AHN chapter 14: care of the pt with a neurological disorder

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

NEUROTRANSMITTERS

Agnosia

inability to recognize familiar objects, tastes, sounds, and other sensations

A patient was involved in a snowmobile accident. On admission to the emergency department, he is receiving oxygen and is intubated. His Glasgow Coma Scale score is 6. About 10 minutes after arrival, he is noted to have a widened pulse pressure, increased systolic blood pressure, and bradycardia. Which finding indicates to the nurse that late-stage increased ICP is present? 1.Anisocoria 2.Supratentorial shift 3.Cushing's response 4.Medullary reflex

2

The nursing care plan for a patient with increased intracranial pressure will include what as the most therapeutic position for the patient? 1.Keep the head of the bed flat. 2.Maintain the head of the bed at 30 degrees. 3.Increase the head of the bed's angle to 30 degrees with patient on left side. 4.Use a continuous-rotation bed to continuously change patient position.

2

1. A patient is admitted to the hospital with a diagnosis of transient ischemic attack (TIA). The patient asks the nurse to explain to him what a TIA is. Which statement by the nurse is most accurate? 1."A TIA is the result of permanent cerebrovascular insufficiency." 2."An episode of a TIA may last up to 2 days." 3."A TIA is often a precursor to a stroke." 4."A TIA generally occurs once and never occurs again."

3

A patient has been diagnosed with Bell's palsy. This condition impacts which cranial nerve? 1.Cranial nerve V 2.Cranial nerve VI 3.Cranial nerve VII 4.Cranial nerve VIII

3

The nurse is caring for a home health patient who had a spinal cord injury at C5 three years ago. The nurse bases the plan of care on the knowledge that the patient will be able to: a. feed self with setup and adaptive equipment. b. transfer self to wheelchair. c. stand erect with full leg braces. d. sit with good balance.

A

What are surgical navigational systems? a. Computerized devices that guide the surgeon b. A set of detailed anatomic maps pinpointing specific areas of the brain c. A written set of progressive processes for the resection of small brain tumors d. The use of radioactive materials to pinpoint small tumors of the brain

A

What is the first sign of Bell's palsy? a. Inability to wrinkle forehead and pucker lips on affected side b. Sudden pain in nostril on affected side c. Excessive salivation on the affected side d. Excessive mucus running from nostril on affected side

A

How would a nurse record the behavior when a patient with Alzheimer disease attempts to eat using a napkin rather than a fork? a. Apraxia b. Agnosia c. Aphasia d. Dysphagia

B

The nurse is aware that the characteristic gait of the person with Parkinson disease is a propulsive gait, which causes the patient to: a. stagger and need support of a walker. b. shuffle with arms flexed. c. fall over to one wide when walking. d. take small steps balanced on the toes.

B

The nurse explains that the two divisions of the autonomic nervous system work to maintain homeostasis. Place in order the autonomic events. (Separate letters by a comma and space as follows: A, B, C, D) a. Parasympathetic nervous system dominates b. Extremely stressful or frightening event c. Blood pressure, heart rate, and adrenaline output decrease d. Sympathetic nervous system dominates e. Heart rate and blood pressure rise, secretion of adrenaline

B, D, E, A, C

What are the effects of normal aging on the nervous system? (Select all that apply.) a. Small vessel occlusion b. Loss of neurons c. Calcification of cerebrum d. Reduction of cerebral blood flow e. Lipofuscin f. Decrease in oxygen use

B, D, E,F

What is the basic problem that prompts most of the early signs of Alzheimer disease? a. Changes in mood b. Misplacing things c. Memory loss that disrupts daily life d. Problems with words in speaking

C

What is the nurse aware of when assessing a person with a craniocerebral injury? a. Most injuries of this type are irreversible b. Open injuries are always more serious than closed injuries c. Signs and symptoms may not occur until several days after the trauma d. Trauma to the frontal lobe is more significant than to any other area

C

What is the purpose of a "drug holiday" in the treatment of Parkinson disease? a. Change all drugs b. Allow the natural dopamine levels to rise c. Restart drugs at a lower dosage with favorable results d. Reduce the extrapyramidal symptoms

C

Why is the patient with suspected Guillain-Barre Syndrome (GBS) hospitalized immediately? a. The infection needs to be treated with IV antibiotics to prevent paralysis b. The brain may swell quickly causing seizures c. The disease can rapidly progress into respiratory failure d. IV hydration is needed to prevent possible fatal hypotension

C

What are the three signs of Cushing response? (Select all that apply.) a. Increased pulse rate b. Increased blood pressure c. Widened pulse pressure d. Bradycardia e. Increased systolic blood pressure f. Uncontrolled thermoregulation

C, D, E

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

NYSTAGMUS

When reviewing the medical plan of treatment for a patient with Guillain-Barré syndrome, what therapies are considered to be most therapeutic? 1.Avonex and Betaseron 2.Thymectomy and Zarontin 3.Depakote and Zarontin 4.Plasmapheresis and intravenous immune globulin

4

The nurse is aware that the drug t-PA (Activase), a tissue plasminogen activator, must be given in____hours of the onset of symptoms to have maximum benefit. a. 3 hours b. 4 hours c. 6 hours d. 8 hours

A

What are the two divisions of the nervous system? a. Somatic and the autonomic b. Cerebellum and the brainstem c. Medulla oblongata and the diencephalon d. Central and the peripheral

D

What does the nurse know about the stroke patient who has expressive aphasia? a. Has difficulty comprehending spoken and written communication b. Cannot make any vocal sounds c. Has total loss and comprehension of language d. Can understand the spoken word, but cannot speak

D

What is the cardinal sign of increased intracranial pressure in a brain injured patient? a. Pupil changes b. Ipsilateral paralysis c. Vomiting d. Decrease in the level of consciousness

D

What is the cranial nerve that supplies most of the organs in the thoracic and abdominal cavities and also carries motor fibers to glands that produce digestive juices and other secretions? a. Somatic motor nerve b. Visceral sensory nerve c. Abducens nerve d. Vagus nerve

D

What is the nurse assessing when asking the patient, "Who is the president of the United States?" during a level of consciousness assessment? a. Orientation b. Memory c. Calculation d. Fund of knowledge

D

Why are the drugs neostigmine (Prostigmin) and pyridostigmine (Mestinon) helpful to the person with myasthenia gravis? a. Improves speech b. Improves visual disturbances c. Reduces pain d. Promotes nerve impulse transmission

D

A frantic family member is distressed about the flaccid paralysis of her son following a spinal cord injury several hours ago. What does the nurse know about this condition? a. It is an ominous indicator of permanent paralysis. b. It is possibly a temporary condition and will clear. c. It degenerates into a spastic paralysis. d. It will progress up the cord to cause seizures.

B

A patient has recently suffered a stroke with left-sided weakness and has problems with choking, especially when drinking thin liquids. What nursing interventions would be most helpful in assisting this patient to swallow safely? a. Use a straw b. Tuck chin when swallowing c. Take a sip of liquid with each bite d. Turn head to the left

B

A patient is in which stage of Alzheimer disease when she demonstrates "sundowning"? a. Early stage b. Second stage c. Third stage d. Final stage

B

An 83-year-old patient has had a stroke. He is right-handed and has a history of hypertension and "little" strokes. He presents with right hemiplegia. To afford him the best visual field, the nurse should approach him: a. from the right side. b. from the left side. c. from the center. d. from either side.

B

As the result of a stroke, a patient has difficulty discerning the position of his body without looking at it. In the nurse's documentation, which would best describe the patient's inability to assess spatial position of his body? a. Agnosia b. Proprioception c. Apraxia d. Sensation

B

Following a myelogram the nurse should include in the postprocedure care assessment for: a. elevation of blood pressure. b. urine retention. c. sensation in lower extremities. d. slurred speech.

C

How would the nurse instruct a patient with Parkinson disease to improve activity level? a. To use a soft mattress to relax the spine b. To walk with a shuffling gait to avoid tripping c. To walk with hands clasped behind back to help balance d. To sit in hard chair with arms for posture control

C

The newly admitted patient to the emergency room after a motorcycle accident has serosanguineous drainage coming from the nose. What is the most appropriate nursing response to this assessment? a. Cleanse nose with a soft cotton-tipped swab b. Gently suction the nasal cavity c. Gently wipe nose with absorbent gauze d. Ask patient to blow his nose

C

The nurse is aware that when assessing a patient by the FOUR score coma scale, the patient is assessed in four categories: eye response, brainstem reflexes, motor response, and respiration. How are these results reported? a. As a sum of the scores of the four categories b. As part of the Glasgow coma scale c. As individual scores in each category d. As progressive scores during a 24-hour period

C

Which of the following techniques are necessary for safely feeding a hemiplegic patient? (Select all that apply.) a. Mixing liquids and solid foods together b. Taking the patient's dentures out to prevent choking c. Checking the affected side of mouth for food accumulation d. Offering small bites of food e. Elevating the patient to no more than 30 degrees f. Adding a thickening agent to liquids

C,D,F

A family member of a patient who has just suffered a tonic-clonic seizure is concerned about the patient's deep sleep. What is this behavior called? a. Convalescent period b. Neural recovery period c. Sombulant period d. Postictal period

D

A patient with a spinal cord injury at T1 complains of stuffiness of the nose and a headache. The nurse notes a flushing of the neck and "goose flesh." What should be the primary nursing intervention based on these assessments? a. Place patient in flat position and check temperature b. Administer oxygen and check oxygen saturation c. Place on side and check for leg swelling d. Sit upright and check blood pressure

D

Which symptom is specific to migraine headaches? a. Tachycardia b. They become worse in the evening c. They involve the entire head d. They are preceded by an aura

D

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

MYELIN

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

MYELOGRAM

aneurysm

Often caused by a hemorrhage. A ruptured hole that occurred by the hemorrhage. a localized weak spot or balloon-like enlargement of the wall of an artery

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

TREMOR, RIGIDITY, BRADYKINESIA

A 76-year-old who has had Parkinson's disease for the past 6 years has now been admitted to a long-term care facility. The nurse doing the admission interview and assessment notices which characteristic sign of the disease? 1.Bradykinesia 2.Increased postural reflexes 3.Sensory loss 4.Intention tremor

1

A right-handed patient has right-sided hemiplegia and aphasia from a stroke. What is the most likely location of the lesion? 1.Left frontal lobe 2.Right brainstem 3.Motor areas of the right cerebrum 4.Medial superior area of the temporal lobe

1

During admission of a patient with a severe head injury to the emergency department, what is the highest priority assessment for the nurse? 1.Patency of airway 2.Presence of a neck injury 3.Neurologic status with the Glasgow Coma Scale 4.Cerebrospinal fluid leakage from the ears or nose

1

The nursing assessment of an 80-year-old who has had a stroke found that she had difficulty swallowing. A videofluoroscopy with barium was performed to rule out aspiration. The rehabilitation team in the skilled nursing facility determined that she can eat a soft diet with one-to-one supervision. Which action is important to prevent aspiration? 1.Tipping the head toward the unaffected side while swallowing 2.Extending the head during swallowing 3.Mixing solids and liquids to facilitate swallowing 4.Encouraging the patient to drink with a straw to make swallowing easier

1

When teaching a patient with Parkinson's disease, which response would indicate the need for further education? 1."If I miss an occasional dose of the medication, it doesn't matter much." 2."I need to exercise at least some every day." 3."I need to be sitting straight up with my chin slightly tucked so I won't choke when I eat or drink." 4."I should eat a diet high in fiber and roughage to decrease my constipation."

1

Which sign or symptom of late-stage increased intracranial pressure should the LPN/LVN be aware of? (Select all that apply.) 1.Increase in systolic blood pressure 2.Widening of pulse pressure 3.Bradycardia 4.Unequal pupils that react slowly to light 5.Tachycardia

1 2 3

2. A 35-year-old patient is being seen for complaints of headache, which she has experienced for the past month. Her health care provider wants to rule out a brain tumor. What diagnostic tests will be most helpful in formulating this diagnosis? (Select all that apply.) 1.Brain scan 2.PET scan 3.Lumbar puncture 4.Electroencephalography 5.MRI

1 2 4 5

The nurse is caring for a patient with myasthenia gravis. The patient asks the nurse about the causes of the disease. Which response by the nurse is correct? 1."Myelin sheath breakdown has caused your myasthenia gravis." 2."Degeneration of the dopamine-producing neurons in the midbrain most commonly causes the disease." 3."Antibodies attacking the acetylcholine receptors, damaging them, and reducing their number is the most likely cause of myasthenia gravis." 4."Myasthenia gravis is usually caused by inflammation of cranial nerve VII."

3

What plan of care is considered beneficial for select patients who have experienced an ischemic stroke? 1.IV Tensilon in the first 3 hours 2.Anticholinesterase in the first 3 hours 3.Thrombolytic such as tPA in the first 3 hours 4.Intravenous immune globulin in the first 3 hours

3

A 70-year-old with back pain is scheduled to have a myelogram in the morning to rule out a pathologic condition of the spine. In preparing him for the procedure, what statement by the nurse is accurate? 1."We will be assessing your mental status frequently after the procedure." 2."You will need to lie completely supine and still during the procedure." 3."You will be able to ambulate immediately after the test." 4."We will ask you if you have any numbness or tingling in your legs after the procedure."

4

A patient who has been experiencing recent seizure activity is preparing to have diagnostic testing performed. The health care provider has explained that the test will provide a graphic recording of the electrical conduction activities of the brain. The patient understands that which test will be performed? 1.ECG 2.MRI 3.PET 4.EEG

4

The nurse is caring for a patient who suffered a cervical spinal cord injury. What injury can most likely be anticipated? 1.Tetraplegia 2.Hemiplegia 3.Paraplegia 4.Paresthesia

4

What is the reticular activating system (RAS) essential to? (Select all that apply.) a. Concentration b. Wakefulness c. Speech d. Attention e. Memory f. Introspection

A, B, D, F

Which foods should the person who suffers from migraine headaches avoid? (Select all that apply.) a. Yogurt b. Caffeine c. Beef d. Pears e. Marinated foods f. Milk

A, B, E

A nurse in the emergency department of her community hospital is teaching a group of high school students how to prevent head and spine injuries. What should the nurse include in the presentation? (Select all that apply.) 1.Use helmets for bicycles, motorcycles, and skateboarding. 2.Use helmets when participating in contact sports. 3.Never drive or ride with someone under the influence of alcohol or drugs. 4.Wear seatbelts and shoulder harnesses when driving or riding in a car. 5.Avoid diving in water less than 6 feet deep.

1 2 3 4

What nursing interventions should the nurse include in the plan of care for a patient who has had a stroke with right-sided hemiplegia and expressive aphasia? (Select all that apply.) 1.Allow the patient ample time to verbalize his needs. 2.Encourage self-help behaviors as much as possible, such as feeding. 3.Monitor the patient's neurologic status once a day. 4.Perform ROM to affected extremities every shift. 5.Implement the use of a communication board for the patient to use as needed.

1 2 4 5

When caring for a patient who has undergone a craniotomy, what is the primary nursing intervention? 1.Preventing infection 2.Ensuring patient comfort 3.Avoiding need for secondary surgery 4.Preventing increased intracranial pressure

4

A 13-year-old student is admitted to the pediatric unit with possible meningitis. The nurse finds that the patient cannot extend her legs completely without experiencing extreme pain. The nurse correctly documents this as which sign? 1.Brudzinski's sign 2.Battle's sign 3.Kernig's sign 4.Cosgrow's sign

3

A patient experiencing TIAs is scheduled for a carotid endarterectomy. The patient asks the nurse what this procedure is. The nurse correctly responds with which response? 1."This procedure promotes cerebral flow to decrease cerebral edema." 2."This procedure reduces the brain damage that occurs during a stroke." 3."This procedure helps prevent a stroke by removing atherosclerotic plaques obstructing cerebral blood flow." 4."This procedure provides a circulatory bypass around thrombotic plaques obstructing cranial circulation."

3

A patient is diagnosed with Bell's palsy as indicated by a feeling of stiffness and a drawing sensation of the face. What is important to teach her about the disease? 1.There is a heightened awareness of taste, so foods must be bland. 2.There may be an increased sensitivity to sound. 3.The eye is susceptible to injury if the eyelid does not close. 4.Drooling from increased saliva on the affected side may occur.

3

6. A 12-year-old has a history of generalized tonic-clonic seizures. The nurse educates the patient and his family by including which teaching points? 1.Most people feel normal immediately after the seizure. 2.It is important to place a tongue blade in his mouth during the seizure. 3.The tonic phase of the seizure usually lasts for 3 to 4 minutes. 4.It is not uncommon to lose consciousness during this type of seizure.

4

The nurse is caring for a patient with a spinal cord injury who displays symptoms of autonomic dysreflexia. What intervention should the nurse implement first? 1.Sit the patient upright, if permitted. 2.Check for bladder distention. 3.Give nitroprusside (Nipride) as ordered. 4.Assess vital signs.

4

A patient, age 45, is to have a myelogram to confirm the presence of a herniated intervertebral disk. Which nursing action should be planned with respect to this diagnostic test? a. Obtain an allergy history before the test. b. Ambulate the patient when returned to the room after the test. c. Use heated blanket to keep patient warm after procedure. d. Keep NPO for 6 to 8 hours after the test.

A

The newly admitted patient to the emergency room 30 minutes ago after a fall off a ladder has gradually decreased in consciousness and has slowly reacting pupils, a widening pulse pressure, and verbal responses that are slow and unintelligible. What is the most appropriate position for the patient? a. Neck placed in a neutral position b. Head raised slightly with hips flexed c. Supine in gravity neutral position d. Turn on right side with head elevated

A

The nurse assures an anxious family member of a 92-year-old patient who is demonstrating signs of dementia that many causes of dementia are reversible and preventable. What is one example? a. Hypotension b. Alzheimer disease c. Diabetes d. Parkinson disease

A

What should the nurse do when the child arrives on the floor with the diagnosis of bacterial meningitis? a. Arrange for humidified oxygen per mask b. Place the child in respiratory isolation c. Inquire about drug allergy d. Hold NPO until orders arrive

B

Which question is likely to elicit the most valid response from the patient who is being interviewed about a neurologic problem? a. "Do you have any sensations of pins and needles in your feet?" b. "Does the pain radiate from your back into your legs?" c. "Can you describe the sensations you are having?" d. "Do you ever have any nausea or dizziness?"

C

What Glasgow Coma Scale rating would a patient receive who opens the eyes spontaneously, but has incomprehensible speech and obeys commands for movement? a. 8 b. 10 c. 11 d. 12

D