Complex Health Challenges II - Neurological Disorders

Which change eventually exhausts compensatory mechanisms, leading to ischemia? 1. Progressive decreases in brain tissue volume 2. Rapid increases in neuronal compression 3. Progressive increases in brain tissue volume 4. Rapid decreases in neuronal compression

3 Brain tissue volume compensates by distention of the dura or compression of the brain tissue. Progressive increases in volume eventually exhaust compensatory mechanisms and results in increased intracranial pressure (ICP), neuronal compression, and ischemia.

Which stage on the pressure-volume curve is associated with high compliance in autoregulation? A. 1 B. 2 C. 3 D. 4

A 1 At stage 1 on the curve, there is high compliance. The brain is in total compensation, with accommodation and autoregulation intact. An increase in volume (in brain tissue, blood, or cerebral spinal fluid [CSF]) does not increase the intracranial pressure (ICP). 2 At stage 2, the compliance is lessening, and an increase in volume places the patient at risk for increased intracranial pressure (ICP). 3 At stage 3, there is low compliance as compensatory mechanisms are becoming exhausted. Any small addition of volume causes a great increase in intracranial pressure (ICP). As compensatory mechanisms fail, there is a loss of autoregulation, and the patient may exhibit symptoms indicating increased ICP, such as headache, changes in level of consciousness, or pupil responsiveness. 4 As the patient enters stage 4, the intracranial pressure (ICP) rises to lethal levels with even slight increases in volume. Here the patient is at significant risk for hypoperfusion and brain herniation and death. Herniation occurs as the brain tissue is forcibly shifted from the compartment of greater pressure to a compartment of lesser pressure. In this situation, intense pressure is placed on the brain stem, and if herniation continues, brainstem death is imminent.

Which medication used to treat multiple sclerosis requires adequate hydration? A. Acetylcholinesterase inhibitors B.. Cholinergic medications C. Corticosteroids D. Immunomodulators

A Acetylcholinesterase inhibitors inhibit the cholinesterase enzyme from breaking down acetylcholine increasing both the level and duration of the neurotransmitter's action. Acetylcholine's parasympathetic actions include vasodilation and bradycardia, therefore adequate hydration is recommended to avoid orthostatic hypotension.

The primary risk for viral encephalitis is which factor? A. Advanced age B. Acquired immunodeficiency syndrome (AIDS) C. Ticks and mosquito bites D. Herpes simplex virus (HSV)

A Advanced age is the primary risk factor for encephalitis and mortality associated with viral encephalopathy.

Which explanation would the nurse provide to a 34-year-old female patient with a spinal cord injury (SCI) who after two months in the hospital expresses concern that she hasn't had a menstrual period since her accident? A. It may take approximately four months for her periods to return. B. She will probably not have a normal menstrual cycle. C. She will most likely not have periods and will not need birth control. D. Her menstrual periods should have started. The nurse will notify the health care provider.

A Amenorrhea can occur following SCI and lasts from four to five months.

Which change in vital signs would the nurse interpret as a manifestation of increased intracranial pressure (ICP)? A. Bradycardia B. Tachypnea C. Hypotension D. Narrowing pulse pressure

A Changes in vital signs indicative of increased intracranial pressure are known as Cushing's triad, which consists of increasing systolic pressure with a widening pulse pressure, bradycardia with a full and bounding pulse, and irregular respirations.

Which head trauma complication describes an older patient who was found unconscious at home, regained consciousness once at the hospital, but complained of a headache and lost consciousness again? A. Epidural hematoma B. Subdural hematoma C. Subacute hematoma D. Subarachnoid hematoma

A Classic signs of an epidural hematoma include an initial period of unconsciousness at the scene, with a brief lucid interval followed by a decrease in level of consciousness (LOC). Other manifestations may be a headache, nausea and vomiting, or focal findings.

Which surgical procedure would the collaborative care team provide for a patient who has suffered an epidural hematoma who is experiencing increased intracranial pressure (ICP)? A. Craniotomy B. Cranioplasty C. Stereotactic biopsy D. Ventricular shunt

A Craniotomy, which involves removing a part of the skull, should be used decrease intracranial pressure (ICP) for a patient with an epidural hemat

When caring for a patient with encephalitis who was positive for cytomegalovirus, the nurse recognizes this is related to what immunocompromising condition? A. HIV B. Diabetes C. Hypertension D. Sarcoidosis

A Cytomegalovirus encephalitis is a common complication in HIV/AIDS patients.

Which step is first in the management of increased intracranial pressure (ICP)? A. Support brain function by adequate oxygenation B. Support the family and caregivers C. Maintain dynamic equilibrium in cerebral responses D. Maintain fluid balance

A Ensuring adequate oxygenation to support brain function is the first step in the management of increased cerebral spinal fluid (CSF). An endotracheal tube or tracheostomy may be necessary to maintain adequate ventilation. Arterial blood gas (ABG) analysis guides the oxygen therapy. The goal is to maintain the PaO2 at 100 mm Hg or greater. It may be necessary to maintain the patient on a mechanical ventilator to ensure adequate oxygenation.

Changes in which factor influence intracranial pressure (ICP) under normal circumstances? A. Blood pressure (BP) B. Blood glucose levels C. Hypovolemia D. Electrolyte deficiencies

A Factors that influence intracranial pressure (ICP) under normal circumstances are changes in blood pressure (BP), cardiac function, intra-abdominal and intrathoracic pressure, body position, temperature, and blood gasses, particularly carbon dioxide (CO2) levels. The degree to which these factors increase or decrease the ICP depends on the ability of the brain to accommodate the changes.

The time when the patient is most vulnerable to the development of post-traumatic seizure (PTS) disorders is during which week after the head injury?A. A. First B. Second C. Third D. Fourth

A First Post-traumatic seizure (PTS) disorders are seen in approximately 5% of patients with a nonpenetrating head injury. The time when the patient is most vulnerable to the development of PTS is during the first week after the head injury.

Which intervention may be used for treating hydrocephalus? A. Ventricular shunt B. Compression therapy C. Corticosteroid therapy D. Craniotomy

A Hydrocephalus is treated by placement of a ventricular shunt to drain the accumulated fluid.

Which medication therapy is first-line treatment for elevated intracranial pressure (ICP)? A. Hypertonic saline B. Corticosteroids C. Phenytoin D. High-dose barbiturates

A Hypertonic saline is the first-line treatment for elevated cerebral spinal fluid (CSF). It reduces swelling and improves cerebral blood flow (CBF), drawing water out of the brain tissue.

Which complication of bacterial meningitis leads to altered mental status? A. Increased intracranial pressure (ICP) B. Cranial nerve dysfunction C. Optic nerve damage D. Vestibular nerve dysfunction

A Increased intracranial pressure (ICP)is the major cause of altered mental status in bacterial meningitis

Which measure would the nurse prioritize when providing care for a patient with a diagnosis of multiple sclerosis (MS)? A. Vigilant infection control and adherence to standard precautions B. Careful monitoring of neurologic vital signs and frequent reorientation C. Maintenance of a calorie count and hourly assessment of intake and output D. Assessment of blood pressure and monitoring for signs of orthostatic hypotension

A Infection control is a priority in the care of patients with MS since infections, such as urinary tract infections and upper respiratory infections, are common precipitators of an exacerbation of the disease.

Which condition results in hydrocephalus? A. Interstitial cerebral edema B. Hypovolemia C. Vasogenic edema D. Cytotoxic cerebral edema

A Interstitial cerebral edema is the result of periventricular diffusion of ventricular intracranial pressure (ICP) in a patient with uncontrolled hydrocephalus.

Which test is contraindicated if intracranial pressure (ICP) is increased? A. Lumbar puncture B. Cerebral angiography C. PET scan D. Brain tissue oxygenation measured via a Licox catheter

A Lumbar punctures are not performed if intracranial pressure (ICP) is increased because of cerebral herniation from the sudden release of the pressure in the skull from the area above the lumbar puncture

Which nursing goal is priority for patients with a head injury? A. Maintain adequate cerebral perfusion. B. Determine the location of the injury. C. Promote independence. D. Determine if there is a cerebrospinal fluid (CSF) leak.

A Maintaining adequate cerebral perfusion is the priority for nursing management of traumatic brain injury (TBI) patients.

Which statement describes how manifestations may indicate the location of a brain tumour? A. Alteration in the function controlled by the affected area. B. EEG indicates changes in activity of the affected area. C. Patient motor movements indicate the affected area. D. Rate of growth is dependent on the affected area.

A Manifestations may clearly indicate the location of the tumour by an alteration in the function controlled by the affected area.

Which categories of brain tumours are usually benign? A. Meningiomas B. Gliomas C. Gliobastoma multiforms D. Secondary brain tumours

A Most meningiomas are benign. But unless treated or removed, growing tumours within the brain increase intracranial pressure (ICP), which eventually causes death.

Which complication of meningitis is related to neurological dysfunction? A. Papilledema B. Retinal detachment C. Low intracranial pressure (ICP) D. Bell's palsy

A Papilledema is often present, and blindness may develop. Ptosis, unequal pupils, diplopia, and trigeminal nerve irritation are commonly seen.

Which step would the nurse anticipate being next when the medical team reports a score of 7 on the Glasgow Coma Scale (GCS) during initial assessment of a patient with head trauma? A. Intubation B. Burr-hole procedure C. Computerized tomography (CT) scan D. Positron emission tomography (PET) scan

A Patients with a Glasgow Coma Scale (GCS) score below 8, which indicates severe head injury, require immediate intubation to allow for mechanical ventilation and to protect the airway.

When meningitis is suspected, which treatment is instituted even before the diagnosis is confirmed? A. Antipyretics B. Analgesics C. Rest D. Antibiotics

A Rapid diagnosis based on history and physical examination is crucial because the patient is usually in a critical state when health care is sought. When meningitis is suspected, antibiotic therapy is instituted after the collection of specimens for cultures, even before the diagnosis is confirmed.

Which prevention strategy works best for meningitis? A. Vaccination B. Antibiotics C. Topical creams for the petechial rash D. Dexamethasone

A Several vaccines are available for bacterial meningitis, including the highly transmitted Meningitis B.

Which device is used to measure cerebral oxygenation levels? A. Licox catheter B. Peripheral arterial line C. Intraventricular catheter D. Ventriculostomy catheter

A The Licox catheter is placed in the healthy white matter of the brain and provides continuous monitoring of the pressure of oxygen in brain tissue (PbtO2).

Which physiological restriction limits the effectiveness of medications for treatment of brain disorders? A. The blood-brain barrier limits chemotherapy from arriving at the interior of the tumour. B. Illness and reactions to the infusions limit the use of these irritating agents. C. Radiosurgery is limited by the location of the tumour. D. Increased intracranial pressure (ICP) is a universal complication.

A The effectiveness of chemotherapy has been limited by difficulty getting medications across the blood-brain barrier, tumour cell heterogeneity, and tumour cell medication resistance. Normally, the blood-brain barrier prohibits the entry of most medications into the brain.

Which teaching point would the nurse emphasize for a 65-year-old female patient who has lived with a T1 spinal cord injury (SCI) for 20 years? A. A breast exam should be done monthly. B. Bladder function tends to improve with age. C. Heart disease is not common in persons with SCI. D. As a person ages, the need to change body position is less important.

A The life expectancy for persons with SCI is increasing; therefore, it is important to encourage preventative care similar to that recommended for non-SCI patients. A monthly breast exam current recommended screening.

Which nursing intervention is a priority for a patient with bacterial meningitis who is found lying supine, complaining of a headache and nausea? A. Elevate the head of the bed. B. Administer pain medication. C. Perform Valsalva manoeuvre. D. Place patient in Trendelenburg position.

A The patient is experiencing a headache and nausea due to increased intracranial pressure from the meningitis. Elevating the head of the bed will promote cerebrospinal fluid drainage and relieve the patient's headache and nausea.

Which assistive support would the nurse expect to be required by a patient with a C3 spinal cord injury? A. Mechanical ventilation B. Manual wheelchair C. Assistance to cough with the use of augmented coughing D. An adaptive spoon to feed themselves

A The patient may be completely apneic or will have a low respiratory reserve which will require mechanical ventilation to maintain respiratory status.

Which relationship between multiple sclerosis (MS) and pregnancy should be highlighted for a 24-year-old female newly diagnosed with MS? A. Some women experience an improvement in symptoms during the gestational period. B. A C-section will be planned to deliver the baby. C. Breastfeeding will not be an option. D. Pregnancy is not recommended, and birth control options should be considered.

A While some women do experience a decrease in their MS related symptoms likely due to the hormonal influence on the immune system, women who are postpartum are more likely to experience remission relapses.

Which clinical manifestation would the nurse interpret as representing neurogenic shock in a patient with acute spinal cord injury (SCI)? A. Bradycardia B. Hypertension C. Neurogenic spasticity D. Bounding pedal pulses

A Without sympathetic innervation, the parasympathetic innervation of the heart via the vagus nerve predominates. This results in bradycardia and diminished cardiac contractility.

Which finding is a subjective indicator of bacterial meningitis? Select all that apply. One, some, or all responses may be correct. A. Stiff neck B. Severe headache C. Nausea and vomiting D. Increased intracranial pressure (ICP) E. Increased cerebrospinal fluid (CSF) production

A, B, C Subjective findings of bacterial meningitis include nuchal rigidity, or a stiff neck, caused by meningeal irritation. Subjective findings of bacterial meningitis include severe headache due to increased intracranial pressure (ICP). Subjective findings of bacterial meningitis include nausea and vomiting due to increased ICP.

Which additional symptom would the nurse assess for when caring for a patient with a brain abscess and notes elevated blood pressure and altered level of consciousness? Select all that apply. A. Fever B. Nausea C. Headache D. Drowsiness E. Nuchal rigidity

A, B, C, D Fever results from the infective process of brain abscesses. Nausea is a sign of increased intracranial pressure (ICP) related to brain abscesses. Headache is a symptom of increased intracranial pressure (ICP) related to brain abscesses. Drowsiness is a symptom of increased intracranial pressure (ICP) related to brain abscesses.

Which component can affect a patient's increased intracranial pressure? Select all that apply. One, some, or all responses may be correct. A. Blood B. Brain tissue C. Hematoma D. Synovial fluid E. Cerebrospinal fluid (CSF)

A, B, C, E Blood, brain tissue, and CSF are components housed in the skull. The balance among the three components housed in the skull maintains the intracranial pressure. Hematomas can occur within the brain tissue and between the brain layers. A hematoma in the brain can lead to an increase in intracranial pressure.

Which action can the nurse take to decrease environmental stimuli for a patient with bacterial meningitis? Select all that apply. One, some, or all responses may be correct. A. Turn off television B. Turn off overhead lights C. Limit patient's visitors D. Hang contact isolation sign on door E. Close the room's window blinds

A, B, C, E Turning off the television decreases visual and auditory stimuli. Turning off the overhead lights decreases visual stimuli and decreases discomfort from photophobia. Visitors should be limited to decrease external stimuli and prevent further increase of the patient's intracranial pressure (ICP). Closing the window blinds is effective in decreasing visual stimuli.

Which factor is a potential concern for patients who develop dementia as their Parkinson's disease (PD) progresses? Select all that apply. One, some, or all responses may be correct. A. Need for placement in a long-term care facility increases B. Chances that the caregiver will develop a new medical condition increase C. Patient's mortality rate rises D. Disease manifestations are more likely to consist of violent outbursts E. Need for medication management will decrease F. Chances of malnutrition increase

A, B, C, F Need for placement in a long-term care facility increases As the care of the patient becomes more complicated by the clinical manifestations of dementia, such as confusion, impulsivity, wandering, their care often becomes more demanding than that which can be provided by the family. Chances that the caregiver will develop a new medical condition increase As the patient's condition deteriorates, the caregiving burden increases. The physical and emotional stress increase the risk of physical (and emotional) illness to the caregiver which further complicates the care of the patient. Patient's mortality rate rises As the disease progresses, complications increase. These include motor symptoms (e.g., dyskinesias, weakness, akinesia) neurological conditions (e.g., dementia), and neuropsychiatric conditions (e.g., depression, hallucinations, psychosis). As PD progresses, it often results in severe dementia, which is associated with an increase in mortality. Chances of malnutrition increase Patients with dementia often lose weight as they no longer sense hunger or take gratification in eating. Unintended weight loss in a long-term care facility patient with dementia is considered a quality indicator and signals a potential problem with overall nursing care.

Which physiologic event can lead to increased intracranial pressure (ICP) and accumulation of CO2? Select all that apply. One, some, or all responses may be correct. A. Brain abscess B. Occipital tumour C. Hyperventilation D. Subdural hematoma E. Bacterial meningitis

A, B, D, E Brain abscess Brain abscesses cause increased intracranial pressure (ICP) and can lead to hypercapnia. Occipital tumour Brain tumours, regardless of location can cause increased intracranial pressure (ICP) and can lead to hypercapnia. Subdural hematoma Subdural hematoma causes increased intracranial pressure (ICP) and can lead to hypercapnia. Bacterial meningitis Bacterial meningitis causes inflammation and increased intracranial pressure (ICP) and can lead to hypercapnia. HyperventilationHyperventilation causes hypocapnia, not hypercapnia.

Which factor is a potential trigger for the development of multiple sclerosis (MS) in a susceptible person? Select all that apply. One, some, or all responses may be correct. A. Emotional stress B. Fatigue C. Low socioeconomic status D. Physical injury E. Pregnancy F. Smoking

A, B, D, E, F While the cause of (MS) is not known, it is unlikely due to a single cause. Possible precipitating factors include emotional stress, infection, smoking, physical injury, excessive fatigue, pregnancy, and a poor state of health.

Which incident is the most common cause of head injury? Select all that apply. One, some, or all responses may be correct. A. Falls B. Assaults C. Car accidents D. Gunshot wounds E. Sports-related trauma

A, C Falls Falls are one of the leading causes of head injury. Assaults Assaults can cause head injury but is not one of the primary causes. Car accidents Motor vehicle collisions are one of the leading causes of head injury. Gunshot wounds Gunshot wounds can cause head injuries but are not the primary reason for head injury. Sports-related trauma Even though sports-related trauma can cause head injury, it is not one of the most common causes.

Which health care provider order would the nurse anticipate when caring for a patient with bacterial meningitis that has a temperature of 101.2°F? Select all that apply. One, some, or all responses may be correct. A. Ampicillin IV B. Mannitol IV C. Maintenance IV fluids D. Acetaminophen PO PRN E. Placement of ventricular shunt

A, C, D Antibiotics, such as ampicillin, are used to treat the bacterial infection causing meningitis. Maintenance IV fluids should be prescribed to patients with meningitis to prevent dehydration. Antipyretics, such as acetaminophen, would be ordered to treat the patient's fever.

Which assessments are most important for the nurse to conduct when admitting a patient diagnosed with a brain tumour? Select all that apply. One, some, or all responses may be correct. A. Pain level B. Primary diet C. Range of motion D. Vision screening E. Patient orientation

A, C, D, E Pain level Pain assessment is important because patients with brain tumours may experience severe pain. Primary diet Dietary preferences are important to assess, but are not the priority for a patient with a brain tumour. Range of motion On admission, the nurse should complete a full neurological assessment, including the motor function. Range of motion is part of motor function. Vision screening On admission, the nurse should complete a full neurological assessment, including the sensory function. Vision is a part of the sensory assessment. Patient orientation On admission, the nurse should complete a full neurological assessment, including the level of consciousness.

Which factor increases the risk of respiratory complication for the patient with a spinal cord injury (SCI)? Select all that apply. One, some, or all responses may be correct. A. Tachypnea on admission B. Tachycardia on admission C. Older age D. Previous respiratory disease E. Higher cord level of injury F. Female gender

A, C, D, E Tachypnea on admission Patient who are tachypneic on admission are already experiencing respiratory insufficiency and have a high likelihood of further respiratory compromise. Tachycardia on admission Heat rate on admission is not a predictor of respiratory complications. Instead, predictive factors of potential respiratory complications include tachypnea on admission, older age, and previous respiratory disease. Older age Older age increases the risk of many complications related to spinal cord injury including respiratory complications. Older persons have a more difficult time responding to hypoxia and hypercapnia. They are less able to respond to hypoxia because of their limited respiratory reserve. Previous respiratory disease Previous respiratory disease increases risk due to the lingering effects of those disease processes. Higher cord level of injury The higher the level of injury, the more likely the patient will experience respiratory compromise due to the neurologic injury to key respiratory muscles at higher levels in the vertebrae. Female gender Gender does not appear to be a predictive factor for the development of respiratory complications. Instead, predictive factors of potential respiratory complications include tachypnea on admission, older age, and previous respiratory disease.

Which order would the nurse anticipate for a patient with a ventricular shunt that has decreased level of consciousness (LOC), a temperature of 102°F, and vomiting? Select all that apply. One, some, or all responses may be correct. A. Prepare for surgery B. Lay patient supine C. Phenergan 25 mg PO D. Ceftriaxone 1 g IV E. Morphine 15 mg IV push

A, D Altered level of consciousness (LOC) and vomiting are signs of a shunt malfunction. The ventricular shunt may need to be adjusted or replaced. Altered level of consciousness (LOC), fever, and vomiting are signs of infection. Antibiotics would be used to treat the infection.

Which diagnostic studies would be performed to determine whether internal bleeding is present in a patient with increased intracranial pressure (ICP)? Select all that apply. One, some, or all responses may be correct. A. MRI B. Burr hole C. Craniotomy D. Infrascanner E. Toxicology screen

A, D MRI MRI provides an image of the brain to determine if bleeding or a mass is present in the brain. Infrascanner An infrascanner can be used to detect intracranial bleeding. Burr hole A Burr-hole procedure would be performed to remove blood that was already detected. It would not determine whether or not bleeding is present. Craniotomy A craniotomy would be performed to decrease intracranial pressure, not to determine whether or not there is internal bleeding. Toxicology screenA toxicology screen may be ordered for patients with head injuries, but would not determine whether internal bleeding is present.

Which teaching point would be important to discuss with the caregiver when providing discharge teaching for a patient experiencing limited mobility secondary to Parkinson's disease (PD)? Select all that apply. One, some, or all responses may be correct. A. Remove rugs in the home B. Provide more frequent meals C. Keep room temperature above 22.2℃ D. Provide passive range of motion two times per day E. Increase dietary fibre F. Increase fluid intake

A, D, E, F Remove rugs in the home Area rugs are a tripping hazard. As the patients gait and muscle strength deteriorate, the environment should be modified by removing rugs and excess furniture or obstacles to decrease the fall risk. Provide passive range of motion two times per day As the patient's ability to move deteriorates, actions to maintain flexibility and muscle tone, while not curative, will help preventing further complications such as contractures and pressure injuries. Increase dietary fibre Constipation is usually manifested. As the patient's ability to move decreases, it become more important to implement strategies to decrease constipation such as adequate fluid intake and high fiber diets. Increase fluid intake Orthostatic hypotension is common with PD. Orthostatic hypotension is a fall risk. Ensuring adequate hydration will prevent hypotension and will ensure adequate tissue integrity to avoid pressure injury.

A patient presents with abnormal extension, does not open their eyes to stimulus, and does not give a sound as reaction to pain. The patient exhibiting these signs would be given a score of ___________ using the Glasgow Coma Scale. A. 2 B. 4 C. 5 D. 7

B According to the Glasgow Coma Scale (GCS), abnormal extension receives a 2, lack of eye opening receives a 1, and lack of sound to stimuli receives a 1, for a total of 4.

Which intervention enables a patient with mild to moderate disability related to multiple sclerosis (MS) to perform activities that would normally be too difficult? A. Stem cell therapy B. Water exercise C. Deep brain stimulation D. Thalamotomy

B An especially beneficial type of physiotherapy is water exercise. Water gives buoyancy to the body and enables the patient to perform activities that would normally be too difficult because the patient has more control over their body.

Which neurologic symptom may be observed early in the disease process for patients with multiple sclerosis (MS)? A. Sudden headache B. Scanning speech C. Pupil dilation D. Loss of taste

B As MS often develops with insidious, vague symptoms, the change in the rate of speech is one of the more common early manifestations of MS.

Which follow-up vital signs would indicate worsening intracranial pressure (ICP) for a patient with a brain tumour and increased ICP with initial vital sins of: BP 128/88, HR 106, RR 22, and oxygen saturation 98%? A. BP 116/82, HR 85, RR 20, oxygen saturation 97% B. BP 172/98, HR 64, RR 24, oxygen saturation 99% C. BP 98/76, HR 85, RR 12, oxygen saturation 90% D. BP 135/86, HR 112, RR 10, oxygen saturation 89%

B BP 172/98, HR 64, RR 24, oxygen saturation 99% is characteristic of Cushing's triad, elevated BP and decreased HR, indicating worsening intracranial pressure (ICP).

Which nursing action would be implemented when caring for a patient who is experiencing increased intracranial pressure (ICP)? A. Position the patient in a high Fowler's position. B. Monitor fluid and electrolyte status astutely. C. Administer vasoconstrictors to maintain cerebral perfusion. D. Maintain physical restraints to prevent episodes of agitation.

B Fluid and electrolyte disturbances can have an adverse effect on intracranial pressure (ICP) and must be monitored astutely.

Which diagnostic test would the nurse anticipate to prepare for when caring for a patient who reports headache, fever, and neck stiffness? A. Blood culture B. Lumbar puncture C. Magnetic resonance imaging (MRI) D. Computerized tomography (CT) scan

B Headache, fever, and nuchal rigidity are symptoms of meningitis. Following the initiation of antibiotic therapy, lumbar puncture is performed to collect culture specimens for diagnosis and confirmation of the disease.

When caring for a patient admitted with a temporal lobe tumour, the nurse prepares the patient for which diagnostic procedure? A. MRI B. Biopsy C. CT scan D. Lumbar puncture

B Histology is performed from tissue obtained during surgery or biopsy to definitively diagnose malignancy.

Which provider order would the nurse question when caring for a patient who sustained major head trauma after a motor vehicle collision and the lab values reveal blood urea nitrogen (BUN) of 47, creatinine of 3.1, hemoglobin of 6.8, and potassium level of 6.1? A. Transfuse PRBC. B. Give Mannitol IV. C. Give Oral Kayexalate. D. Maintain HOB at 30 degrees.

B Mannitol is an osmotic diuretic given to decrease intracranial pressure (ICP); however, it is contraindicated in patients with renal failure. The patients elevated blood urea nitrogen (BUN) and creatinine indicate the presence of acute renal failure. The nurse would question this order.

Which statement justifies the concern when spinal cord injury (SCI) patients demonstrate poikilothermism? A. The interruption of the parasympathetic system means that the patient will not be able to decrease their body temperature through perspiration. B. The patient's inability to sense peripheral temperature means that they can neither increase nor decrease their body temperature naturally. C. The patient will need to rely solely on vasodilation as the mechanism to increase body temperature. D. Patients lose the piloerection reflex which limits their ability to decrease their body temperature.

B Patients are limited in their ability to retain heat due to a lack of vasoconstriction and piloerection. Patients also are unable to increase perspiration below the injury level limiting their ability to decrease body temperature.

Which statement illustrates the nurse's understanding of multiple sclerosis (MS) during patient education? A. "You should be cured within 6 to 12 months of treatment." B. "There may be fewer remissions because you are 56." C. "You can expect predictable periods of remission and relapse throughout your life." D. "It is uncommon for people diagnosed in their fifties to experience debilitating symptoms."

B Patients who are first diagnosed with MS after age 50 experience more progressive symptoms than those who are diagnosed at a younger age.

Which neurologic finding is expected in a patient with a complete cord transection above C8? A. Flaccid paralysis below C8 and intact sensory function below C8 B. Tetraplegia C. Paraplegia D. Flaccid paralysis below C8 and sensory loss above C8

B Tetraplegia (paralysis of all four extremities) generally occurs with injuries above C8.

Which set of symptoms represents the classic assessment findings for a client with Parkinson's disease? A. Spasticity, diplopia, tremor, ataxia B. Tremor, rigidity, ataxia, postural instability C. Ataxia, drowsiness, dysarthria, tremor D. Diplopia, tremor, bradykinesia, postural instability

B The mnemonic "TRAP" can be used to remember the classic clinical manifestations of PD: tremors, rigidity, ataxia, and postural instability.

Which patient would have the highest risk of developing multiple sclerosis? A. A 22-year-old male born in India who migrated to Canada at age 20. B. A 32-year-old female Canadian with a family history of multiple sclerosis (MS). C. A 15-year-old Canadian female with type 1 diabetes. D. A 21-year-old male Indigenous Canadian.

B This person has four risk factors: age, gender, climate, and familial history and would therefore have the highest risk of developing MS.

Which process is included in the pathophysiology of multiple sclerosis (MS)? Select all that apply. One, some, or all responses may be correct. A. Ablation B. Demyelination C . Gliosis D. Inflammation E. Subluxation

B, C, D Demyelination Demyelination is one of the three pathophysiologic processes of multiple sclerosis (MS). Myelin sheaths are damaged early in the disease. Later, the axons are demyelinated resulting in complete loss of function. Gliosis Gliosis is a fibrous proliferation of glial cells in injured areas of the CNS. In MS, myelin is replaced by glial scar tissue disrupting the nerve impulse across the nerve fibre. Inflammation MS is an autoimmune disorder where an unknown trigger in a susceptible person activates T cells. Subsequent antigen-antibody reactions lead to the inflammatory process and the demyelination of the axon.

Which pulmonary complication is possible with cervical spinal cord injuries (SCIs)? Select all that apply. One, some, or all responses may be correct. A. Pneumothorax B. Hypoventilation C. Atelectasis D. Pneumonia E. Neurogenic pulmonary edema F. Pulmonary edema

B, C, D, E, F Pneumothorax Unless there were a traumatic injury to the chest, it would be unlikely for a pneumothorax to develop secondary to a spinal cord injury. Hypoventilation Results from diaphragmatic respirations when there is phrenic nerve impairment. Atelectasis Paralysis of abdominal and intercostal muscles limits the patient's ability to cough. Secretions accumulate in the lungs and alveoli collapse. Pneumonia Cervical and thoracic injuries cause paralysis of abdominal muscles and, often, of intercostal muscles. The patient cannot cough effectively enough to remove secretions, which leads to atelectasis and pneumonia. Neurogenic pulmonary edema Develops from dramatic increases in sympathetic nervous system activity which causes increases in pulmonary interstitial and alveolar fluid. Pulmonary edema Peripheral vasodilation causes hypotension that is treated with significant amounts of fluid which can lead to pulmonary edema.

Which response is part of the evaluation of a brain injury patient using the Glasgow Coma Scale (GCS)? Select all that apply. One, some, or all responses may be correct. A. Judgement B. Eye opening C. Orientation to person, time, and place D. Best verbal response E. Best motor response

B, D, E The three dimensions of the Glasgow Coma Scale (GCS) are eye opening, best verbal response, and best motor response. *Orientation status is part of the best verbal response... soooo....

Which type of diet would the nurse emphasize for a patient recovering from bacterial meningitis? A. Low protein B. Large, hearty meals C. High calorie D. Intermittent fasting

C After the acute period has passed, the patient requires several weeks of convalescence before normal activities can be resumed. In this period, good nutrition should be stressed, with an emphasis on a high-protein, high-calorie diet in small, frequent feedings.

Which information would the nurse include when teaching about gastrointestinal function during spinal shock for patients with spinal cord injury (SCI)? A. During spinal shock, the bladder is hyperirritable. B. An indwelling urinary catheter is used to treat reflex emptying of the bladder. C. Anal sphincter tone is decreased during spinal shock. D. Reflex bowel emptying occurs during early spinal shock.

C Anal sphincter tone is decreased during spinal shock. As spinal shock resolves, sphincter tone is one of the first reflexes to return.

Which treatment would the health care provider suggest for helping some multiple sclerosis (MS) patients to decrease bladder spasticity? A. Avoid fatigue. B. Minimize caffeine intake. C. Take anticholinergics. D. Eat a high fibre diet.

C Anticholinergics may help some patients prevent urine leaks by controlling bladder spasms.

Which condition is suspected in a patient with a T6 spinal cord lesion with blood pressures that have been decreasing over the last 4 hours, a precipitous drop in hemoglobin levels, and increasing abdominal girth? A. Paralytic ileus B. Bladder distention C. Intra-abdominal bleed D. Bowel obstruction

C As the patient will not have sensation of the abdomen, they will not sense the increase in pain and pressure associated with an intra-abdominal bleed. Ongoing hypotension, a decrease in hemoglobin, and increase in abdominal girth signal an intra-abdominal hemorrhage.

Which statement best describes bacterial meningitis? A. Infection of spinal cord caused by Haemophilus influenzae B. Accumulation of pus within the brain tissue caused by Strep pneumoniae C. Inflammation of brain and spinal cord tissue caused by Strep pneumoniae D. Viral infection causing inflammation of the brain and surrounding tissues

C Bacterial meningitis is an acute inflammation of meningeal tissue surrounding brain and spinal cord.

Which physiologic event leads to decreased oxygen and death of the brain cells? A. Tissue edema B. Excessive hydration C. Decreased cerebral blood flow D. Accumulation of carbon dioxide

C Decreased cerebral blood flow from compression of cerebral blood vessels leads to decreased oxygen and brain tissue death.

Which order would the nurse anticipate for a patient with a parietal lobe tumour who is receiving radiation therapy that complains of worsening headaches, nausea, and drowsiness? A. Morphine 5 mg IV push B. Ampicillin 2 g IVPB C. Dexamethasone 10 mg IV D. Phenergan 10 mg IV push

C Dexamethasone is a corticosteroid and is used to treat cerebral edema. Headache, nausea, and drowsiness are symptoms of cerebral edema.

Which action would the nurse take when caring for a patient with a cerebrospinal fluid (CSF) drainage system that begins to complain of headache and nausea? A. Give oral mannitol B. Administer an IV fluid bolus C. Elevate head of patient's bed D. Administer narcotic pain medicine

C Elevating the head of the bed allows for appropriate drainage of CSF and is helpful for the patient with increased intracranial pressure (ICP).

Which mechanism of injury is most commonly associated with spinal cord injuries (SCIs) in older adults? A. Motor vehicle accidents (MVAs) B. Sporting accidents C. Falls D. Motorcycle crashes

C Falls and work-related injuries are more commonly seen in older adults.

In the acute phase after head injury, how can the nurse determine the progression of the patient's injury? A. Monitor patient vital signs. B. Administer fluids and note results. C. Ask questions to determine cognition. D. Prepare patient for surgical evacuation of blood.

C Frequent neurological checks are completed to assess the progression of the patient's injury, to monitor for worsening neurological function and recognize decompensation early.

Which pharmacological intervention requires the nurse to monitor the patient's psychomotor ability? A. Anticholinergics B. Cholinergic C. Immunomodulators D. Muscle relaxants

C Immunomodulators to treat MS are given subcutaneously or intramuscularly by the patient. Interferon Beta is administered every 48 hours. An assessment of the patient's psychomotor ability to self-administer is required. If the patient is unable to learn or perform the self-injection technique, the caregiver is trained in the administration.

Which information would the nurse include when teaching about why nutrition is an important part of the care of a patient with increased intracranial pressure (ICP)? A. Serum osmolarity must decrease to decrease ICP. B. Glucose levels must remain constant to decrease intracranial pressure (ICP). C. Malnutrition promotes cerebral edema. D. Mild dehydration is preferable in early stages.

C Malnutrition causes a decrease in albumin related to low protein intake. This increases the fluid shift that causes cerebral edema.

Which action to promote adequate nutrition would be indicated in the care of a patient with a diagnosis of Parkinson's disease recently admitted to a long-term care facility? A. Supply a multivitamin with each meal. B. Provide a diet that is low in complex carbohydrates and high in protein. C. Provide small, frequent meals throughout the day that are easy to chew and swallow. D. Supply the patient with a minced or puréed diet that is high in potassium and low in sodium.

C Nutritional support is a priority in the care of individuals with Parkinson's disease (PD). Such patients may benefit from meals that are smaller and more frequent than normal (this will be less tiring than eating three larger meals a day) and that are easy to chew and swallow.

Which information would the nurse include when teaching about rehabilitation of patients with spinal cord injury (SCI)? A. Rehabilitation is a passive process where patients receive the care that they need. B. Rehabilitation uses a standardized plan of care to ensure every patient is provided the same level of care C. Patients actively participate in the therapies designed to meet their individual needs. D. Caregivers are not included in the rehabilitation process so that the patient can become as independent as possible.

C Patients and their caregivers are actively involved in the rehabilitation process, often spending several hours every day in therapy sessions and/or in teaching/learning activities to prepare them to be successful in the community.

Which diagnostic test results would the nurse expect for a patient who recently travelled abroad and reports headache, fatigue, and fever? A. CT reveals a solid mass compressing the brain stem . B. CT reveals area of consolidation in the parietal lobe. C. Lumbar puncture reveals clear cerebral spinal fluid (CSF), with glucose and white blood cells (WBCs). D. Lumbar puncture reveals cloudy cerebral spinal fluid (CSF), high glucose level, and red blood cells (RBCs).

C Patients who have recently travelled to areas with West Nile virus and who report fatigue, headache, and fever should be screened for encephalitis. A possible normal lumbar puncture with clear cerebral spinal fluid (CSF), with glucose and white blood cells (WBCs) would be expected.

Which bacteria are the primary infective organisms leading to brain abscess? A. Escherium Coli (E. Coli) B. Cytomegalovirus C. Staphylococcus aureus D. Haemophilus influenzae

C Staphylococcus aureus is a bacteria and one of the primary infective organisms responsible for brain abscess.

Which term describes the most unstable of injuries? A. Compression B. Hyperextension C. Flexion-rotation D. Extension-rotation

C The major mechanisms of injury are flexion, hyperextension, flexion-rotation, extension-rotation, and compression. The flexion-rotation injury is the most unstable of all injuries because the ligamentous structures that stabilize the spine are torn. This injury is most often implicated in severe neurological deficits.

Which action would the nurse take next when caring for a patient with increased intracranial pressure (ICP) due to a subdural hematoma and upon assessment notes one pupil is 3 mm and the other is 7 mm? A. Assess the patient's lung sounds. B. Notify the health care provider. C. Assess the cranial nerves for abnormalities. D. Document findings in the patient's medical record.

C The nurse would complete a full neurological exam, including assessment of the cranial nerves.

Which provider order would the nurse anticipate when caring for a patient with increased intracranial pressure (ICP) with nausea and vomiting? A. IV protonix B. PO antibiotics C. Insert NG tube D. Obtain hemoccult

C The nurse would expect to insert an NG tube to decompress the stomach. Increased intra-abdominal or intrathoracic pressures can contribute to elevated intracranial pressure (ICP) by impeding cerebral venous drainage. Insertion of a nasogastric tube to aspirate the stomach contents can prevent distension, vomiting, and possible aspiration.

Which statement describes the pathophysiology of secondary spinal cord injury (SCI) in a patient admitted to the hospital with SCI after an automobile accident? A. Displacement of the spinal column B. Mechanical transection of the cord by the trauma C. Necrotic destruction of the cord from hemorrhage and edema D. Release of epinephrine leading to massive vasodilation of spinal cord vessels

C This is considered the secondary injury occurring after the spinal cord is injured. Hemorrhage and edema cause tissue hypoxia and vasospasm leading to vasoconstriction, further hypoxia, and necrosis. The spinal cord has minimal ability to adapt to vasospasm.

Which action would the nurse take first when a patient with a C7 spinal cord injury (SCI) undergoing rehabilitation tells the nurse he must have the flu because he has a bad headache and nausea? A. Call the health care provider. B. Check the patient's temperature. C. Take the patient's blood pressure. D. Elevate the head of the bed to 90 degrees.

C This is the appropriate first action to assess for autonomic dysreflexia as the patient reports a bad headache and nausea. The nurse may also raise the head of the bed, begin to look for the noxious stimulus responsible for the autonomic dysreflexia and contact the provider.

Which action would the nurse take when caring for a patient with a brain tumour in the temporal region who has developed aphagia? A. Provide verbal instructions rather than written instructions. B. Give the patient a four-point walker to use when ambulating. C. Keep a white board and markers in the patient's room at all times. D. Place padding on all four side rails and place patient on fall precautions.

C Tumours in the temporal region affect the patient's speech and may cause aphagia. The nurse should develop a means of communication, such as use of a white board.

Which technique should be highlighted by the nurse when providing home-care instructions to a spinal cord injury (SCI) patient with a halo vest and their caregiver during discharge? A. The patient should sit upright when the vest is removed to provide skin care to areas under the vest. B. The halo spanner should be worn on a belt around the waist at all times. C. Do not use any ointments or antiseptics on the pin sites. D. Report crusting at pin sites immediately to the health care provider.

C Unless ordered by the provider, ointments and antiseptics should not be applied to the pin sites.

Which clinical manifestation is indicative of autonomic dysreflexia? Select all that apply. One, some, or all responses may be correct. A. Tachycardia B. Circumoral cyanosis C. Throbbing headache D. Hypertension E. Diaphoresis above the level of the lesion F. Warm, flushed skin below the level of the lesion

C, D, E Throbbing headache A throbbing headache is a common indicator of autonomic dysreflexia. Any patient with a spinal cord injury (SCI) who complains of headache should be assessed for hypertension. Hypertension Patients with autonomic dysreflexia can have systolic blood pressures higher than 300 mm Hg. A patient with SCI and a blood pressure greater than 100 mm Hg should be assessed for autonomic dysreflexia. Diaphoresis above the level of the lesion Diaphoresis is under sympathetic control, therefore above the lesion, sympathetic stimulation will cause sweating.

Which reason is a CT scan the best diagnostic test for evaluating acute head trauma? A. Measures cerebral blood flow velocity B. Useful in detecting small lesions C. Most sensitive imaging technique D. Allows for rapid diagnosis and intervention

D CT scan is best for evaluating acute head trauma because the procedure is quick and can be performed in an acute care setting.

Which collaborative care order would the nurse anticipate when caring for a patient with a brain abscess that is causing a severe increase in intracranial pressure (ICP) and drug therapy has been ineffective thus far? A. Intravenous (IV) Vidarabine B. Intravenous (IV) fluid bolus C. Lumbar puncture D. Draining of the abscess

D Draining the abscess or surgical removal of the encapsulation are required if antibiotic therapy is ineffective. Draining of the brain abscess is an appropriate care action for this patient.

Which action would the nurse take if cerebrospinal fluid (CSF) rhinorrhea occurs? A. Initiate nasotracheal suctioning. B. Encourage patient gently blow their nose. C. Place dressing into the nasal cavity. D. Inform the health care provider immediately

D If CSF rhinorrhea occurs, the nurse should inform the health care provider immediately. The head of the bed may be raised to decrease the cerebrospinal fluid (CSF) pressure so that a dural tear can seal.

Which statement describes the cause of interstitial cerebral edema? A. Local disruption of the functional or morphological integrity of cell membranes B. Changes in the endothelial lining of cerebral capillaries C. Fluid and protein shift from the extracellular space directly into the cells, with subsequent swelling D. Periventricular diffusion of ventricular cerebral spinal fluid (CSF) in a patient with uncontrolled hydrocephalus

D Interstitial cerebral edema is the result of periventricular diffusion of ventricular cerebral spinal fluid (CSF) in a patient with uncontrolled hydrocephalus. It can also be caused by enlargement of the extracellular space because of systemic water excess (hyponatremia).

Which finding indicates the presence of nuchal rigidity? A. Tonic spasms of the legs B. Curling in a fetal position C. Arching of the neck and back D. Resistance to flexion of the neck

D Nuchal rigidity is a clinical manifestation of meningitis. During assessment, the patient will resist passive flexion of the neck by the health care provider.

Which nursing assessment can indicate the presence of increased intracranial pressure (ICP)? A. Capillary refill B. Lung sounds C. Pain assessment D. Pupillary assessment

D Pupillary reaction is tested with a penlight. The normal reaction is brisk constriction when the light is shone directly into the eye. A consensual response (a slight constriction in the opposite pupil) should also be noted at the same time. A sluggish reaction can indicate early pressure on CN III. A fixed pupil shows no response to light stimulus, which usually indicates increased intracranial pressure (ICP).

Which intervention would the emergency department nurse expect when caring for a newly admitted patient after a motor vehicle accident who injured their right side and is experiencing right lower leg paralysis and the inability to sense pain on the left lower leg? A. Laminectomy B. Spinal fusion C. Spinal tap D. Traction

D Spinal stabilization and realignment with spinal traction would likely be indicated in this case. Initial treatments focus on stabilization and realignment of the injured spinal segment through traction. Stabilization methods eliminate damaging motion at the injury site. They are intended to prevent secondary spinal cord damage caused by repeated contusion or compression.

Which benefit does surgery offer to brain tumour patients? A. Quicker than medication or radiation treatments. B. Provide test biomarkers to determine treatment medications. C. Allows for nonpharmacological intervention to work. D. Reduces the size of tumours.

D Surgery can reduce tumour mass, which decreases intracranial pressure (ICP) and provides relief of symptoms with an extension of survival time.

Which treatment is preferred for brain tumours? A. Pharmacological treatment B. Radiation therapy C. Chemotherapy D. Surgery

D Surgical removal is the preferred treatment for brain tumours.

Which surgical intervention would be indicated for a patient with multiple sclerosis (MS) that has tremors that are not controlled with medication? A. Genome therapy B. Neurectomy C. Rhizotomy D. Thalamotomy

D Thalamotomy is the surgical intervention used to treat unmanageable tremors associated with MS.

Which characteristic most closely represents an areflexic neurogenic bladder? A. The bladder empties when triggered by bladder wall stretch receptors. B. There is a lack of sensing the need to void. C. Spastic, uninhibited bladder emptying. D. The bladder fills but does not empty.

D The atonic, flaccid bladder will fill, but does not empty. This leads to overflow incontinence.

Which statement is an accurate reflection of the pathophysiology of multiple sclerosis? A. The axions become myelinated. B. Nerve fibres are the first structures to be affected. C. Nerve axons are replaced by glial scar tissue. D. T-Cell activation and resulting inflammation leads to axon demyelination.

D The cause of the T-Cell activation is unknown, but several potential triggers have been identified. As the disease progresses, it ultimately demyelinates the axon which leads to the complete loss of the transmission capability of the nerve fiber.

Which physical examination finding would the nurse find with a patient admitted to the critical care unit with a C7 spinal cord injury (SCI) and diagnosis of Brown-Séquard Syndrome? A. Upper extremity weakness only B. Complete motor and sensory loss below C7 C. Loss of position sense on the contralateral side with loss of pain on the ipsilateral side D. Ipsilateral motor loss with contralateral pain sensation loss below C7

D This pattern of motor and sensory loss is consistent with the partial spinal cord transection called Brown-Séquard syndrome.

Which statement about the etiology of Parkinson's disease (PD) is accurate? A. The cause of Parkinson's disease (PD) is damage to the white matter. B. PD is an autoimmune disease caused by activation of T-Cells. C. Demyelination of the myelin sheath causes a disruption the nerve transmission. D. Unusual aggregation of proteins disrupts cognition, movement, mood, and behaviour.

D While the exact cause of PD is unknown, patients with PD do develop Lewy bodies in the nerve cells that derive from the unusual aggregation of proteins in nerve cells. The cause of the protein aggregation is unknown.