routine before bedtime?" b) "Did you go to the hospital following the accident?" c) "How long have you been married?" d) "Did you sustain any injuries in the accident?"
"Did you sustain any injuries in the accident?" Postconcussion syndrome can interfere with daily living and also with relationships and can continue for months. The syndrome can include amnesia, insomnia, headache, difficulty concentrating, and irritability. In this situation, it would be very important to determine if the patient sustained a head injury to rule out postconcussion syndrome.
A patient discharged from the hospital 5 days ago following a stroke has come to the emergency department with facial droop that progressed with hemiplegia and aphasia. The patient's spouse is extremely upset because the physician stated that the patient cannot receive thrombolytic medications to reestablish cerebral circulation and the spouse asks the nurse why. Which of the following is the nurse's most accurate response? a) "All the brain tissue damage is already done." b) "Thrombolytics may cause cerebral hemorrhage." c) "The medications do not work with subsequent strokes." d) "The stroke is hemorrhagic, not thrombotic."
"Thrombolytics may cause cerebral hemorrhage." A previous stroke, occurring within 3 months of the administration of thrombolytics, significantly increases the risk of intracranial hemorrhage.
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? a) "The patient would be fine without showering." b) "You should remind the patient to shower." c) "The patient is experiencing a temporary relapse." d) "The patient just does not care anymore."
"You should remind the patient to shower." The patient should be reminded to shower because most likely he or she has difficulty remembering to do so. In the moderate stage of Alzheimer's disease, which can last for several years, it is not unusual for hygiene to be neglected because the person may just not remember if he or she did or did not shower. There is no information in the question to support the remaining responses.
A 20 year-old has been diagnosed with an astrocytic brain tumor located in the brainstem. Which of the following statements by the oncologist treating the client is most accurate? a) "Your prognosis will depend on whether we can surgically resect your tumor." b) "This is likely a result of a combination of heredity and lifestyle." c) "The major risk that you face is metastases to your lungs, liver or bones." d) "Our treatment plan will depend on whether your tumor is malignant or benign."
"Your prognosis will depend on whether we can surgically resect your tumor." The prognosis of people with pilocytic astrocytomas is influenced primarily by their location. The prognosis is usually better for people with surgically resectable tumors, such as those located in the cerebellar cortex, than for people with less accessible tumors, such as those involving the hypothalamus or brain stem. -Because of infiltration of brain tissue that prevents total resection, surgery rarely cures brain tumors. -The binary of malignant and benign is not used to characterize brain tumors and the etiology and substantive risk factors are largely unknown. - Brain tumors rarely metastasize outside the CNS.
stereogenesis
*Dorsal Column Medial Lemniscal Pathway* conveys information on size/shape of object without visual input
without aura
*Migraine* increased sensitivity to light & sound
without aura
*Migraine* may be accompanied by nausea & vomiting
without aura
*Migraine* pulsating, throbbing, unilateral headache that lasts 1-2 days and is aggravated by physical activity
with aura
*Migraine* same symptoms as without aura + visual or neurologic symptoms that precede the headache cluster headache
chickenpox (varicella)
*Postherpetic Neuralgia* herpes zoster (shingles) is caused by the same herpesvirus that causes...
proprioceptive receptors
-muscle spindle fibers -Golgi tendon organs
thalamus
2 parallel pathways transmit information from spinal cord to the _______: 1.dorsal column medial lemniscal pathway 2.anterolateral pathway
Which of the following clients may be experiencing a sensory focal seizure that has sent an abnormal cortical discharge to the Autonomic Nervous System (ANS)? a) 44 year old patient complaining of constant movement and pain in the legs that gets worse when they try to sleep. b) 85 year old patient experiencing drooping of the right side of face and numbness in right arm and leg. c) 56 year old complaining of tingling sensations and has both an elevated pulse and BP. d) 22 year old complaining of a stiff neck and achiness, along with some nausea and vomiting.
56 year old complaining of tingling sensations and has both an elevated pulse and BP. Sensory symptoms correlate with the location of seizure activity on the contralateral side of the brain and may involve somatic sensory disturbance (tingling). With abnormal cortical discharge stimulating ANS, see tachycardia, diaphoresis, hypo- or hypertension, or papillary changes. Distractor A is associated with restless leg syndrome (RLS). Distractor B is associated with stroke (CVA). Distractor D is associated with meningitis.
Which of the following individuals has the highest chance of having a medulloblastoma?
A 4-year-old child who has become uncoordinated in recent months
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) An absence seizure b) A myoclonic seizure c) A complex partial seizure. d) A tonic-clonic seizure.
A tonic-clonic seizure. A tonic-clonic seizure often begins with tonic contraction of the muscles with extension of the extremities and immediate loss of consciousness. Incontinence of bladder and bowel is common. Cyanosis may occur from contraction of airway and respiratory muscles. The tonic phase is followed by the clonic phase, which involves rhythmic bilateral contraction and relaxation of the extremities. -A myoclonic seizure involves bilateral jerking of muscles, generalized or confined to the face, trunk, or one or more extremities. -Absence seizures are nonconvulsive and -complex partial seizures are accompanied by automatisms (aimless and apparently undirected behavior that is not under conscious control and is performed without conscious knowledge).
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? a) Psychotherapy b) Acetylcholinesterase inhibitors c) Antioxidant therapy d) Lipid-lowering agents
Acetylcholinesterase inhibitors Cognitive function in Alzheimer's disease (AD) can be enhanced by the use of medications. The acetylcholinsterase inhibitors donepezil, rivastigmine, and galantamine all increase concentration of acetylcholine in the cerebral cortex. -There has been no demonstrated improvement of cognitive function with use of lipid-lowering statins or antioxidant nutritional supplement therapy. -Psychotherapy is appropriate for depression.
A client is brought to the emergency department and is diagnosed with an ischemic stroke confirmed by CT scan. The most important treatment for this client would be to: a) Prepare the client for emergency surgery b) Monitor vital signs closely for improvement c) Administer IV tissue-type plasmin activator (tPA) d) Administer analgesics for the relief of pain
Administer IV tissue-type plasmin activator (tPA) tPA administration is the treatment of choice for an ischemic stroke after confirmation that it is not a hemorrhagic stroke. Monitor vital signs and provide pain relief to prevent complications
For seizure disorders that do not respond to anticonvulsant medications, the option for surgical treatment exists. What is removed in the most common surgery for seizure disorders? a) Amygdala b) Temporal neocortex c) Hippocampus d) Entorhinal cortex
Amygdala The most common surgery consists of removal of the amygdala and an anterior part of the hippocampus and entorhinal cortex, as well as a small part of the temporal pole, leaving the lateral temporal neocortex intact. Only a portion of the hippocampus and entorhinal cortex, and temporal pole are removed.
A nurse is teaching a client newly diagnosed with a seizure disorder about medications. The most important information for the nurse to provide would be: a) Antiepileptic medications should never be discontinued abruptly. b) Pregnant women should reduce the dose of medication they are taking. c) All antiepileptic medications should be taken with food. d) Children can build up a tolerance to the medication quickly.
Antiepileptic medications should never be discontinued abruptly. Consistency in taking seizure medications is essential to obtaining and maintaining therapeutic blood levels of the medication. Abrupt withdrawal can cause seizure recurrence. Monitoring and assessment of drug levels are important. Each prescribed drug will provide information regarding administration to provide client safety.
What medication teaching should be done for a woman of childbearing age with a seizure disorder? a) Antiseizure drugs do not interact with oral contraceptives. b) Antiseizure drugs increase the risk for congenital abnormalities. c) All women of childbearing age should be advised to take a vitamin C supplement. d) Some antiseizure drugs can interfer with vitamin K metabolism.
Antiseizure drugs increase the risk for congenital abnormalities. For women with epilepsy who become pregnant, antiseizure drugs increase the risk for congenital abnormalities and other perinatal complications. - Many of the antiseizure medications interact with oral contraceptives and can interfere with vitamin D metabolism. -All woman should be advised to take folic acid supplementation.
The nurse is caring for a client with a brain tumor when the client begins to vomit. Which intervention should the nurse do first? a) Document the finding as it is an expected symptom b) Assess for signs/symptoms of cerebral vascular accident c) Assess for other signs/symptoms of increased intracranial pressure d) Contact physician for anti-nausea medication orders
Assess for other signs/symptoms of increased intracranial pressure The tumor may be causing increased intracranial pressure. Vomiting, with or without nausea, is a common symptom of increased intracranial pressure and/or brain stem compression. The nurse's first action is to assess for other signs/symptoms of increased intracranial pressure. Once the assessment is completed, the nurse should contact the physician if indicated by the findings.
The two main categories of glial tumors include which of the following? a) Meningiomas b) Oligohydraminos c) Ependymomas d) Astrocytic
Astrocytic Glial tumors are divided into two main catgories: astrocytic and oligodendroglial.
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? a) CT scan b) MRI c) Intravenous antibiotics d) pain medication
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).
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? a) Blood has accumulated between the man's dura and subarachnoid space. b) A traumatic lesion in the frontal or temporal lobe has resulted in increased ICP. c) Blood has displaced CSF in the ventricles as a consequence of his coup-contrecoup injury. d) Vessels have burst between the client's skull and his dura.
Blood has accumulated between the man's dura and subarachnoid space. A subdural hematoma develops in the area between the dura and the arachnoid space while epidural hematomas exist between the skull and dura. -Intracerebral hematomas are located most often in the frontal or temporal lobe and the ventricles are not directly involved in a subdural hematoma.
A teenager has been in a car accident and experienced acceleration-deceleration head injury. Initially, the client was stable but then started to develop neurological signs/symptoms. The nurse caring for this client should be assessing for which type of possible complication? a) Status epilepticus b) Brain contusions and hematomas c) Momentary unconsciousness d) TIAs and cerebrovascular infarction
Brain contusions and hematomas Contusions (focal brain injury) cause permanent damage to brain tissue. The bruised, necrotic tissue is phagocytized by macrophages, and scar tissue formed by astrocyte proliferation persists as a crater. The direct contusion of the brain at the site of external force is referred to as a acceleration injury, whereas the opposite side of the brain receives the deceleration injury from rebound against the inner skull surfaces. As the brain strikes the rough surface of the cranial vault, brain tissue, blood vessels, nerve tracts, and other structures are bruised and torn, resulting in contusions and hematomas. -TIAs and cerebral vascular infarction (stroke) are often caused by atherosclerotic brain vessel occlusions that cause ischemic injuries. - In mild concussion head injury, there may be momentary loss of consciousness without demonstrable neurologic symptoms or residual damage, except for possible residual amnesia. -Status epilepticus is not related to this situation.
A teenager has been in a car accident and experienced acceleration-deceleration head injury. Initially, the client was stable but then started to develop neurological signs/symptoms. The nurse caring for this client should be assessing for which type of possible complication? a) Brain contusions and hematomas b) Momentary unconsciousness c) TIAs and cerebrovascular infarction d) Status epilepticus
Brain contusions and hematomas Contusions (focal brain injury) cause permanent damage to brain tissue. The bruised, necrotic tissue is phagocytized by macrophages, and scar tissue formed by astrocyte proliferation persists as a crater. The direct contusion of the brain at the site of external force is referred to as a acceleration injury, whereas the opposite side of the brain receives the deceleration injury from rebound against the inner skull surfaces. As the brain strikes the rough surface of the cranial vault, brain tissue, blood vessels, nerve tracts, and other structures are bruised and torn, resulting in contusions and hematomas. -TIAs and cerebral vascular infarction (stroke) are often caused by atherosclerotic brain vessel occlusions that cause ischemic injuries. -In mild concussion head injury, there may be momentary loss of consciousness without demonstrable neurologic symptoms or residual damage, except for possible residual amnesia. -Status epilepticus is not related to this situation.
Manifestations of brain tumors are focal disturbances in brain function and increased ICP. What causes the focal disturbances manifested by brain tumors? a) Brain edema and disturbances in blood flow b) Brain compression and decreased ICP c) Tumor infiltration and decreased ICP d) Tumor infiltration and increased blood pressure
Brain edema and disturbances in blood flow Intracranial tumors give rise to focal disturbances in brain function and increased ICP. Focal disturbances occur because of brain compression, tumor infiltration, disturbances in blood flow, and brain edema. Blood pressure, either increased or decreased, is not a manifestation of a brain tumor.
A patient admitted to the emergency department with a change in mental status and a history of AIDS and primary central nervous system (CNS) lymphoma becomes extremely combative with the medical personnel. A family member is very upset with the patient's behavior. The nurse explains that these behaviors are most likely caused by which of the following? a) Recurrence of primary CNS lymphoma b) Decrease in intracranial pressure c) Onset of early dementia d) AIDS-induced encephalopathy
Brain edema and disturbances in blood flow Intracranial tumors give rise to focal disturbances in brain function and increased ICP. Focal disturbances occur because of brain compression, tumor infiltration, disturbances in blood flow, and brain edema. -Blood pressure, either increased or decreased, is not a manifestation of a brain tumor.
Intracranial aneurysms that rupture cause subarachnoid hemorrhage in the client. How is the diagnosis of intracranial aneurysms and subarachnoid hemorrhage made? a) CT scan b) Loss of cranial nerve reflexes c) MRI d) Venography
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.
Peripheral Neuropathy Involvement:
Can involve a single nerve (mononeuropathy) or multiple nerves (polyneuropathy).
A compression of the medial nerve:
Carpal Tunnel Syndrome
An elderly male patient has been brought to the emergency department after experiencing stroke-like symptoms a few hours ago, and has been subsequently diagnosed with an ischemic stroke. The care team is eager to restore cerebral perfusion despite the likely death of the brain cells directly affected by the stroke. What is the rationale for the care teams emphasis on restoring circulation?
Cells of the penumbra may be saved from hypoxic damage if blood flow is promptly restored
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? a) Vegetative state b) Brain death c) Delirium d) Coma
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.
A patient with a history of a seizure disorder has been observed suddenly and repetitively patting his knee. After stopping this repetitive action, the patient appears confused and is oriented to person and place but not time. What type of seizure did this patient most likely experience?
Complex partial seizure
The nurse knows that which of the following treatment plans listed below is most likely to be prescribed after a computerized tomography (CT) scan of the head reveals a new-onset aneurysmal subarachnoid hemorrhage? a) Craniotomy and clipping of the affected vessel. b) STAT administration of tissue-type plasminogen activator (tPA). c) Administration of a diuretic such as mannitol to reduce cerebral edema and ICP. d) Monitoring in ICU for signs and symptoms of cerebral insult.
Craniotomy and clipping of the affected vessel. Surgery for treatment of aneurysmal subarachnoid hemorrhage involves craniotomy and inserting a specially designed silver clip that is tightened around the neck of the aneurysm. Administration of tPA would exacerbate bleeding and a diuretic would not address the issue of bleeding. Monitoring alone would be an insufficient response given the severity of the problem.
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? a) Increase oxygen demands and metabolic needs b) Decrease the patient's ability to attempt suicide again c) Decrease metabolic needs and increase oxygenation d) Decrease intracranial fluid volumes and pressures
Decrease metabolic needs and increase oxygenation The general goal of treatment with global cerebral ischemia is to decrease metabolic needs and increase oxygenation to the injured cerebral tissue. Artificial ventilation provides appropriate oxygenation; keeping the patient paralyzed decreases the body's metabolic needs.
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: a) Decreased level of carbon dioxide b) Decreased hydrogen ions c) Decreased level of PCO2 d) Decreased level of oxygen
Decreased level of oxygen Regulation of blood flow to the brain is controlled largely by autoregulatory or local mechanisms that respond to the metabolic needs of the brain. Metabolic factors affecting cerebral blood flow include an increase in carbon dioxide and hydrogen ion concentrations; cerebral blood flow is affected by decreased O2 levels and increased hydrogen ions, carbon dioxide, and PCO2 levels.
After evaluating the patient, the physician thinks that his elderly patient is exhibiting signs and symptoms of normal pressure hydrocephalus. Which of the following symptoms would be seen? a) Papilledema b) Headache c) Vomiting d) Disturbances in gait
Disturbances in gait In adults, slowly developing hydrocephalus may produce deficits such as progressive dementia and gait changes. The other options are symptoms of increased ICP seen in acute onset hydrocephalus.
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? a) Encephalitis b) Bacterial meningitis c) Viral meningitis d) Meningioma
Encephalitis Less frequent causes of encephalitis include ingesting toxic substances such as lead. -People experience neurologic disturbances such as lethergy, disorientation, seizures, focal paralysis, delirium and coma. - Bacterial and viral meningitis are caused by bacterial and viral infections. -Meningiomas are a type of brain tumor that are seen in the middle or later years of life.
The CT scan report identified that a client with a skull fracture has developed a hematoma that resulted from a torn artery. The report would be interpreted as: a) Epidural hematoma b) Intracranial hematoma c) Subdural hematoma d) Chronic subdural hematoma
Epidural hematoma An epidural hematoma is one that develops between the inner side of the skull and the dura, usually resulting from a tear in an artery, most often the middle meningeal, usually in association with a head injury in which the skull is fractured. -A subdural hematoma results from a torn vein; -chronic subdural hematoma is common in older persons: -brain atrophy causes the brain to shrink away from the dura and to stretch fragile bridging veins. - An intracranial hematoma occurs when a blood vessel ruptures within your brain or between your skull and your brain.
The nurse assessing for the doll's head response (doll's eye response) in an unconscious client documents which of the following as an abnormal response? a) Eyes turn up when head is tilted down b) Eyes turn toward right when head is turned to left c) Eyes turn right when head is turned right d) Eyes turn down when head is tilted up
Eyes turn right when head is turned right The normal doll's head response (doll's eye response) is movement of the eyes in conjugate gaze to the opposite side or direction when the head is moved from side to side or up and down. An abnormal response is fixed position of the eyes or movement in the same direction as the head.
An emergency room nurse receives a report that a client's Glasgow Coma Scale (GCS) is 3. The nurse prepares to care for a client with which of the following? a) Normal flexion b) Confused conversation c) Flaccid motor response d) Spontaneous eye opening
Flaccid motor response A score of 3 on the Glasgow Coma Scale indicates the lowest possible score in each of the three scoring categories (eye opening, motor response, and verbal response) and includes flaccid or no motor response, no verbal response and the inability to open the eyes.
A client with a history of a seizure disorder has been observed suddenly and repetitively patting his knee. After stopping this repetitive action, the client appears confused but is oriented to person and place but not time. What type of seizure did this client most likely experience? a) Focal seizure with impairment to consciousness b) Atonic seizure c) Tonic-clonic seizure d) Myoclonic seizure
Focal seizure with impairment to consciousness Focal seizures with impairment of consciousness, sometimes referred to as psychomotor seizures, are often accompanied by automatisms or repetitive nonpurposeful activities such as lip smacking, grimacing, patting, or rubbing clothing. Confusion during the postictal period (after a seizure) is common. -Atonic seizures are characterized by loss of muscle tone, and -myoclonic seizures involve brief involuntary muscle contractions induced by stimuli of cerebral origin. -With tonic-clonic seizures, formerly called grand mal seizures, a person has a vague warning (probably a simple focal seizure) and experiences a sharp tonic contraction of the muscles with extension of the extremities and immediate loss of consciousness.
Knowing that she is a carrier for Duchene muscular dystrophy (DMD), a pregnant woman arranged for prenatal genetic testing, during which her child was diagnosed with DMD. As her son develops, the woman should watch for which of the following early signs that the disease is progressing?
Frequent falls and increased muscle size
Following surgery for a large malignant brain tumor, the nurse should anticipate discussing which further treatment option with the family that may ensure that any remaining cancer cells will be killed? a) Gamma knife radiation b) Immunotherapy c) Chemotherapy d) Stem cell transplant
Gamma knife radiation Most malignant brain tumors respond to external irradiation. Irradiation can increase longevity and sometimes can allay symptoms when tumors recur. The treatment dose depends on the tumor's histologic type, responsiveness to radiation, and anatomic site and on the level of tolerance of the surrounding tissue. A newer technique called gamma knife combines stereotactic localization of the tumor with radiosurgery, allowing delivery of high-dose radiation to deep tumors while sparing the surrounding brain.
Which of the following disorders of neuromuscular function typically has the most rapid onset?
Guillain-Barr Syndrome
A 9 year-old boy has been brought to the emergency department by his father who is concerned by his son's recent fever, stiff neck, pain and nausea. Examination reveals a petechial rash. Which of the following assessment questions by the emergency room physician is most appropriate? a) "Does your son have a history of cancer?" b) "Has your son had any sinus or ear infections in the last little while?" c) "Was your son born with any problems that affect his bone marrow or blood?" d) "Is your son currently taking any medications?"
Has your son had any sinus or ear infections in the last little while?" The most common symptoms of acute bacterial meningitis are fever and chills; headache; stiff neck; back, abdominal, and extremity pains; and nausea and vomiting. Risk factors associated with contracting meningitis include otitis media and sinusitis or mastoiditis. -Particular medications, a history of neoplasm and hematopoietic problems would be unlikely to relate directly to his symptoms of meningitis.
A high school senior sustained a concussion during a football game. Which of the following signs and symptoms would indicate the presence of postconcussion syndrome in the days and weeks following his injury?
Headaches and memory lapses
A college student has been experiencing frequent headaches that he describes as throbbing and complaining of difficulty concentrating while studying. Upon cerebral angiography, he is found to have an arteriovenous malformation. Which of the following pathophysiological concepts are likely responsible for his symptoms? a) Increased tissue perfusion at the site of the malformation. b) High pressure and local hemorrhage of the venous system. c) Hydrocephalus and protein in the cerebral spinal fluid. d) Localized ischemia with areas of necrosis noted on CT angiography.
High pressure and local hemorrhage of the venous system. Answer B is incorrect since arteriovenous malformation is associated with blood vessels and not the fluid within the ventricles of the brain. Answer D is incorrect in that there is blood flow to the area. Ischemia is associated with decreased arterial flow resulting in death to brain tissue. In arteriovenous malformations, a tangle of arteries and veins acts as a bypass between the cerebral arterial and venous circulation, in place of the normal capillary bed. However, the capillaries are necessary to attenuate the high arterial blood pressure before this volume drains to the venous system. As a result, the venous channels experience high pressure, making hemorrhage and rupture more likely; the lack of perfusion of surrounding tissue causes neurologic deficits such as learning disorders. Headaches are severe, and people with the disorder may describe them as throbbing (synchronous with their heartbeat). Increased tissue profusion means that more oxygenated blood is brought to the area which is not the case. The elevated arterial and venous pressures divert blood away from the surrounding tissue, impairing tissue perfusion.
A patient with memory loss is concerned about the possibility that it may be inherited. Which of the following disorders is an inherited dementia? a) Vascular dementia b) Wernicke-Korsakoff syndrome c) Frontotemporal dementia d) Huntington's disease
Huntington's disease Vascular dementia occurs as a result of brain injury from hemorrhage or occlusion. Frontotemporal dementia causes atrophy of the brain but is not hereditary. Wernicke-Korsakoff syndrome is a result of chronic alcoholism. Huntington's disease is an inherited disorder with chorea and dementia.
The nurse is planning an inservice on hypoxia versus ischemia in brain-injured clients. The nurse should include which of the following? a) Ischemia does not interfere with delivery of glucose. b) Ischemia denotes a deprivation of oxygen with maintained perfusion. c) Hypoxia denotes an interruption in blood flow. d) Hypoxia produces a generalized depressive effect on the brain.
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.
Which of the following statements by the husband of a patient with Alzheimer disease demonstrates an accurate understanding of his wifes medication regimen?
Im really hoping these medications will slow down her mental losses
A family is sitting with a patient in the intensive care unit who sustained significant head injuries in a motorcycle accident. They are questioning the nurse about why the patient's eyes open but do not stay open for long. The nurse explains that the patient is probably in which of the following states? a) In a stuporous state due to a reticular activated system (RAS) injury b) In a stuporous state due to acidosis c) In an obtunded state due to possible brain injury d) In an obtunded state due to a concussion
In a stuporous state due to a reticular activated system (RAS) injury Injury to the RAS would be suspected due to the change in the level of consciousness. The RAS and functional cerebral hemispheres are necessary for arousal and wakefulness; damage to either will negatively affect a person's level of consciousness.
A client has developed global ischemia of the brain. The nurse determines this is: a) Inadequate perfusion of the nondominant side of the brain b) Inadequate perfusion to the dominant side of the brain c) Inadequate perfusion of the right side of the brain d) Inadequate to meet the metabolic needs of the entire brain
Inadequate to meet the metabolic needs of the entire brain Global ischemia occurs when blood flow is inadequate to meet the metabolic needs of the entire brain. The result is a spectrum of neurologic disorders reflecting diffuse brain dysfunction.
Which of the following pathophysiologic processes occurs in cases of bacterial meningitis?
Inflammation allows pathogens to cross into the cerebrospinal fluid
A patient admitted to the emergency department with a change in mental status and a history of AIDS and primary central nervous system (CNS) lymphoma becomes extremely combative with the medical personnel. A family member is very upset with the patient's behavior. The nurse explains that these behaviors are most likely caused by which of the following? a) Recurrence of primary CNS lymphoma b) Onset of early dementia c) Decrease in intracranial pressure d) AIDS-induced encephalopathy
Recurrence of primary CNS lymphoma Primary CNS lymphoma has a higher incidence in people who are immunocompromised and who also have a high rate of recurrence in spite of treatment. The most common symptoms include behavioral and cognitive changes that occur in about 43% of the cases. There is no information in the question to support any of the other options.
A client has started having uncontrolled seizures that are not responding to usual medications. Nursing working with the client must pay special attention to which of the following priority aspects of this clients care? Assessment of: a) Ability to grasp hands and squeeze on command b) ECG for arrhythmias c) Respiratory status and oxygen saturation d) Urine output and continence
Respiratory status and oxygen saturation Tonic-clonic status epilepticus is a medical emergency and, if not promptly treated, may lead to respiratory failure and death. Treatment consists of appropriate life support measures. Airway/breathing is always the priority in this emergency situation
A patient with a diagnosis of myasthenia gravis has required a mastectomy for the treatment of breast cancer. The surgery has been deemed a success, but the patient has gone into a myasthenic crisis on postoperative day 1. Which of the following measures should the care team prioritize in this patient's immediate care?
Respiratory support and protection of the patient's airway
A patient is devastated to receive a diagnosis of amyotrophic lateral sclerosis (ALS). The symptomatology of this disease is a result of its effects on upper and lower motor neurons. The health care provider caring for this patient will focus on which priority intervention for this patient?
Respiratory ventilation assessment and prevention of aspiration pneumonia
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 of the following abnormalities in the patient's gait?
Slow to start walking and has difficulty when asked to "stop" suddenly
The emergency department nurse is caring for a patient who fell and had a head injury. Which of the following assessments would be noted during the early stage of intracranial pressure increase? a) Vomiting b) Hemiplegia c) Nonreactive pupils d) Stable vital signs
Stable vital signs The vital signs remain unchanged in the early stage of increased intracranial pressure. The remaining options are characteristic of late signs.
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: a) Normal physiologic circumstances result in decreased adsorption of CSF. b) There is a decrease in the amount of fluid volume in the brain. c) The blood-brain barrier is disrupted, allowing fluid to escape into the extracellular fluid. d) There is an increase in the production of cerebral spinal fluid volume.
The blood-brain barrier is disrupted, allowing fluid to escape into the extracellular fluid. Vasogenic brain edema occurs with conditions that impair the function of the blood-brain barrier and allow the transfer of water and protein from the vascular space into the interstitial space. Increased production of CSF and decreased absorption result in hydrocephalus. It occurs in conditions such as hemorrhage, brain injury, and infectious processes. (less
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: a) There is a decrease in the amount of fluid volume in the brain. b) There is an increase in the production of cerebral spinal fluid volume. c) Normal physiologic circumstances result in decreased adsorption of CSF. d) The blood-brain barrier is disrupted, allowing fluid to escape into the extracellular fluid.
The blood-brain barrier is disrupted, allowing fluid to escape into the extracellular fluid. Vasogenic brain edema occurs with conditions that impair the function of the blood-brain barrier and allow the transfer of water and protein from the vascular space into the interstitial space. Increased production of CSF and decreased absorption result in hydrocephalus. It occurs in conditions such as hemorrhage, brain injury, and infectious processes.
During class, the instructor asks students to explain the pathophysiology behind development of multiple sclerosis. Which student gave the most accurate description?
The demyelination and subsequent degeneration of nerve fibers and decreased oligodendrocytes, which interfere with nerve conduction
A nurse is discussing how vascular dementia differs from Alzheimer disease with a client. Select the most appropriate information. a) The main presenting symptom of vascular dementia is slow psychomotor function. b) Alzheimer disease most often presents with a rapid onset of memory loss followed by slowly progressive dementia that has a course of several years. c) Vascular dementia develops between the ages of 35 and 45. d) Vascular dementia is caused by neuritic (senile) plaques.
The main presenting symptom of vascular dementia is slow psychomotor function. The main presenting symptom of vascular dementia is slow psychomotor function. Alzheimer disease has been linked to neuritic plaque and has a slow onset. Vascular dementia usually manifests at age 50 or beyond.
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? a) Hemolysis b) Hemostasis c) Thrombolysis d) Thrombogenesis
Thrombolysis Synthetic tissue plasminogen activators work with the body's natural tissue plasminogen activators to convert plasminogen to plasmin, which breaks down clots to allow for the reestablishment of blood flow. There are two causes of strokes: hemorrhagic and thrombotic, with thrombotic strokes occurring much more frequently. Thrombolytics play a large role in increased outcomes seen with thrombotic strokes.
The most common cause of an ischemic stroke is which of the following? a) Thrombosis b) Cardiogenic embolus c) Intracerebral arterial vasculitis d) Vasospasm
Thrombosis Thrombi are the most common cause of ischemic strokes, usually occurring in atherosclerotic blood vessels.
A client who is being seen in the outpatient clinic reports a single episode of unilateral arm and leg weakness and blurred vision that lasted approximately 45 minutes. The client is most likely experiencing: a) Transient ischemic attack (TIA) b) Lacunar infarct c) Cardiogenic embolic stroke d) Thrombotic stroke
Transient ischemic attack (TIA) Transient ischemic attacks are brief episodes of neurologic function resulting in focal cerebral ischemia not associated with infarction that usually resolve in 24 hours. The causes of transient ischemic attack are the same as they are for stroke. Embolic stroke usually has a sudden onset with immediate maximum deficit. Lacunar infarcts produce classic recognizable "lacunar syndromes" such as pure motor hemiplegia, pure sensory hemiplegia, and dysarthria with clumsy hand syndrome.
Global or diffuse brain injury is manifested by changes in the level of consciousness. a) False b) True
True Global brain injury nearly always results in altered levels of consciousness, ranging from inattention to stupor or coma.
A patient is devastated to receive a diagnosis of amyotrophic lateral sclerosis (ALS). The symptomatology of this disease is a result of its effects on:
UPPER and LOWER motor neurons
A patient has been diagnosed with a cerebral aneurysm and placed under close observation before treatment commences. Which of the following pathophysiologic conditions has contributed to this patients diagnosis?
Weakness in the muscular wall of an artery
first
______-order neurons & their receptors detect painful stimuli
Myasthenia gravis is characterized by muscle weakness caused by antibody-mediated destruction of:
acetylcholine receptors
glutamate
acts quickly but lasts only a few sec
cluster headache
affects men more than weomen
cluster (headache)
affects men more than women; episodic occurrences
primary (somatosensory) cortex
akapostcentral gyrus
tension-type
analgesic relief provided by aspirin and NSAIDs
proprioceptive receptors
are found in muscles, tendons & joint capsules
dermatome maps
are used to assess level/extent of damage to segmental nerves &/or spinal cord
PAG (periaqueductal gray) region
area of the midbrain with ↑[opioid receptors] & with descending connections to the brainstem & spinal cord
A patient with a spinal cord injury at T8 would likely retain normal motor and somatosensory function of her:
arms
pain threshold
associated with tissue damage & point at which stimulus is received
thalamic neuron
axon reaches the somatosensory cortex of parietal lobe
thalamus
basic sensation of pain occurs at level of _______
(somatosensory) association area
behind primary somatosensory cortex
The cardinal symptoms of Parkinson disease include:
bradykinesia
nociceptors
bradykinin, histamine, serotonin, & K activate & sensitize
migraine headache
can occur without or with aura
second-order neurons
communicate with spinal reflexes & ascending tract from spinal cord → thalamus
slower
conduction of thermal information is (faster/slower) than the rapid tactile tracts
cluster (headache)
is accompanied by conjunctival injection (redness) or lacrimation (tearing), ipsilateral nasal congestion, eyelid edema, or forehead/facial sweating
glutamate
is an excitatory NT released by the Aδ fibers within the spinal cord
somatosensory cortex
is needed to add precision/discrimination to the pain
substance P
is released more slowly & increases in concentration over seconds/minutes
secondary (headache)
due to meningitis, tumor or cerebral aneurysm
A sudden traumatic complete transection of the spinal cord results in _______ below the level of injury.
flaccid paralysis
intracranial lesions
headaches that disturb sleep, are triggered by exertion, or are accompanied by drowsiness, visual or limb disturbances, or altered mental status suggest underlying ______ ______
Ruffini end organs
heavy continuous touch or pressure
A late indicator of increased intracranial pressure is:
high mean arterial pressure
Extreme cerebral edema may cause the brain to herniate into another compartment. Upward herniation from the infratentorial compartment against the aqueduct of Sylvius causes:
hydrocephalus
cluster (headache)
hypothalamus is believed to play a key role in this pathology
A clinician is assessing the muscle tone of a patient who has been diagnosed with a lower motor neuron (LMN) lesion. Which of the following assessment findings is congruent with the patients diagnosis?
hypotonia
discriminative touch
identify size/shape of object moving across skin surface
TMJ (temporomandibular joint pain)
imbalance in joint movement because of poor bite, bruxism (teeth grinding), inflammation, trauma or degenerative changes
The earliest signs of decreased level of consciousness include:
inattention
Metabolic factors that increase cerebral blood flow include:
increased carbon dioxide level
hyperalgesia
increased painfulness
prostaglandins
induce pain
NSAIDs
inhibit production of PGs; inhibits COX 1/2 enzymes
receptor
innervates a certain area of the periphery
(somatosensory) association area
integrates sensory information with past learning to produce a meaningful experience
phantom limb pain
involvement of forebrain (site of pain integration) has also been suggested
An intracranial epidural hematoma causes focal symptoms that can include:
ipsilateral pupil dilation
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: a) the sign elicited was the Budzinski's sign. b) the sign elicited was the obturator sign. c) resistance should be provided with the knee in a flexed position. d) the client should be in a sitting position.
resistance should be provided with the knee in a flexed position. The test for Kernig's sign for meningeal irritation is performed by providing resistance to flexion of the knees while the client is lying with the hip flexed at a right angle.
Transient ischemic attacks (TIAs) are characterized by ischemic cerebral neurologic deficits that:
resolve within one hour of onset
A patient with a diagnosis of myasthenia gravis has required a mastectomy for the treatment of breast cancer. The surgery has been deemed a success, but the patient has gone into a myasthenic crisis on postoperative day one. Which of the following measures should the care team prioritize in this patients immediate care?
respiratory support and protection of the patients airways
pain receptors
respond to 'freezing cold', < 5°C or 'burning hot', > 45°C
cold receptors
respond to < 34°C
warmth receptors
respond to > 34°C
nociceptors
respond to mechanical, chemical, & thermal stimuli
dermatome
segmental region of the body supplied by a single dorsal root ganglion
proprioception
sense of joint/limb position without visual cues
neuralgia
severe, brief, often repetitive attacks of lightning-like or throbbing pain
cluster (headache)
severe, unilateral, supraorbital, or temporal pain lasting 15-180 minutes
cluster headache
severe, unilateral, supraorbital, or temporal pain lasting 15-180 minutes
Ruffini end organs
signal continuous states of deformation
unmyelinated
slower onset, longer duration
paresthesias
spontaneous, unpleasant sensations
paresthesias
spontaneous, unpleasant sensations seen with severe irritation
hyperpathia
syndrome where sensory threshold is raised
third-order neurons
thalamus → somatosensory cortex (parietal lobe, postcentral gyrus)
The most common cause of ischemic stroke is: a) vasospasms. b) cryptogenesis. c) arterial vasculitis. d) thrombosis.
thrombosis. Ischemic stroke includes those caused by large artery thrombosis (20%), small artery thrombosis (25%), cardiogenic embolism (20%) and cryptogenic (undetermined cause)(30%), making thrombosis the most common cause (45%).
trigeminal neuralgia
tic douloureux
fast-conducting (neospinothalamic tract)
transmits sharp-fast pain to thalamus
cluster headache
uncommon
trigeminal neuralgia
unilateral sensory distribution of one or more branches of CN V
hyperesthesia
unpleasant hypersensitivity
pain
unpleasant sensory & emotional experience associated with actual or potential tissue damage
dorsal column (medial lemniscal pathway)
used for transmission of discriminative touch & proprioception
dorsal column (medial lemniscal pathway)
uses three neurons to transmit information: 1. primary dorsal root ganglion neuron → dorsal column neuron 2.the medial lemniscus → thalamic neuron
A patient with a long history of cigarette smoking and poorly controlled hypertension has experienced recent psychomotor deficits as a result of hemorrhagic brain damage. The patients psychomotor deficits are likely the result of:
vascular dementia
Autonomic dysreflexia (autonomic hyperreflexia) is characterized by:
vasospasms and hypertension
temperature
warmth & cold
tactile
when _____ information is lost → total anesthesia (numbness)
Pacinian corpuscles
within hypodermis
general visceral (afferent neurons)
within visceral structures
Unlike disorders of the motor cortex and corticospinal (pyramidal) tract, lesions of the basal ganglia disrupt movement:
without causing paralysis
pain threshold
~ same for all individuals
A client may be at risk for the development of hypoxia. Select the conditions that would place a client at risk. Select all that apply. a) Increased atmospheric pressure b) Increased oxygenation by the lungs c) Thrombocytopenia d) Age e) Severe anemia f) Carbon monoxide poisoning
• Carbon monoxide poisoning • Increased oxygenation by the lungs • Severe anemia Hypoxia usually is seen in conditions such as exposure to reduced atmospheric pressure, carbon monoxide poisoning, severe anemia, and failure of the lungs to oxygenate the blood. The other options will not alter oxygen levels.
When trying to explain the difference between vasogenic versus cytotoxic cerebral edema, the physiology instructor mentions that cytotoxic edema displays which of the following functions in the brain? Select all that apply. a) May cause herniation by displacing a cerebral hemisphere b) Impaired blood-brain barrier that allows water/proteins to leave vessels and go into the interstitial space c) Allows cells to increase volume to the point of rupture, damaging neighboring cells d) Mainly allows edema to form in the white mater of the brain e) Causes ischemia to build up lactic acid due to anaerobic metabolism
• Causes ischemia to build up lactic acid due to anaerobic metabolism • Allows cells to increase volume to the point of rupture, damaging neighboring cells Cytotoxic edema involves an increase in intracellular fluid. Ischemia results in the inadequate removal of anaerobic metabolic end products such as lactic acid, producing extracellular acidosis. If blood flow is reduced to low levels for extended periods or to extremely low levels for a few minutes, cellular edema can cause the cell membrane to rupture, allowing the escape of intracellular contents into the surrounding extracellular fluid. This leads to damage of neighboring cells. Vasogenic edema occurs with conditions that impair the function of the blood-brain barrier and allow transfer of water and proteins from the vascular into the interstitial space. It occurs primarily in the white matter of the brain, possibly because the white matter is more compliant than the gray matter. Vasogenic edema can result in displacement of a cerebral hemisphere and various types of brain herniation.
The nurse contacts the physician regarding a client's early signs of diminishing level of consciousness based on which of the following? Select all that apply. a) Stupor b) Inattention c) Disorientation d) Blunted responsiveness
• Inattention • Disorientation • Blunted responsiveness The earliest signs of diminution in level of consciousness are inattention, mild confusion, disorientation, and blunted responsiveness.
A brain tumor causing clinical manifestations of headache, nausea, projectile vomiting and mental changes is likely located in which part of the brain? Select all that apply. a) Temporal lobe. b) Frontal lobe. c) Intra-axially. d) Brain stem. e) Extra-axially.
• Intra-axially. • Extra-axially. • Frontal lobe. Tumors within the intracranial (intra-axially) cavity is fixed and cause s/s of increased ICP like headache, n/vomiting, mental changes, papilledema, visual disturbances, alterations in sensory and motor function... Outside the brain tissue (extra-axially) but within the cranium, tumors may reach large sizes without producing s/s. After they reach a sufficient size, s/s of increased ICP appear. -Temporal lobe tumors often produce seizures as their first symptom. -Brain stem tumors commonly produce upper/lower motor neuron s/s such as weakness of facial muscles and ocular palsies. -Frontal lobe tumors also grow to a large size and cause s/s of increased ICP.
Which symptoms would support the diagnosis of a stroke involving the posterior cerebral artery? Select all that apply. a) Repeating of verbal responses b) Loss of central vision c) Contralateral hemiplegia d) Denial of paralyzed side e) Aphasia
• Loss of central vision • Repeating of verbal responses Posterior cerebral artery stroke would produce visual defects and the repeat of verbal and motor responses. -The other options are seen in middle cerebral artery strokes.
A nurse in the emergency room is assessing a client's level of consciousness. The client appears very drowsy but is able to follow simple commands and respond to painful stimuli appropriately. The nurse should document the client's level of consciousness as which of the following? a) Confusion b) Obtundation c) Lethargy
• Obtundation Characteristics of obtundation include responding verbally with a word, arousable with stimulation, responds appropriately to painful stimuli, follows simple commands, and appears very drowsy.
The nurse is providing discharge instructions on the antiseizure medication valproic acid to a woman of childbearing age. Which of the following should the nurse include? Select all that apply. a) The medication may interact with oral contraceptives. b) The medication should be stopped in the third trimester of pregnancy c) The medication may predispose her to osteoporosis. d) The medication should be taken consistently. e) The client should also take a folic acid supplement daily.
• The client should also take a folic acid supplement daily. • The medication may predispose her to osteoporosis. • The medication should be taken consistently. • The medication may interact with oral contraceptives. The nurse should include in the teaching that the client should also take folic acid supplementation daily, that the medication may predispose the client to osteoporosis, and that it may interact with oral contraceptives. The nurse should also caution the client to take the medication on a consistent basis to prevent recurring seizures.
The nurse is caring for a client who has received tissue plasminogen activator (tPA). The nurse's plan of care should include education relating to which of the following? Select all that apply. a) Warfarin (Coumadin) therapy b) Aspirin (ASA) therapy c) Reduction of risk factors d) Signs and symptoms of occurrence
• Warfarin (Coumadin) therapy • Reduction of risk factors • Signs and symptoms of occurrence Clients receive tPA as treatment for ischemic stroke. In her plan of care the nurse should include education related to: warfarin (Coumadin therapy), signs and symptoms of stroke recurrence (most likely in first week post-tPA administration) and ways for the client to reduce risk factors for another stroke.
