Med Surge II: Exam 4

What is the sixth stage of Alzheimer's?

Personality change.

Mechanism of action of Verapamil:

prevent Ca influx into myocytes by blocking the L-type voltage gated Ca channels --> arterial vasodilation AND decrease HR contractility

Mechanism of action of Carbidopa/Levodopa (Sinemet):

-Levodopa: converts to dopamine in the CNS -Carbidopa: Prevents peripheral destruction of levodopa

What is the pathophysiology involved with Parkinson's disease?

-Loss of dopamine-producing brain cells -Decreased dopamine in the brain

What are the medications that are given to prevent ischemic stroke and how does it work?

-Verapamil (Calcium channel blockers). -How it works: Decreases blood pressure. --> Relaxes blood vessels so the heart doesn't have to pump as hard.

What are the functions of the Occipital lobe?

-Vision processing -Perception of color and shapes

Clinical manifestations of Embolic stroke:

-Weakness -Numbness -Paralysis on one side of the body -Confusion -Dizziness

What are symptoms that are common in late stage PD?

-Weakness -Widened stance -Gagging/swallowing -Bladder/bowel problems

What is a generalized seizure?

-It is a seizure that affects both halves of the brain. -It is due to abnormal electrical activity in multiple parts of the brain.

How is a partial/focal seizures described?

-It originates from a specific hemisphere, usually being more localized. -It can be either complex (patient is unconscious) or simple (patient is conscious).

The nurse is teaching about the interventions provided before a cerebral angiography procedure. Which statement indicates the need for further teaching? 1. "I must advise the patient to be well hydrated and to drink plenty of fluids." 2. "I must inform the patient that it takes 60 to 120 minutes for the procedure." 3. "I will ensure that the procedure is started only after the patient gives informed consent." 4. "I will inform the patient not to worry if he or she feels warmth when the IV contrast is administered."

"I must advise the patient to be well hydrated and to drink plenty of fluids." --This procedure is an invasive, intraarterial, radiological procedure that involves the administration of radiopaque dye through a catheter, the patient should not eat or drink anything by mouth after midnight before the procedure. P. 774 (Ch. 35)

The nurse is teaching a patient about seizure management. Which statement by the patient about this image demonstrates understanding? 1. "I should wear this all of the time." 2. "If I don't have it on, I can tell people I have a seizure disorder." 3. "I only need to wear this when I leave the house." 4. "This will help me if I get pulled over when driving."

"I should wear this all of the time." --This facilitates prompting necessary interventions in the event of a seizure. P. 798 (Ch. 36)

Which question by the patient having cerebral angiography indicates that teaching has been effective? 1. "This is a fairly simple x-ray test, right?" 2. "Is it unusual if I get hot and flushed when you inject the dye?" 3. "My kidneys have to be in good shape to get this dye, right?" 4. "Is this test to see if an infection is causing my problem?"

"My kidneys have to be in good shape to get this dye, right?" --Contrast dye is nephrotoxic.

The nurse is caring for a patient who is prescribed carbamazepine for complex partial seizures. Which is the most appropriate information for the nurse to teach the patient? 1. "The medication must be chewed." 2. "The medication may cause blurred vision." 3. "Weight gain is a side effect of the medication." 4. "The medication may cause sedation."

"The medication may cause blurred vision." **Carbamazepine is a sustainable-release capsule, that should NOT be chewed. **Gabapentin administered for partial seizures increases appetite and leads to weight gain. **Phenobarbital causes sedation and changes in sleep patterns. P. 795 (Ch. 36)

What are the type of questions asked in the Motor assessment?

-"Grasp the hands and squeeze bilaterally." -"Pull me toward you." and "Push me away." (Checks biceps and triceps). -Ask patient to lift the legs against gravity and then resistance (To check for quadricep strength).

What type of questions can you ask a patient with Alzheimer's to check his or her Immediate (recent) memory?

-"What TV show did you watch this morning?" -Provide patient with a short list of colors, then ask patient to identify same colors provided a few minutes later.

What questions can be asked to check orientation on a patient to understand his or her state of confusion?

-"What is the current date?" -"Who is the president?" -"Where are you and why?"

What type of questions can you ask a patient with Alzheimer's to check his or her remote (long-term) memory?

-"Where did you work in 1950?" -"What elementary school did you go to?" (Know the answer to questions being asked).

What are the type of questions asked in the Mini-mental status exam?

-"Who are you?" -"Spell a word backward." -"What did you have for breakfast?" -"What is this object in my hand?"

Clinical manifestations of Hemorrhagic stroke:

-"Worst headache ever" -N/V -Sudden change in LOC -Focal seizures

Why is a Parkinson's patient taking Sinemet (Carbidopa/Levodopa)?

-"on-off" phenomenon: The medication becomes less effective in the elimination of related motor symptoms. --The "on" state diminishes & in the "off" state the patient with PD becomes stiff and slow and may be unable to move for several minutes.

Which neurotransmitters are Excitatory?

-Acetylcholine -Glutamate -Norepinephrine

What is a priority when a patient has status epilepticus?

-Airway --Lay side ways and insert an airway.

Which medications are prescribed for secondary stroke prevention?

-Antihypertensives -Lipid-lowering Medications -Platelet inhibitors -Anticoagulants

What are the functions of the Temporal lobe?

-Auditory sensation -Long-term memory -Receptive speech

How is an Absent (typical) seizure characterized?

-Blank stare, possibly upward deviation of the eyes. -Patient will be unresponsive when spoken to. -Duration is few seconds to half a minute with very rapid recovery. -A seizure of generalized onset.

How is a Myoclonic seizure characterized?

-Brief, jerking spasms of muscle(s) or muscle groups. -They often occur with atonic seizures (Loss of muscle tone, lasting 1 - 2 seconds).

What labs need to be monitored with Phenytoin (Dilantin)?

-CBC levels -Monitor for gingival hyperplasia -Monitor total phenytoin levels in the blood: 10 - 20 mcg/mL -Monitor free phenytoin levels: 1 - 2 mcg/mL

What tests are completed to test for seizures?

-CT -MRI -EEG (abnormal electrical activity)

Diagnostics for strokes:

-CT scan -MRI -Carotid duplex -Echocardiogram -Laboratory tests

What are the type of questions asked in the Glasgow Coma Scale?

-Call the patient by their name, if no response... -Call the patient by their name louder, if no response... -Slightly shake the patient to wake them, if no response... -Attempt a sternal rub, if no response... -Apply pain (nail bed pressure or a pinch to the inner arm)

What are some predisposing conditions that can cause embolic stroke?

-Carotid plaque (occluding large cerebral blood vessels) --> This can lead to embolism (blood clot)

Different kinds of auras that can occur with possibly having a seizure?

-Color changes -Hallucinations -Scents

What are the levels of consciousness?

-Conscious -Confusion -Lethargic -Obtundation -Stupor -Coma

What is the difference between dementia and delirium?

-Dementia: Chronic and gradual (slow & progressive) -Delirium: Acute and generally happens in the evening (sun down) and is abrupt.

Why are expanded neuro assessments done in stroke patients?

-Determine the patient's level of consciousness (for indicators of increased ICP). -Neurological deterioration needs to be identified quickly to mitigate further brain injury. -Once IV rt-PA is administered, the patient will have assessments verifying LOC, motor strength, and pupillary reflexes every 15 minutes for 6 hours, then every 30 minutes for 2 hours and every hour for 16 hours.

Clinical manifestations of Basilar artery syndrome:

-Dizziness -Ataxia -Tinnitus -N/V -Weakness on one side of the body that is on the same side of the body of ischemia. -Decrease in sensation on one side of the body -Difficulty in articulation of speech -Difficulty swallowing or managing oral secretions

Important side effects of Carbamazepine?

-Dizziness (upon standing) -Blurry/double vision

Patient education when it comes to stroke:

-Educate patient and family members of signs/symptoms related to the different types of stroke -Educate patient on risk factors associated with strokes -Educate patient to adhere to secondary medications to prevent stroke to avoid having a stroke.

What is deep brain stimulation?

-Electrodes are surgically implanted in the brain (thalamus and hippocampus). -Electrodes release electrical impulses and reduces the amount of seizure the patient may have.

What are normal age related cognitive changes?

-Episodic memory diminishes -Free recall diminishes -Working memory ability decreases -Semantic memory is maintained or increased -Processing speed decreases -Formation of neurofibrillary tangles and senile plaque (leads to development of Alzheimer's dementia).

A family member is concerned due to patient being confused, a different type of confusion than typical confusion. How do you explain to the family member as normal and abnormal confusion?

-Explain to patient family they can call the doctor to investigate the concerns further (Tests to rule out causes). -UTI is a major cause of confusion in elderly patients. -Medications can also alter a patients confusion level.

What is involved with the 3rd stage (Midpoint stage) of Parkinson's disease?

-Falls become common -Loss of balance is frequent -Rigidity of movement -Patient needs assistance with eating and dressing

Risk factors for strokes:

-Hypertension -Smoking -Heavy alcohol use -Sympathetic nervous system stimulants (cocaine) -Female gender -History of cerebrovascular disease -Postmenopausal state

Nursing interventions for a patient with Parkinson's disease:

-Implement safety precautions (due to high risk for falls) -Facilitate nutritional intake (assist with feedings due to risk of aspiration and decreased oral intake) -Elevate head of bed when patient is eating or drinking (helps facilitate swallow reflex). -Keep suction equipment at the bedside (due to increased risk of drooling and impaired swallowing).

How is the Mini Nutritional Assessment tool completed?

-It consists of 6 screening questions and 12 assessment questions. -It seeks to correlate readily available data such as: Appetite, typical foods and liquids consumed, mobility, living situation, number of medications taken, recently experienced psychological stress, midarm and midcalf circumferences, and body weight.

Signs and symptoms the patient is progressing with Alzheimer's?

-Loss of multitasking -Lack of problem solving -Trouble finding words -Gets lost easily (like in their own driveway occasionally) -Gets flat affect -Loss of social skills -Changes in personality -Aggressive, uncontrollable acting out and behavior

What is an atonic seizure?

-Loss of muscle tone without preceding myoclonic or tonic event. -Lasts approximately 1-2 seconds -Involves the head, trunk, jaw, or limb musculature.

Education for family members of a patient with Alzheimer's:

-MAINTAIN SAFETY!!! -Child proof EVERYTHING (locks, poisons, electricity, heat, fire) -Find the best nursing home due to different care levels with different nursing homes.

Patient education for taking Phenytoin:

-Maintain good oral hygiene while taking medication -Prolongs half-life of Coumadin if taken together.

When doing a neuro assessment, what are some questions that can be asked to do to make sure everything is functioning correctly?

-Mini cognitive assessment (3-item recall test & clock drawing test). -Wiggle fingers and toes -Hold up "this" many fingers -Thumbs up 5 times. -Check all extremities (to make sure all parts of brain are working).

What are the types of neuro exams?

-Mini-mental status examination -Cranial nerve assessment -Glasgow Coma Scale -Motor assessment

What labs need to be monitored with Levetiracetam (Keppra):

-Monitor RBC and WBC -Monitor liver function

What labs need to be monitored with carbamazepine?

-Monitor liver function -Monitor CBC -Discontinue if bone marrow suppression occurs

Nursing interventions with Carbamazepine:

-Monitor liver functions with blood draw. -Do not crush or chew sustained-release capsules. -Monitor CBC levels -Monitor for visual changes

What is involved with the 1st stage of Parkinson's disease?

-One-sided weakness -Tremors -Trouble with posture and walking and facial expressions -Patient can still function well

What is VNS (Vagal nerve stimulator) surgery?

-Pacemaker for the brain -Treats both simple and complex seizures -Stimulates cranial nerve X (Vagal nerve) to control seizure activity by altering release of norepinephrine and increasing levels of GABA. -Generator is placed in a small pouch in left chest by the clavicle & set to continuous for bad seizures and can be stimulated by a special magnet.

What is involved with the 5th stage of Parkinson's disease?

-Patient cannot walk anymore due to rigidity -Around the clock nursing care is needed -Patient has hallucinations/delusions -Patient should no longer be allowed to stand due to muscle rigidity

What are the functions of the Parietal lobe?

-Perception -Spatial relationships (body position) -Integration of sensory input (especially visual)

What are the functions of the Frontal lobe?

-Personality -Expressive speech -Voluntary movement -Judgement

Clinical manifestations of Parkinson's disease:

-Resting tremors -Muscle rigidity -Slowness of movement (bradykinesia) -Loss of movement (akinesia) -Postural instability (impaired balance and frequent falls) --Other clinical manifestations include: Mood, cognitive, and behavioral alterations.

How is Alzheimer's diagnosed?

-Rule out other possible diagnosis -History and physical

Types of seizures Carbamazepine (Tegretol) treats?

-Secondary tonic-clonic seizures -Complex partial seizures -Simple partial seizures

What is status epilepticus?

-Seizures that last longer than 5 minutes. -2 or more seizures that the patient hasn't fully recovered from (a short period of time). ****This is considered a MEDICAL EMERGENCY.

Which neurotransmitters are Inhibitory?

-Serotonin -Gamma-aminobutyric acid (GABA) -Dopamine

What is involved with the 4th stage of Parkinson's disease?

-Sever and limiting -Patient cannot walk without walker/device -Needs ADL assistive care -Needs full time help

What are some characteristics of Parkinson's that would require the need for a fall care plan?

-Shuffling of feet. -Unsteady gait. -Orthostatic hypotension. -Rigidity and tremors.

How is an Absent (atypical) seizure characterized?

-Similar to typical seizures, except they begin more slowly and last longer (up to a few minutes). -They can include slumping or falling down. -The person may feel confused for a short time after regaining consciousness.

What labs are looked at for metabolic seizures?

-Sodium levels (lowered or increased sodium levels --> Not by just a point or two in either direction).

Pathophysiology of Ischemic strokes:

-Sudden blockage of a cerebral blood vessel. -Resulting in reduced blood supply to the region of the brain that is blocked.

What is involved with the 2nd stage of Parkinson's disease?

-Symptoms worsen and two-sided weakness develops -Everything takes longer/is slower -Patient can still live by themselves and perform ADLs.

How do anticholinergics work for PD patients?

-They reduce tremors and drooling. -They may be used in younger patients.

What are the different type of Ischemic strokes to know?

-Thrombotic -Embolic

What is the difference between Thrombotic stroke and Embolic stroke?

-Thrombotic stroke: A blood clots form in an artery leading to the brain. -Embolic stroke: A clot forms elsewhere in the body and travels to an artery leading to the brain.

How are nonepileptic seizures caused?

-Trauma -Surgery -Tumors -Stroke

What are signs and symptoms of Parkinson's disease?

-Tremors -Bradykinesia (slowness of movements) -Stoop posture -Shuffling -Flexed arms and elbows

Clinical manifestations of Right middle cerebral artery syndrome:

-Weakness of left face, arm, and leg (arm weakness greater than leg weakness) -Decrease in sensation on the left side of the body -Loss of visualizing objects on the left side -Inattention/neglect of the left side

Clinical manifestations of Left middle cerebral artery syndrome:

-Weakness of the right face, arm, and leg (arm weakness greater than leg weakness) -Decrease in sensation on the right side of the body -Loss of visualizing objects on the right side -Dysphagia -Inattention/neglect of the right side

A patient has been treated with tissue plasminogen activator (t-PA) for an ischemic stroke. What actions should the nurse take? Select all that apply. 1. Use an electric razor for shaving. 2. Use a soft toothbrush for oral hygiene. 3. Never rotate IV sites. 4. Keep the blood pressure (BP) cuff on one arm only. 5. Avoid rectal temperature.

1, 2, 3, 4, 5 -Use an electric razor for shaving. -Use a soft toothbrush for oral hygiene. -Never rotate IV sites. -Keep the blood pressure (BP) cuff on one arm only. -Avoid rectal temperature. P. 890 (Ch. 39)

The nurse is teaching a patient about seizure management. Which statement made by the patient indicates effective teaching? Select all that apply. 1. "I should wear a medic alert bracelet." 2. "I should refrain from driving." 3. "I should monitor my blood glucose levels daily." 4. "I should take short and deliberate steps while walking." 5. "I should apply sunscreen and skin emollients while going out in sunlight."

1 & 2 -"I should wear a medic alert bracelet." (This facilitates prompting necessary interventions in the event of a seizure). -"I should refrain from driving." (Due to impaired motor skills). **Patients on glucocorticoid treatment may become hyperglycemic. **A patient with Parkinson's disease should take short and deliberate steps to reduce the risk of falling. **A patient on radiation therapy should use sunscreen and skin emollients while going out in sunlight for proper sun protection. P. 798 (Ch. 36)

The nurse is developing a plan of care for a patient with Alzheimer's disease recently admitted to a nursing home. What priority goals should the nurse consider? Select all that apply. 1. Maintain patient safety 2. Socialization with residents 3. Improve the quality of life 4. Perform ADLs independently 5. Independently take medications

1 & 3 -Maintain patient safety -Improve the quality of life P. 809 (Ch. 36)

The nurse correlates which responses as associated with the sympathetic nervous system? Select all that apply. 1. Increased heart rate 2. Decreased respiratory rate 3. Increase in peristalsis 4. Dilated bronchioles 5. Decreased heart rate

1 & 4 -Increased heart rate -Dilated bronchioles --Sympathetic nervous system: Increases respiratory rate (dilates bronchioles) and heart rate. **Parasympathetic nervous system: Causes decreased heart rate and respiratory rate, increased peristalsis of the GI tract, and constricts pupils.

The nurse assess for which cardinal clinical manifestations in the patient with Parkinson's disease? (Select all that apply.) 1. Rigidity 2. Disorientation 3. Tremor 4. Bradykinesia 5. Dementia 6. Postural changes

1, 3, 4, 6 -Rigidity -Tremor -Bradykinesia -Postural changes

What is used to diagnose a seizure disorder? (Select all that apply.) 1. Electroencephalogram 2. Lumbar puncture 3. Metabolic panel 4. Coagulation studies 5. Electromyogram

1, 2, 3 -Electroencephalogram -Lumbar puncture -Metabolic panel

What is used to diagnose a seizure disorder? (Select all that apply.) 1. Electroencephalogram 2. Lumbar puncture 3. Metabolic panel 4. Coagulation studies 5. Electromyogram

1, 2, 3 -Electroencephalogram (Abnormal electrical activity). -Lumbar puncture -Metabolic panel --Lab work-up is used to rule out other causes (lesions, tumors) --Diagnosis is also done via imaging (CT, MRI).

When educating a patient with migraine headaches, the nurse includes which interventions? Select all that apply. 1. Practice a healthy lifestyle (cease smoking, alcohol in moderation, exercise). 2. Avoid triggers. 3. Use techniques like relaxation and stress reduction. 4. Stop taking medications if symptoms subside in order to decrease tolerance. 5. Eliminate all salt and caffeine from the diet.

1, 2, 3 -Practice a healthy lifestyle. -Avoid triggers -Use techniques like relaxation and stress reduction.

The nurse correlates which clinical manifestations to age-related changes of the nervous system? (Select all that apply.) 1. Decreased visual acuity 2. Increased pain sensation 3. Balance problems 4. Dementia 5. Decreased pain sensation

1, 3, 5 -Decreased visual acuity -Balance problems -Decreased pain sensation

The nurse is caring for a patient in the skilled nursing facility with the condition here. Who should be included as a part of the collaborative team? Select all that apply. 1. Physical therapist 2. Patient and family 3. Occupational therapist 4. Security guard 5. Speech therapist

1, 2, 3, 5 -Physical therapist (Provides exercises and activities to maximize strength, flexibility, and movement). -Patient and family (Involvement in decision making about the priorities of care is essential). -Occupational therapist (Provides strategies to promote independence, as well as offers accommodations that may need to be made in the home to promote safety and maximize independence in activities of daily living (ADLs). -Speech therapist (Completes a swallowing evaluation and makes suggestions to promote safe oral intake, also to promote verbal communication). P. 806 (Ch. 36)

The nurse assess for which cardinal clinical manifestations in the patient with Parkinson's disease? Select all that apply. 1. Rigidity 2. Disorientation 3. Tremor 4. Bradykinesia 5. Dementia 6. Postural changes

1, 2, 3, 5 -Rigidity -Disorientation -Tremor -Dementia --Four cardinal signs of Parkinson's disease: bradykinesia, tremor, rigidity, and postural stability. --These occur as an imbalance between dopamine and acetylcholine.

A nurse is performing the initial interview of a patient presenting to the clinic because of neurological complaints. Which actions by the nurse are appropriate? (Select all that apply.) 1. Assessment of physical appearance 2. Comprehensive medication list review 3. Reassurance that all will be okay 4. Review of alcohol and drug use 5. Review of risks

1, 2, 4 -Assessment of physical appearance -Comprehensive medication list review -Review of alcohol and drug use

A nurse is performing the initial interview of a patient presenting to the clinic because of neurological complaints. Which actions by the nurse are appropriate? Select all that apply. 1. Assessment of physical appearance 2. Comprehensive medication list review 3. Reassurance that all will be okay 4. Review of alcohol and drug use 5. Review of risks

1, 2, 4 -Assessment of physical appearance -Comprehensive medication list review -Review of alcohol and drug use

Which interventions should the nurse implement for the patient with Parkinson's disease (PD)? Select all that apply. 1. Elevate head of bed when eating and drinking. 2. Arrange speech therapy for the patient. 3. Teach the patient to take long steps while walking. 4. Teach the patient to call the healthcare provider for medical compliance. 5. Discuss and evaluate the patient's ability to drive.

1, 2, 4, 5 -Elevate head of bed when eating and drinking. (Due to increased risk of aspiration due to swallowing impairment). -Arrange speech therapy for the patient. (Speech therapy will help improve the patient's breathing, swallowing, and speech, and identify if assistive devices are needed to assist with communication). -Teach the patient to call the healthcare provider for medical compliance. (The pt should contact the provider if the effectiveness of medications seems to be declining and dosage adjustments are needed). -Discuss and evaluate the patient's ability to drive. (Due to tremors and muscle rigidity, and medications causing sleep deprivation, the nurse should discuss if the patient is at risk for driving). **The nurse should teach the patient to take short, deliberative steps, with the feet spread to decrease the risk of falls. P. 806 (Ch. 36)

The nurse has received the following provider orders for a patient who was recently admitted to the emergency department with acute stroke symptoms and time of symptom onset of 70 minutes prior to presentation. Which actions are of highest priority in evaluating this patient and preparing to administer IV rt-PA? (Select all that apply.) 1. Establish two peripheral intravenous catheters 2. Check blood glucose 3. Perform bedside swallow screen 4. Check temperature 5. Assist with transport of the patient to CT scan

1, 2, 5 -Establish two peripheral intravenous catheters -Check blood glucose -Assist with transport of the patient to CT scan

The nurse has received the following provider orders for a patient who was recently admitted to the emergency department with acute stroke symptoms and time of symptom onset of 70 minutes prior to presentation. Which actions are of highest priority in evaluating this patient and preparing to administer IV tissue plasminogen activator (rt-PA)? Select all that apply. 1. Establish two peripheral intravenous catheters 2. Check blood glucose 3. Perform bedside swallow screen 4. Check temperature 5. Assist with transport of the patient to CT scan

1, 2, 5 -Establish two peripheral intravenous catheters (One for IV rt-PA infusion and other medications and the other for blood draws since venipuncture is discouraged for 24 hours after rt-PA administration). -Check blood glucose (Hypoglycemia can mimic stroke signs and symptoms). -Assist with transport of the patient to CT scan (This will rule out presence of intracerebral hemorrhage as the cause of stroke signs and symptoms).

The nurse includes which information in the teaching plan about management of acute ischemic stroke? (Select all that apply.) 1. Stroke risk factors 2. Need for annual CT scan 3. Prevention of aspiration 4. Prevention of deep vein thrombosis 5. Importance of BP control

1, 3, 4, 5 -Stroke risk factors -Prevention of aspiration -Prevention of deep vein thrombosis -Importance of BP control

The nurse correlates which clinical manifestations to age-related changes of the nervous system? Select all that apply. 1. Decreased visual acuity 2. Increased pain sensation 3. Balance problems 4. Dementia 5. Decreased pain sensation

1, 3, 5 -Decreased visual acuity -Balance problems -Decreased pain sensation **Dementia should not be considered a normal part of aging, other causes should be ruled out.

The nurse monitors which diagnostic results in the patient with bacterial encephalitis? Select all that apply. 1. Isolation of CSF via polymerase chain reaction 2. Gram stain and culture of CSF 3. CT 4. MRI 5. EMG

2, 3, 4 -Gram stain and culture of CSF (Identification of the invading organism and for antibiotic treatment). -CT (Increased ICP and signs of the infectious process). -MRI(Increased ICP and signs of the infectious process).

Which clinical manifestations are included in a diagnosis of Parkinson's disease? Select all that apply. 1. Flaccidity 2. Total resistance to movement 3. Bradykinesia 4. Tremors 5. Photophobia

2, 3, 4 -Total resistance to movement -Bradykinesia -Tremors --Four signs of Parkinson's disease include: Bradykinesia, resting tremor, rigidity, and postural instability. --> Two or more of these symptoms with asymmetrical presentation are observed for diagnosis of PD.

What structures make up the gray matter in the central nervous system? Select all that apply. 1. Axons 2. Cell bodies 3. Dendrites 4. Myelin sheath 5. Synapses

2, 3, 5 -Cell bodies -Dendrites -Synapses

Which of the following are modifiable risk factors for stroke? (Select all that apply) 1. 58 years old 2. History of hypertension 3. History of high cholesterol 4. Male 5. Tobacco use

2, 3, 5 -History of hypertension -History of high cholesterol -Tobacco use

What interprofessional team members are involved in the management of the patient with Parkinson's disease? (Select all that apply.) 1. Oncologist 2. Speech therapist 3. Occupational therapist 4. Interventional radiologist 5. Physical therapist

2, 3, 5 -Speech therapist -Occupational therapist -Physical therapist

What interprofessional team members are involved in the management of the patient with Parkinson's disease? Select all that apply. 1. Oncologist 2. Speech therapist 3. Occupational therapist 4. Interventional radiologist 5. Physical therapist

2, 3, 5 -Speech therapist (Completes a swallowing evaluation and makes suggestions to promote safe oral intake). -Occupational therapist (Provides strategies to promote independence as well as offer accommodations that may need to be made in the home to promote safety and independence in ADLs). -Physical therapist (Provide exercises and activities that minimize strength, flexibility, and movement).

Which is a first-line medication used in the immediate treatment of seizures and status epilepticus? Select all that apply. 1. Propofol 2. Phenytoin 3. Lorazepam 4. Midazolam 5. Levetiracetam

3 & 4 -Lorazepam (A benzodiazepine). -Midazolam (A benzodiazepine). **Propofol: Used in high doses to treat the refractory seizure. **Phenytoin: Loading dose is given around the clock to stabilize a patient with seizures. **Levetiracetam: A loading dose is given around the clock to stabilize the patient with seizures. P. 796 (Ch. 36)

The nurse is monitoring a patient receiving rt-PA who develops a sudden headache. Which are the priority actions in evaluating this change in assessment? (Select all that apply.) 1. Decrease the rate of the rt-PA infusion. 2. Administer Tylenol for pain. 3. Stop the rt-PA infusion. 4. Notify the provider of the change. 5. Perform a neurologic assessment.

3, 4, 5 -Stop the rt-PA infusion -Notify the provider of the change -Perform a neurologic assessment

The nurse is monitoring a patient receiving rt-PA who develops a sudden headache. Which are the priority actions in evaluating this change in assessment? Select all that apply. 1. Decrease the rate of the rt-PA infusion. 2. Administer Tylenol for pain. 3. Stop the rt-PA infusion. 4. Notify the provider of the change. 5. Perform a neurologic assessment.

3, 4, 5 -Stop the rt-PA infusion -Notify the provider of the change -Perform a neurologic assessment

Patient education for taking Levetiracetam:

Do not discontinue medication abruptly.

Which drugs are first line of treatment for PD?

Dopamine receptor agonists: -Ropinirole (Requip)

The nurse recognizes which patient is at greatest risk for death secondary to stroke? 1. A 45-year-old Asian male 2. A 56-year-old African American female 3. A 36-year-old Caucasian male 4. A 62-year-old Hispanic female

A 56-year-old African American female.

The nurse recognizes which patient is at greatest risk for death secondary to stroke? 1. A 36-year-old Caucasian male 2. A 45-year-old Asian male 3. A 56-year-old African American female 4. A 62-year-old Hispanic female

A 56-year-old African American female. --Stroke is greater in men than women until age 55, when the incidence of stroke is greater in women than men. --Death by stroke is greater in African Americans.

The nurse monitors for which clinical manifestations of the older adult patient diagnosed with delirium? 1. Somnolence and fever 2. Disorientation and word-finding difficulty 3. Feelings of hopelessness and early morning wakening 4. Abrupt onset of confusion and hallucinations

Abrupt onset of confusion and hallucinations.

A patient with a history of seizures experiences lip smacking and daydreams during a seizure with no loss of consciousness. The nurse recognizes these clinical manifestations as associated with which type of seizure? 1. Absence seizure 2. Complex partial seizure 3. Atonic seizure 4. Myoclonic seizure

Absence seizure. --This type of seizure usually lasts 5 to 10 seconds and involves minimal if any, loss of muscle tone. --The patient will exhibit automatisms such as the lip smacking or excessive swallowing. **Myoclonic seizures: Present with no loss of consciousness and include brief contractures of muscles that may be symmetrical or asymmetrical. **Atonic seizures: May or may not lose consciousness and exhibit sudden momentary loss of motor tone. **Complex partial seizures: Include loss of consciousness and are preceded by an aura, there may also be demonstrations of automatisms.

The primary healthcare provider orders IV recombinant tissue plasminogen activator (rt-PA) therapy for a patient. Which is the most likely condition of the patient? 1. Neurogenic shock 2. Acute ischemic stroke 3. Traumatic brain injury 4. Increased intracranial pressure

Acute ischemic stroke. --IV rt-PA therapy is the only FDA approved treatment for ischemic stroke. **Neurogenic shock: Phenylephrine is used. **Traumatic brain injury: Mannitol is used. **Increased intracranial pressure: Osmotic diuretics are used. P. 881 (Ch. 39)

The nurse should assess for diabetes in the patient receiving contrast dye for what reason? 1. Administration of metformin and contrast may cause hypoglycemia. 2. Administration of metformin and contrast may cause hyperglycemia. 3. Administration of metformin and contrast may impair renal function. 4. Administration of metformin and contrast may result in lactic acidosis.

Administration of metformin and contrast may result in lactic acidosis. --Due to impaired renal function, it would lead to high systemic metformin levels as metformin is cleared through the kidneys. --High metformin levels result in lactic acidosis.

What is the fourth stage of Alzheimer's?

Agnosia (inability to process sensory information).

The nurse notes neglect, or inattention, to one side of the body in a patient who recently had a stroke. Which describes this condition in the patient? 1. Apraxia 2. Agnosia 3. Battle's sign 4. Hemianopia

Agnosia. --The patient has neglect or has become inattentive toward one part of the body, this condition is also known as hemiparesis. **Apraxia: Disturbances in the planning of motor activities. **Battle's sign: Bruising around the ears. **Hemianopia: The visual field deficit in which the patient is unable to scan the entire environment. P. 884 (Ch. 39)

What are signs and symptoms of post-ictal phase?

Altered state of consciousness that can last 5 to 30 minutes. The patient may present with the following symptoms: -Drowsiness -Confusion -Disorientation -Nausea -Hypoxia -Headache -Migraine --Oxygen levels are measured (due to risk of hypoxia). --Patient's short-term memory is affected as well as attention span.

When assessing the patient with cognitive impairment, the nurse should be aware that this is the most common cause of dementia. 1. Parkinson's disease 2. Multi-infarct dementia 3. Vascular dementia 4. Alzheimer's disease

Alzheimer's disease.

A patient is admitted to a unit with a diagnosis of left middle cerebral artery acute ischemic stroke and is not eligible for thrombolytic therapy. The nurse recognizes that this patient is at a high risk for which complication? 1. Delirium 2. Palpitations 3. Aspiration 4. Bronchospasms

Aspiration.

A patient is admitted to a unit with a diagnosis of left middle cerebral artery acute ischemic stroke and is not eligible for thrombolytic therapy. The nurse recognizes that this patient is at a high risk for which complication? 1. Delirium 2. Aspiration 3. Bronchospasm 4. Palpitations

Aspiration. --Due to difficulty swallowing after a stroke.

What does the Mini Nutritional Assessment tool test for?

Assess the nutritional status for those aged 65 and over. --It is used to identify individuals who are malnourished or at risk for malnourishment.

What does the Mini-mental status examination test for?

Assesses cognitive function. Assesses the following: -Orientation -Attention -Calculation -Memory -Language abilities --Patients are asked 30 questions, a correct answer gains 1 point. --If the patient scores below 20 points there is an indication of cognitive impairment.

What does the Glasgow Coma Scale test for?

Assesses level of consciousness. Assesses the following: -Best eye opening -Best motor response -Best verbal response --The highest score is a 15. --A score of 8 or less indicates severe neurological issues.

What does the Mini-Cognition screening tool test for?

Assessing cognitive impairment.

The nurse is caring for an older adult patient presenting with delirium and confusion. As the patient becomes increasingly combative, which action does the nurse implement first? 1. Placing the patient in soft wrist restraints 2. Administering the ordered sedative 3. Placing the patient in a vest restraint 4. Assigning a staff member to stay with the patient.

Assigning a staff member to stay with the patient. P. 74 (Ch. 6)

What are signs and symptoms of the pre-ictal phase?

Auras occur that include: -Pleasant or unpleasant odors -Visualizations/hallucinations -The sense of "butterflies" in the stomach -intense feeling that a seizure is about to happen

How is Alzheimer's confirmed?

Autopsy.

What is a contraindication to the administration of rt-PA in a patient with suspected ischemic stroke? 1. Platelet count 200,000 mm3 2. Onset of symptoms 2 1/2 hours before presenting to ED 3. Patient who awakens from 6 hours of sleep with symptoms of stroke 4. Neurological impairment based on the NIHSS

Patient who awakens from 6 hours of sleep with symptoms of stroke.

Prior to the start of the semester, what type of meningitis can college-aged students be vaccinated against? 1. Bacterial meningitis 2. Viral meningitis 3. Aseptic meningitis 4. Fungal meningitis

Bacterial meningitis. --Vaccine name is HiB (Haemophilus influenza type B).

Mechanism of action of benztropine (Congentin):

Blocks cholinergic activity in the CNS.

Pathophysiology of Alzheimer's disease:

Both Neurofibrillary tangles and Beta-amiloid plaques build up in the brain blocking communication between the nerves and impedes function.

The nurse monitors for which clinical manifestations in the patient diagnosed with Parkinson's disease? 1. Photophobia 2. Decreased level of consciousness 3. Nuchal rigidity 4. Bradykinesia

Bradykinesia. P. 804 (Ch. 36)

In which state of a seizure is a patient most likely to have compromised airway and decreased level of consciousness? 1. After a seizure episode 2. During the preictal state 3. During the postictal state 4. Between seizure episodes

During the postictal state. --Also during the seizure. **After a seizure: Patient may have an unstable airway and need immediate suctioning of the oral airway. **Preictal state: Associated with alterations of the vital signs. **Between seizure episodes: Vital signs (BP, heart rate, ox sat) may not vary between seizures. P. 797 (Ch. 36)

What is the fifth stage of Alzheimer's?

Emotional instability (turning emotions on a dime).

Which type of neuroglial cell lines the ventricles of the brain and spinal cord? 1. Astrocytes 2. Ependymal cells 3. Microglial cells 4. Oligodendrocytes

Ependymal cells.

The patient is not arousable and unresponsive, what type of consciousness is this?

Coma.

The patient is disoriented, bewildered, and has difficulty following commands, what type of consciousness is this?

Confusion.

The patient is awake with appropriate speech and behavior, what type of consciousness is this?

Conscious.

A patient with a history of complex partial seizures has a phenytoin (Dilantin) level (free) of 3.1 mcg/mL. The nurse calls the patient and instructs the patient to take which action? 1. Stop the medication and make an appointment for the following week with the provider. 2. Continue the medication and make an appointment right away with the healthcare provider. 3. Take an extra dose now and continue with the current regimen. 4. Skip the next dose and make an appointment right away with the healthcare provider.

Continue the medication and make an appointment right away with the healthcare provider. --This free level is high and the patient needs to be evaluated by their provider. --Do not stop or skip doses without approval from the provider. --Normal free phenytoin levels: 1.0-2.0 mcg/mL.

Assessing vision and smell is done during what part of the neurological assessment? 1. Glasgow Coma Scale assessment 2. Cranial nerve assessment 3. Health concern assessment 4. Babinski sign assessment

Cranial nerve assessment. **Glasgow Coma Scale: Assesses wakefulness and arousal state. **Babinski reflex: Assesses if an upper motor neuron lesion, MS, or drug and alcohol problem are suspected.

The nurse is caring for a patient who is being transported to the emergency department with clinical manifestations of stroke. Which is the priority action upon arrival to the hospital? 1. Draw blood for coagulation studies. 2. Establish the time that the patient was last known to be without symptoms 3. Perform an EEG 4. Perform and electrocardiogram

Establish the time that the patient was last known to be without symptoms.

A patient reports numbness, pain, weakness in the lower extremities, and an inability to control motor movement. The primary healthcare provider prescribes gabapentin and tramadol. What should be the outcome of this intervention? 1. Decreased lower back pain 2. Suppression of spinal cord tumors 3. Reduced symptoms of multiple sclerosis 4. Relief from symptoms associated with amyotrophic lateral sclerosis (ALS)

Decreased lower back pain. --Gabapentin (an anticonvulsant) and tramadol (a nonopioid analgesic) often help to relieve nerve damage pain, a major reason for lower back pain. **Chemotherapy: Treats spinal cord tumors. **Beta interferons, immunosuppressive agents, and corticosteroids: Treat multiple sclerosis. **Benzothiazole, muscle relaxants, antispasmodics, analeptics, antimuscarinics, anticholinergics, laxatives, and tricyclic antidepressants: Used to treat amyotrophic lateral sclerosis (ALS) symptoms. P. 820 (Ch. 37)

Mechanism of action of Levetiracetam (Keppra):

Decreases incidence and severity of seizures.

Which clinical manifestation indicates an adverse effect of rt-PA? 1. Decreasing level of consciousness 2. Gastroparesis 3. Hyperglycemia 4. Productive cough

Decreasing level of consciousness.

A patient with a brain tumor has been admitted to the hospital due to changes in level of consciousness. The nurse correlates the action of which medication to the treatment of suspected increasing cerebral edema? 1. Dexamethasone (Decadron) 2. Phenytoin (Dilantin) 3. Carbamazepine (Tegretol) 4. Furosemide (Lasix)

Dexamethasone (Decadron). --This medication is used to treat and prevent local cerebral edema, it shows to stabilize cell membranes to prevent the occurrence of cerebral edema.

What is the second stage of Alzheimer's?

Difficulty with language.

Patient education for taking carbamazepine:

Do not crush or chew sustained release capsules.

The nurse is caring for a patient who is being transported to the emergency department with clinical manifestations of stroke. Which is the priority action upon arrival to the hospital? 1. Establish the time that the patient was last known to be without symptoms. 2. Draw blood for coagulation studies. 3. Perform an electrocardiogram. 4. Perform an EEG

Establish the time that the patient was last known to be without symptoms. --This helps to guide the response to the patient's signs and symptoms. --A CT scan needs to be performed within 25 minutes of the patient arriving to the ER to rule out hemorrhage.

Which confirms the diagnosis of Alzheimer's disease (AD)? 1. Neuropsychiatric testing 2. Written and oral testing 3. Examination of the brain following death 4. Examination of cerebrospinal fluid

Examination of the brain following death. --Neurofibrillary tangles and beta-amyloid plaques can be observed microscopically. **Neuropsychiatric testing: Used to rule out depression and delirium. **Written and oral testing: Assesses the patient's cognitive functions, such as mental status, language ability, functional ability, memory, and concentration. **Examine cerebrospinal fluid: Tested to diagnose meningitis & encephalitis. P. 807 (Ch. 36)

What is the first stage of Alzheimer's?

Forgetfulness.

Which lobes of the cerebrum are largely responsible for movement and personality? 1. Frontal 2. Occipital 3. Parietal 4. Temporal

Frontal.

The nurse recognizes that patient with major changes in personality most likely have damage in which love of the brain? 1. Frontal 2. Occipital 3. Parietal 4. Temporal

Frontal. --Frontal lobe is responsible for voluntary motor movement, Broca's speech, personality, and behavior. **Occipital lobe: Responsible for vision. **Parietal lobe: Responsible for sensory input and integration and spatial relationships. **Temporal lobe: Responsible for auditory sensation and perception, memory, and Wernicke's speech center.

During morning rounds, the nurse notes that the unlicensed assistive personnel is assisting a patient with Parkinson's disease with breakfast. Which observation requires an immediate intervention? 1. Head of the bed raised 30 degrees. 2. Patient sitting out of bed in a chair. 3. Thickener added to liquid menu items. 4. Oral suction catheter equipment turned on.

Head of the bed raised 30 degrees. (Head of the bed should be raised higher due to risk of aspiration). P. 806 (Ch. 36)

After a lumbar puncture, the nurse asks the patient to lay flat for several hours. This helps prevent which post-procedure complication? 1. Hypertension 2. Bleeding 3. Headache 4. Seizure

Headache. --Sitting up after lumbar puncture may result ins CSF leak, causing the headache.

What is the responsibility of the nervous and endocrine system?

Helps maintain homeostasis in the body and coordinate the functions.

Which patient would be at highest risk for a stroke?

High Blood pressure (182/90).

A patient who has had a thrombotic stroke, has motor deficits (left sided), and dysphagia. What is the priority nursing diagnosis?

High risk for aspiration, due to dysphagia (due to thickened fluids).

Patient education with Sinemet:

High-protein meals may impair levodopa's effects.

The nurse is caring for a hypertensive patient who had an acute stroke a few hours ago. The nurse reviews the orders and sees this: "Keep systolic blood pressure greater than 170 mm Hg." What action should the nurse take? 1. Clarify the order with the provider. 2. Assume there is an error and correct the order. 3. Hold all blood pressure medications to keep the blood pressure high. 4. Show a colleague the inappropriate order.

Hold all blood pressure medications to keep the blood pressure high. --A BP may be required to rise to a systolic goal of 180 - 220 mm Hg in some instances of stroke (depending on type, location and comorbidities). --Control in acute stroke is based on concept of cerebral autoregulation: Cerebral blood vessels dilate when systemic BP is reduced and constrict when systemic BP is elevated to maintain constant blood flow. P. 882 (Ch. 39)

Mechanism of action for Phenytoin (Dilantin):

Limits seizure activity by altering ion transport.

What is the seventh stage of Alzheimer's?

Loss of cognitive skills (abstract thinking, judgement, and calculations).

Mechanism of action of Lipitor (Atorvastatin):

Lowers cholesterol levels.

What does the Cranial nerve assessment for?

Identifies neurological impairment due to disease or trauma to the brain. Assess the following: -I Olfactory: Smell aromatic items (coffee) -II Optic: Visual acuity -III Oculomotor: Darken the room & check pupils for dilation -IV Trochlear: Extraocular movement is checked (follow finger as it moves towards pt's nose) -V Trigeminal: Assess facial sensation for light touch, sharpness, and dullness. -VI Abducens: Extraocular movement is checked (follow finger with eyes laterally) -VII Facial: Smile, frown, puff cheeks, raise eyebrows -VIII Vestibulocochlear (acoustic): Hearing is checked by rubbing fingers next to ear. -IX Glossopharyngeal: Gag reflex is checked -X Vagus: Assess gag and ability to swallow, "Ah" -XI Accessory: Shrug shoulder against resistance -XII Hypoglossal: Stick out tongue and move it side to side.

What is difficult about using an EEG to diagnose a seizure?

If the patient isn't having a seizure during the time frame of testing it can be difficult to to confirm the cause of seizure.

The nurse suspects lower cranial nerve dysfunction in a patient with hemorrhagic stroke. Which diagnostic characteristic supports the nurse's suspicion? 1. Impaired swallowing 2. Impaired family coping 3. Impaired physical mobility 4. Impaired verbal communication

Impaired swallowing. --Related to lower cranial nerve dysfunction or decreased level of consciousness. **Impaired family coping: Related to catastrophic illness. **Impaired physical mobility: Related to hemiparesis. **Impaired verbal communication: Related to decreased perfusion to the speech centers in the brain. P. 888 (Ch. 39)

The nurse monitors for which clinical manifestation as indication that a patient's Alzheimer's disease is progressing? 1. Unable to find sweater in the waiting room. 2. Inability to recall the word for "car." 3. Leaving the practitioner's office without taking prescriptions. 4. Misplacement of health insurance cards.

Inability to recall the word for "car." P. 807 (Ch. 36)

The nurse correlates increased intracranial pressure in the patient with meningitis to which pathophysiologic process? 1. Increased production of cerebrospinal fluid 2. Decreased reabsorption of cerebrospinal fluid 3. Increased turbidity of cerebrospinal fluid 4. Decreased protein levels in cerebrospinal fluid

Increased turbidity of cerebrospinal fluid. --Due to the inflammatory process within the meninges, which in turn causes sluggish flow of Cerebral spinal fluid.

What does the Motor assessment check for?

Inspect and assess muscle mass and tone as well as strength and equality between the left and right and to note for any abnormalities. Assess the following: -Upper extremities -Lower extremities

The nurse understands maintaining good head and neck alignment is an important component of managing increased intracranial pressure because venous drainage from the brain occurs via which part of the vascular system? 1. Internal carotid arteries 2. External carotid arteries 3. Internal jugular veins 4. External jugular veins

Internal jugular veins. --Primary means of draining blood from the brain. **Internal and external carotids are ARTERIES that bring blood flow to the brain.

Why is tPA used during a stroke?

It can dissolve the stroke-causing clot.

What is considered a symptom of delirium?

It causes day and night reversal, lasts no more than a month.

After a conversation with a provider, a patient asks what a psychogenic nonepileptic attack disorder (PNES) is. How should the nurse explain it? 1. It does not involve abnormal electrical discharges. 2. It is provoked by other disorders and conditions. 3. It is a chronic disorder. 4. It is an uncontrolled, sudden, excessive discharge of electrical activity.

It does not involve abnormal electrical discharges. --A client with PNES appears to be having an epileptic seizure, there are no abnormal electrical discharges. --Psychogenic nonepileptic attack disorder (PNES) is classified as a conversion disorder. **Secondary seizures/nonepileptic seizures: Provoked by other disorders and conditions (lesions in the brain caused by trauma, surgery, tumors, and strokes). **Chronic disorder of epilepsy: Characterized by the occurrence of two seizures unprovoked by any immediately identifiable cause arising more than 24 hours apart. **Seizure: Uncontrolled, sudden, excessive discharge of electrical activity. P. 791 (Ch. 36)

What is the expected outcome of using tPA for an ischemic stroke?

It helps to restore the blood flow to the brain regions affected by the stroke, limiting risk of damage and impairment.

What is the sensory system test?

It is a test to determine if the patient can feel or identify specific sensations such as: -Temperature -Vibration -Superficial or deep pain -Proprioception or position sense -Cortical sensory interpretation.

What are the parameters for using tPA for an ischemic strokes?

It is most effective when used 3 - 4.5 hours from start of stroke.

When is tPA used during stroke?

It is used when a patient has an ischemic stroke (caused by a blood clot).

How is a clonic seizure characterized?

Jerking (symmetric or asymmetric) regularly repetitive and involves the same muscle groups.

The patient is sleepy, slow and delayed in responding to stimulus, what type of consciousness is this?

Lethargic.

Which assessment data does the nurse recognize as the most sensitive indicator of increased ICP? 1. Pupillary 2. Respiratory 3. Level of consciousness 4. Cranial nerves

Level of consciousness. --This is the earliest sign of increased ICP.

Why is Verapamil used for stroke patients?

Manages hypertension.

Anticholinergics are used to reduce tremors and drooling associated with Parkinson's disease (PD). Which side effect of this drug contraindicates it for older patients? 1. Memory impairment 2. Urinary frequency 3. Nausea and vomiting 4. Disorders of impulse control

Memory impairment. --Side effects of anticholinergics: Confusion & Memory impairment. --Anticholinergics also cause: Urinary retention, and constipation. **Side effects of Dopamine-receptor agonists (first-line treatment for PD): N/V, impulse control (gambling and hypersexuality). P. 804 (Ch. 36)

During a home visit the nurse is concerned that the patient with Alzheimer's disease is deteriorating. What patient observation caused the nurse to have this concern? 1. Sitting in a chair watching a television program. 2. Staying away from the door leading to the backyard. 3. Eating cheese and crackers placed on a table near the living room chair. 4. No recognition of bowel incontinence during the visit.

No recognition of bowel incontinence during the visit. P. 808 (Ch. 36)

The patient is drowsy between sleep states, they have less interest in the environment, and respond slowly to stimulation, what type of consciousness is this?

Obtundation.

The nurse is caring for a patient after a stroke who is having difficulty processing visual information. What part of the patient's brain is most like involved? 1. Frontal 2. Parietal 3. Temporal 4. Occipital

Occipital. --Processes visual information and the perception of color and shapes. **Frontal lobe: Functions include the motor cortex, voluntary movement, Broca's expressive speech center - dominant hemisphere, personality, behaviors: social, sexual, judgement, and problem solving. **Parietal lobe: Controls sensation interpretation and perception, spatial relationships such as body position, integration of sensory input, especially visual input. **Temporal lobe: Controls auditory sensation and perception, long-term memory, Wernicke's receptive speech center. P. 754 (Ch. 35)

The nurse recognizes that the patient with Parkinson's disease is at risk for which complication? 1. Excessive dry mouth due to autonomic dysfunction 2. Facial twitching secondary to seizure activity 3. Flaccid extremities related to the increased levels of dopamine 4. Orthostatic hypotension due to involvement of the sympathetic nervous system

Orthostatic hypotension due to involvement of the sympathetic nervous system.

The nurse recognizes that the patient with Parkinson's disease is at risk for which complication? 1. Excessive dry mouth due to autonomic dysfunction 2. Facial twitching secondary to seizure activity 3. Orthostatic hypotension due to involvement of the sympathetic nervous system 4. Flaccid extremities related to the increased levels of dopamine

Orthostatic hypotension due to involvement of the sympathetic nervous system. --PD leads to reduced sympathetic nervous influences on the heart and blood vessels which leads to orthostatic hypotension.

What risks are associated with PD medication?

Orthostatic hypotension.

Which patient is most likely to experience atonic seizures? 1. Patient A 2. Patient B 3. Patient C 4. Patient D

Patient B. --Patient B is unconscious with a sudden loss of motor tone and head drop due to fall = atonic seizures. **Patient A: May have complex partial seizures. **Patient C: May have absence seizures. **Patient D: May have simple partial seizures. P. 792 (Ch. 36)

The nurse is caring for a patient with tonic-clonic seizures. Which action of the nurse is most likely to benefit the patient? 1. Encouraging the patient to eat finger foods 2. Placing the patient in a left recumbent position 3. Placing a clock and calendar in the patient's room 4. Encouraging the patient to participate in self-care activities

Placing the patient in a left recumbent position. --This is encouraged with patients who have tonic-clonic seizures to reduce the risk of aspiration. P. 797 (Ch. 36)

In assessing a patient with encephalitis, the nurse notes that when the patient's neck is flexed, the legs flex. The nurse documents this as which of the following? 1. Positive Kernig's sign 2. Positive Brudzinski's sign 3. Nuchal rigidity 4. Clonus

Positive Brudzinski's sign. --There is involuntary flexion of hips in response to passive flexion of the neck with the patient in a supine position.

Which finding is used to diagnose the presence of Parkinson's disease (PD)? 1. Electroencephalogram (EEG) 2. Magnetic resonance imaging (MRI) 3. Cerebrospinal fluid (CSF) testing 4. Presence of tremors and muscular rigidity

Presence of tremors and muscular rigidity. --There is no specific diagnostic studies for PD. --Presence of two or more cardinal symptoms with asymmetrical presentation is considered in the diagnosis of PD. --Diagnosis is made by: Considering progressive decline in motor function, accompanied by tremors and rigidity. **EEG: Diagnosis seizures, tumors, inflammations, and brain injury. **MRI: Detects masses, cysts, and irregularities in the vessels or bone of the head. **Cerebrospinal fluid (CSF): Obtained by lumbar puncture is used to diagnose headaches, encephalitis, and meningitis. P. 804 (Ch. 36)

Mechanism of action of Carbamazepine (Tegretol):

Prevents seizures from occurring.

What is the third stage of Alzheimer's?

Problems with short-term memory.

What is an example of an age related change in the neuro system?

Reaction time is slower.

Mechanism of action of Plavix (clopidogrel):

Reduce risk of stroke.

The nurse observes a patient experiencing a partial seizure. Which behavior does the nurse document as automatism? 1. Unilateral, rhythmic muscle movements 2. Rhythmic jerkiness of all extremities 3. Repetitive unconscious movements 4. Visualizations or hallucinations

Repetitive unconscious movements. --Automatism: Involves repetitive unconscious movements such as lip smacking, chewing, or swallowing. **Partial seizure: Involves the rhythmic muscle movements on one side of the body. **Preictal phase: This precedes a seizure and the patient may experience auras (visualizations or hallucinations). P. 791 (Ch. 36)

The nurse is caring for a patient with hemiplegia and hemiparesis of the right leg after a recent stroke. What action is a priority of care? 1. Preventing foot drop 2. Reposition often 3. Aspiration precautions 4. Active range of motion (ROM) of the right side

Reposition often. --Patients with hemiparesis or hemiplegia are at greater risk for development of pressure injuries due to decreased mobility. P. 890 (Ch. 39)

How is a Tonic-Clonic seizure characterized?

Rigidity (Tonic) followed by jerking motions (Clonic). --Tonic: Sustained increase in muscle contraction lasting a few seconds to minutes. --Clonic: Jerking (symmetric or asymmetric), that is repetitive and involves the same muscle groups.

What test can be used to test a patient for ataxia to see if he or she has any issues (with gait)?

Romberg test. --Requires feet to be together, hands at side and eyes open, then the patient will close eyes and see how long they can stand with eyes closed. --The test is scored by how long the patient can stand with eyes closed.

When do Auras normally occur with a seizure?

Several seconds up to an hour before a seizure occurs.

Medications used for Parkinson's disease:

Sinemet (carbidopa/levodopa)

What is ataxia?

Slurring of speech, stumbling, falling, and incoordination. --Caused by damage to the cerebellum (part of brain responsible for coordinating movements).

The home healthcare nurse is caring for an elderly patient with Alzheimer's disease (AD). Which intervention should the nurse implement for the patient? 1. Provide the patient with semi-soft diet. 2. Encourage the patient to take an afternoon nap. 3. Provide the patient with a different schedule every day. 4. Speak calmly using positive statements.

Speak calmly using positive statements. --As the patient develops memory loss, the patient may require frequent reminders to complete an activity. The nurse and other caregivers should use a calm approach and tone to decrease escalation of the patient's agitation. **The patient should be provided finger foods. **The patient should be busy during the day to encourage sleeping better at night due to sleep disturbances. **The patient should follow a regular routine every day. P. 809 (Ch. 36)

What is the patient required to do prior to testing for a seizure?

Stay awake all night, this causes stress to the patient, likely triggering a seizure for testing.

Which surgical procedure is used to treat the patient with Parkinson's disease (PD)? 1. Vagal nerve stimulator (VNS) 2. Stereotactic pallidotomy 3. Deep brain stimulation 4. Partial corpus callosectomy

Stereotactic pallidotomy. --Involves the opening of the pallidum within the corpus striatum. --A cylindrical rod or electrode is implanted, allowing the targeted area to receive mild electrical stimulation to reduce tremors and the rigidity associated with PD. **Vagal nerve stimulator (VNS): Used to stimulate vagus nerve (10th cranial nerve) to effectively control seizure activity. **Deep brain stimulation: Used to treat uncontrolled seizure activity --> Electrodes are placed in deep brain structures and programmed to activate when a seizure activity is sensed. P. 805 (Ch. 36).

A patient is admitted for evaluation and treatment of generalized tonic-clonic seizures. Which clinical manifestations does the nurse assess for in this type of seizure disorder? 1. Persistent jerking movement of one half of the body 2. Muscle flaccidity followed by tremors of all extremities 3. Stiffening of muscles of arms and legs, followed by jerking movements 4. Unilateral jerking movement of one extremity

Stiffening of muscles of arms and legs, followed by jerking movements.

A patient is admitted for evaluation and treatment of generalized tonic-clonic seizures. Which clinical manifestations does the nurse assess for in this type of seizure disorder? 1. Persistent jerking movement of one half of the body 2. Unilateral jerking movement of one extremity 3. Muscle flaccidity followed by tremors of all extremities 4. Stiffening of muscles of arms and legs, followed by jerking movements

Stiffening of muscles of arms and legs, followed by jerking movements. --Characterized by a loss of consciousness, a tonic phase marked by rigidity, followed by rhythmic jerking of all extremities that reflect the clonic phase.

The patient has minimal movement without stimulus, they require strong vigorous stimulation and then drifts back into unresponsiveness, what type of consciousness is this?

Stupor.

Which intervention should the nurse implement for a patient who experienced a seizure? 1. Restrain the patient's movements. 2. Assist the patient to a supine position. 3. Suction the oral airway. 4. Encourage the patient to drink water.

Suction the oral airway. --The patient may have a compromised airway after a seizure, so the nurse would want to maintain the patency of the airway with oral suctioning. **Guide patient's movement to prevent injury. **Turn the patient to the left to reduce the risk of aspiration. **To reduce the risk of aspiration, water shouldn't be encouraged right after a seizure. P. 797 (Ch. 36)

How is an Atonic seizure characterized?

Sudden loss of muscle tone (1-2 seconds, including the head and trunk).

The nurse correlates which clinical manifestation to a secondary headache? 1. Sudden severe onset 2. Tense neck muscles 3. Nausea 4. Tingling scalp sensation

Sudden severe onset. --Caused by an underlying pathology such as infection, neoplasms (tumor), vascular (blood vessel) abnormalities, drug induced disorders, idiopathic causes.

How is a tonic seizure characterized?

Sustained muscle contractions lasting a few seconds to minutes.

When educating a patient on dementia, what should be stated?

Symptoms of dementia may cause impaired judgement.

Transmission of information via neurotransmitters occurs between what structures of a neuron? 1. Cell body and dendrites 2. Axon and synaptic bulb 3. Synaptic bulb and post-synaptic neuron 4. The nodes of Ranvier and synaptic bulb

Synaptic bulb and post-synaptic neuron.

Which lobe of the brain controls receptive language? 1. Frontal 2. Parietal 3. Temporal 4. Occipital

Temporal.

The nurse documents that a patient had an atonic seizure. What did the nurse observe? 1. The patient experienced a brief contracture of muscles or muscle groups. 2. The patient developed shallow breathing and periods of apnea. 3. The patient had rhythmic jerking of all extremities. 4. The patient experienced a severe fall to the ground with loss of consciousness.

The patient experienced a severe fall to the ground with loss of consciousness. --A patient who experiences an atonic seizure has sudden momentary loss of motor tone, and is at high risk of injury. **Myoclonic seizures: The patient experiences brief contracture of muscles or muscle groups --> The patient does NOT lose consciousness. **Tonic-clonic seizures: Affect both the cerebral hemispheres (slow breathing and periods of apnea), the patient also experiences rigidity during the tonic phase and rhythmic jerking of all extremities during the clonic phase. P. 792 (Ch. 36)

What is a simple partial/focal seizure?

The patient is aware they are having a seizure.

What is a complex partial/focal seizure?

The patient is unaware they are having a seizure.

The nurse has the following assignment. Which patient should be seen first? 1. The patient post-lumbar puncture complaining of headache pain 2. The newly admitted patient expressing anxiety over potential neurological diagnosis 3. The patient returning from cerebral angiography 4. The patient with a change from a Glasgow coma scale of 11 to 3.

The patient with a change from a Glasgow coma scale of 11 to 3. --This patient is experiencing a critical change in status and must have emergent medical care to prevent permanent damage or death.

A patient is scheduled for an emergency CT scan because of clinical manifestations of a CVA/stroke. The nurse recognizes which statement as true about the findings of the CT scan? 1. Thrombolytics are contraindicated if the scan identifies an occlusion. 2. Thrombolytics are indicated if the scan identifies a bleed. 3. Thrombolytics are contraindicated if the scan identifies a bleed. 4. Thrombolytics are indicated if the scan is positive for a bleed.

Thrombolytics are contraindicated if the scan identifies a bleed.

A patient is scheduled for an emergency CT scan because of clinical manifestations of a CVA/stroke. The nurse recognizes which statement as true about the findings of the CT scan? 1. Thrombolytics are contraindicated if the scan identifies a bleed. 2. Thrombolytics are indicated if the scan is positive for a bleed. 3. Thrombolytics are contraindicated if the scan identifies an occlusion. 4. Thrombolytics are indicated if the scan identifies a bleed.

Thrombolytics are contraindicated if the scan identifies a bleed. --Thrombolytics are clot busters, hemorrhagic stroke (bleeding in the brain) will cause additional bleeding.

Which describes the role of the speech therapist in terms of care provided for a patient with Parkinson's disease? 1. To maximize independence in activities of daily living (ADLs) 2. To evaluate the patient's ability to swallow 3. To provide exercises that increase strength 4. To promote home safety

To evaluate the patient's ability to swallow. --A swallowing evaluation is completed & suggestions would be made to promote safe oral intake. **Occupational therapist: Maximizes independence activities in daily living (ADLs) and promotes home safety. **Physical therapists: Provide exercises and activities that maximize strength, flexibility, and movement. P. 806 (Ch. 36).

Why would a lab draw be ordered for a patient with seizure symptoms?

To make sure there isn't another issue causing the patient's seizures (Such as low sodium).

Why would a patient be asked to stay awake all night before an EEG?

To stress the patient (sleep deprivation) to have a seizure for testing.

How is Parkinson's disease diagnosed?

Two or more cardinal symptoms with asymmetrical presentation. --No specific diagnostic studies to confirm PD. --Progressive decline in motor function accompanied by tremors and rigidity is how diagnosis is made.

The nurse is caring for a patient whose progressive confusion and increasing lethargy has gone to unresponsiveness. What additional assessments are consistent with cerebral herniation? 1. Focal contralateral motor weakness 2. No change in vital signs 3. Unilateral pupillary dilation without reaction 4. Sluggish pupillary reaction with ovoid shape

Unilateral pupillary dilation without reaction. --Unilateral or bilateral pupillary dilation (depending on type of herniation) without reaction is a sign of cerebral herniation. **Focal contralateral motor weakness: Sign of increased intracranial pressure. **No change in vital signs: Sign of increased intracranial pressure. **Sluggish pupillary reaction with ovoid shape: Sign of increased intracranial pressure. P. 864 (Ch. 39)

The nurse recognizes which as the probable cause of Alzheimer's disease? 1. Exposure to environmental toxins 2. CNS trauma 3. Unknown 4. Chronic hypertension

Unknown. --The actual diagnosis is made only at the time of the autopsy.

Which assessment finding corresponds with the first stage of Parkinson's disease (PD)? 1. Upper extremity tremors 2. Muscle rigidity 3. Shuffling gait 4. Postural instability

Upper extremity tremors. --Parkinson's disease (PD) is characterized by five progressive stages: 1st stage: Pt presents with unexplained unilateral weakness and upper extremity tremors. 2nd stage: Slowness of movement & shuffling gait. Later stages: Postural instability & increased risk for fall, and muscle rigidity is more pronounced. P. 804 (Ch. 36)

The nurse recognizes that supplementation with which vitamin has been found to help with symptoms of Alzheimer's disease? 1. Vitamin E 2. Vitamin B 3. Vitamin C 4. Vitamin A

Vitamin E.

The nurse recognizes that supplementation with which vitamin has been found to help with symptoms of Alzheimer's disease? 1. Vitamin A 2. Vitamin C 3. Vitamin D 4. Vitamin E

Vitamin E. --It is an antioxidant that helps with symptoms of Alzheimer's disease by decreasing the damage caused by free radicals in the brain.