N123 Chp 57 neuro
A nurse is assessing four patients with different types of skull fractures. Which patient would have a low-velocity injury as the cause of skull fracture? Correct1 Patient A 2 Patient B 3 Patient C 4 Patient D
1 A low-velocity injury is the most common cause of a linear fracture of the skull bone. A depressed type of skull fracture, seen in Patient B, is caused by a powerful blow that creates an inward indentation of the skull. Patient C has a comminuted type of skull fracture, which is caused by a direct high momentum impact and multiple linear fractures with fragmentation of the bone. Patient D has a compound type of skull fracture, which is associated with a depressed skull fracture and scalp laceration and is caused by a severe head injury. Text Reference - p. 1369
Which actions of a student nurse who is providing care to a patient with cerebrospinal fluid (CSF) rhinorrhea indicate the need for further instructions? Select all that apply. 1 Using a nasogastric tube 2 Raising the head of the bed 3 Performing nasotracheal suctioning 4 Placing a dressing in the nasal cavity 5 Placing a loose collection pad under the nose
1, 3, 4 Using a nasogastric tube and performing nasotracheal suctioning for a patient with CSF rhinorrhea may cause tearing of the dura mater and lead to meningitis. Placing a dressing in the nasal cavity may block it. Raising the head of the bed will decrease the pressure of the CSF and seal the tear associated with CSF rhinorrhea. Placing a loose collection pad under the nose will help in cleaning. Test-Taking Tip: Recollect the measures to be followed while caring for a patient with cerebrospinal fluid (CSF) rhinorrhea. Text Reference - p. 1374
Which type of skull fracture would the nurse suspect if the imaging studies of a patient with cerebrospinal fluid (CSF) rhinorrhea reveals the presence of air between the patient's cranium and the dura mater? 1 Orbital fracture 2 Frontal fracture 3 Temporal fracture 4 Posterior fossa fracture
2 A frontal fracture of skull is characterized by the presence of air between the cranium and the dura matter or pneumocranium and CSF rhinorrhea. Periorbital ecchymosis indicates an orbital fracture. CSF otorrhea indicates a temporal fracture. Visual field defects indicate a posterior fossa type of skull fracture. Test-Taking Tip: Identify option components as correct or incorrect. This may help you identify a wrong answer. Text Reference - p. 1369
Which surgical procedure is indicated for a patient who is diagnosed with hydrocephalus? 1 Drainage of abscess 2 Excision of malformation 3 Placement of a ventriculoatrial shunt 4 Debridement of fragments and necrotic tissue
3 Hydrocephalus occurs due to overproduction of cerebrospinal fluid, which can be treated by placing a ventriculoatrial shunt, allowing excess cerebrospinal fluid to drain. Drainage of abscess is a surgical procedure indicated for brain abscess. Excision of malformation is a surgical procedure indicated for arteriovenous malformation. Debridement of fragments and necrotic tissue is a surgical procedure indicated for skull fractures. Text Reference - p. 1379
Which type of cranial surgery is performed to provide an alternate pathway to redirect cerebrospinal fluid (CSF)? 1 Burr hole 2 Craniotomy 3 Shunt placement 4 Stereotactic procedure
3 Shunt procedures use a tube or implanted device to provide an alternate pathway to redirect CSF when its absorption is impaired. A burr hole is used to remove localized fluid and blood beneath the dura. Craniotomy is done to remove a lesion or repair a damaged area. Stereotactic procedure is used for biopsy, radiosurgery, or dissection. Text Reference - p. 1379
Before administering temozolomide to a patient with a brain tumor, the patient's neutrophil count is checked to verify it is greater than 1500/μL. What is the rationale behind this nursing intervention? 1 To reduce nausea and vomiting 2 To prevent metabolic inactivation 3 To prevent immune-related complications 4 To prevent drug interactions with corticosteroids
3 Temozolomide can cross the blood-brain barrier and is used to treat brain tumors. It causes myelosuppression in patients with low levels of neutrophils. Therefore, the neutrophil count of the patient should be greater than or equal to 1500/μL before administering temozolomide to prevent immune-related complications. Temozolomide should be taken on an empty stomach to prevent nausea and vomiting. It does not require activation, because it is a metabolically active drug. This drug does not react with corticosteroids. Test-Taking Tip: You should recollect the pharmacodynamics of temozolomide before administering the drug to answer this question accurately. Text Reference - p. 1377
The laboratory reports of a patient with a brain tumor, who reports uncontrolled urination and excessive thirst, show high sodium levels. If the nurse also observes involuntary eye movements, which type of brain tumor does the nurse suspect? 1 Subcortical tumors 2 Cerebellopontine tumor 3 Thalamus and sellar tumor 4 Fourth ventricle and cerebellar tumors
3 Thalamus and sellar tumors may induce diabetes insipidus. This causes symptoms of diabetes insipidus such as excessive urine production, thirst, and elevated sodium and potassium levels. Tumors in the hypothalamic region may cause nystagmus or involuntary eye movements. Subcortical tumors cause hemiplegia. Cerebellopontine tumors cause tinnitus and vertigo. Fourth ventricle and cerebellar tumors cause headache, nausea, and papilledema. Test-Taking Tip: Recall the type of brain tumor that is associated with signs of diabetes insipidus. Text Reference - p. 1376
What will be the Glasgow Coma Scale score of a patient who has a moderate type of head injury? 1 3 2 5 3 10 4 14
3 The Glasgow Coma Scale range for patients with a moderate type of head injury is 9 to 12. Therefore, for the patient with a moderate type of head injury, a score of 10 is suitable. A score of 3 or 5 is given for a patient with a severe type of head injury. A score of 14 is given for a patient who has a minor type of head injury. Test-Taking Tip: Avoid looking for an answer pattern or code. There may be times when four or five consecutive questions have the same letter or number for the correct answer. Text Reference - p. 1369
What will the nurse expect if a patient's nasal discharge is positive to a Dextrostix test? 1 The patient has sinusitis. 2 The patient has glaucoma. 3 The patient has allergic rhinitis. 4 The patient has cerebrospinal fluid (CSF) rhinorrhea.
4 A positive Dextrostix test indicates that CSF is leaking from the nose or ear. The fluid from the nose generally leaks due to a cerebrospinal leak and results in CSF rhinorrhea. A Dextrostix test will not give positive results for sinusitis, glaucoma, or allergic rhinitis. Text Reference - p. 1369
Which laboratory finding is consistent with the diagnosis of cerebrospinal fluid (CSF) rhinorrhea? 1 Blood is found in the leaking fluid. 2 Glucose is found in the fluid containing blood. 3 Microorganisms are found in the leaking fluid. 4 Blood is found in the center with a yellowish ring outside.
4 CSF rhinorrhea is assessed by the presence of a halo or ring sign. Coalescence of blood in the center with an outer yellowish ring indicates the leakage of cerebrospinal fluid from the patient's nose. Blood may commonly be found in the leaking fluid due to an injury. Glucose is generally found in blood. Microorganisms can be found in the leaking fluid due to infections. Text Reference - p. 1369
Which condition of the patient with a brain injury causes the nurse to tape the patient's eyes shut after examining the patient? 1 Diplopia 2 Otorrhea 3 Periorbital ecchymosis 4 Loss of the corneal reflex
4 Loss of the corneal reflex may cause abrasion, and taping of the eyes is necessary to protect the eyes. An eye patch is used in patients with diplopia. A loose collection pad is used over the ear in patients with otorrhea. Cold and warm compresses are used in patients with periorbital ecchymosis. Text Reference - p. 1374
The family of a patient who received a traumatic brain injury three days ago asks the assigned nurse: "The health care provider is going to start tube feedings. Why so soon?" The nurse's best response to the family is: A "I will call the health care provider back to explain everything". B "Early feedings will reestablish bowel function". C "Studies have shown that early feedings after brain injury may improve outcomes". D "Intravenous (IV) nutrition is harmful to veins and tissues, so that is why the tube feedings."
Sharing of evidence-based practice with family members will help understanding of the treatment plan. Early feedings after brain injury may improve outcomes if nutritional replacement begins within three days of injury, as a patient with increased intracranial pressure is in a hypermetabolic state, which increases the need for glucose. Suggesting the health care provider come back to explain everything is not addressing the family's concern. Tube (enteral) feedings should be used only when there is a functioning gastrointestinal (GI) system. Intravenous nutrition can be administered safely with appropriate and careful monitoring of IV site to identify early complications. Text Reference - p. 1365
Which diagnostic test would the nurse anticipate to further localize and detect blood flow for a patient with a brain tumor? A Electroencephalogram (EEG) B Angiography C Lumbar puncture D Endocrine studies
b For a patient with brain tumor, angiography can be used to localize the tumor and determine blood flow. EEG helps to detect seizures. Lumbar puncture does not detect the blood flow to the tumor and involves additional risk. Endocrine studies are helpful when a pituitary adenoma is suspected. Text Reference - p. 1377
The nurse notes watery sanguineous drainage from the nares of a patient who is being evaluated after falling from a roof. What is the best method for the nurse to validate suspicion of rhinorrhea? A The halo hest B Gram stain C Use a dextrostix D Slide smear for presence of leukocytes
a The patient may being experiencing rhinorrhea, or leakage of cerebral spinal fluid (CSF) from the nose, which is also sanguineous (bloody). In the presence of blood, the halo test will be the most accurate for determining presence of CSF. A gram stain is used to identify bacterial presence. If blood is present, the dextrostix will not be accurate, because glucose is present in blood. CSF is sterile in the body and, under normal circumstances, does not contain white cells (leukocytes) or bacteria. Text Reference - p. 1369
A patient with a tumor of the frontal lobe is reported to have disorientation and confusion due to perceptual problems. What actions should the nurse perform to comfort the patient? Select all that apply. A Create a routine. B Use reality orientation. C Provide increased stimuli. D Make the patient drive a vehicle. E Minimize environmental stimuli.
a, b, e Creating a routine, using reality orientation, and minimizing environmental stimuli are appropriate actions to comfort the confused patient and to familiarize the confused patient with the environment. Providing increased stimuli and making the patient drive a vehicle are not advisable, because they increase the risks for confusion. Text Reference - p. 1378
A nurse from the adult medical-surgical unit is reassigned for the shift to the neurologic intermediate care unit. An appropriate assignment would include which patient? A A patient just returning from a craniotomy for evacuation of subdural hematoma. B An alert patient with viral encephalitis who has a scheduled dose of intravenous (IV) acyclovir. C An unconscious patient with bacterial meningitis who is needing another lumbar puncture for repeat cultures. D A patient with traumatic brain injury who is being transferred to a rehabilitative facility.
b The nurse from a medical-surgical unit would have the skills to perform an IV piggyback medication, as well as basic neurologic assessment skills. A patient just returning from surgery for a neurologic problem will need a staff member who is experienced with assessment of potential complications. A patient with an altered level of consciousness is more acute then one who is alert. Although the medical-surgical nurse may be familiar with assisting with a lumbar puncture, the fact the patient is unconscious requires a more experienced nurse. A patient being transferred to a rehabilitative facility is more involved, requiring appropriate documentation, nurse-to-nurse report, and instructions to the patient and family, with which the medical-surgical nurse may not be familiar. Text Reference - p. 1384
When planning the care of a patient with a brain tumor, which goals should the nurse select as primary goals? Select all that apply. A Making patient walk B Removing tumor mass C Managing patient's family D Identifying the tumor type and location E Managing increased intracranial pressure (ICP)
b, d, e Removing tumor mass, identifying the tumor type and location, and managing the ICP are the primary goals of treatment of a patient with brain tumor. Assisting the patient with walking and managing the patient's family are not appropriate primary goals. STUDY TIP: Try to decrease your workload and maximize your time by handling items only once. Most of us spend a lot of time picking up things we put down rather than putting them away when we have them in hand. Going straight to the closet with your coat when you come in instead of throwing it on a chair saves you the time of hanging it up later. Discarding junk mail immediately and filing the rest of your bills and mail as they come in rather than creating an ever-growing stack saves time when you need to find something quickly. Filing all items requiring further attention in some fashion helps you remember to take care of things on time rather than being so engrossed in your schoolwork that you forget about them. Many nursing students have had their power or telephone service cut off because the bill simply was forgotten or buried in a pile of old mail. Text Reference - p. 1378
The nurse is providing care for a patient who has been admitted to the hospital with a head injury and who requires regular neurologic and vital sign assessment. Which assessments will be components of the patient's score on the Glasgow Coma Scale (GCS)? Select all that apply. A Judgment B Eye opening C Abstract reasoning D Best verbal response E Best motor response F Cranial nerve function
b, d, e The three dimensions of the GCS are eye opening, best verbal response, and best motor response. Judgment, abstract reasoning, and cranial nerve function are not components of the GCS. Text Reference - p. 1365
When educating the patient about ways to prevent head injuries, which measures should the nurse counsel this patient? Select all that apply. A Use of carpooling B Use of car seat belts C Use of tinted glasses D Use of child car seats E Use of helmets by cyclists
b, d, e Using car seat belts, using child car seats, and using helmets by cyclists can help to prevent head injuries. Use of carpooling and use of tinted glasses do not help to reduce the rate of head injuries. Text Reference - p. 1373
In planning long-term care for a patient after a craniotomy, what must the nurse include when teaching the patient, family, and caregiver? A Seizure disorders may occur in weeks or months. B The family will be unable to cope with role reversals. C There are often residual changes in personality and cognition. D Referrals will be made to eliminate residual deficits from the damage.
c In long-term care planning, the nurse must include the family and caregiver when teaching about potential residual changes in personality, emotions, and cognition, because these changes are most difficult for the patient and family to accept. Seizures may or may not develop. The family and patient may or may not be able to cope with role reversals. Although residual deficits will not be eliminated with referrals, they may be improved. Test-Taking Tip: Answer the question that is asked. Read the situation and the question carefully, looking for key words or phrases. Do not read anything into the question or apply what you did in a similar situation during one of your clinical experiences. Think of each question as being an ideal, yet realistic, situation. Text Reference - p. 1374
A patient with a head injury presents with a loss of corneal reflexes. What action should the nurse take to prevent abrasion? A Use antibiotic eye drops. B Use an eye patch. C Tape the eyes shut. D Apply warm compresses.
c Loss of the corneal reflexes may necessitate taping the eyes shut to prevent abrasion. Using antibiotic eye drops may not help in preventing corneal abrasions; however, lubricating eyedrops can be used. Using an eye patch helps in case of diplopia and applying warm compresses is used at a later stage in case of periorbital ecchymosis and edema. Test-Taking Tip: Multiple-choice questions can be challenging, because students think that they will recognize the right answer when they see it or that the right answer will somehow stand out from the other choices. This is a dangerous misconception. The more carefully the question is constructed, the more each of the choices will seem like the correct response. Text Reference - p. 1374
A patient presents with a headache, which is worse in the morning and is aggravated with movements. The patient states they have vomiting without any preceding nausea. When assessing the patient, which common causes should the nurse consider when suspecting increased intracranial pressure? Select all that apply. A Sinusitis B Glaucoma C Hematoma D Head injury E Brain tumor
c, d, e Common causes of increased intracranial pressure include a mass-like hematoma or tumor and cerebral edema due to brain tumors or hydrocephalus, head injury, or brain inflammation. Sinusitis and glaucoma do not cause an increase in intracranial pressure. Text Reference - p. 1359
A patient with a head injury presents to the emergency department. For which potential complication related to cerebral hemorrhage and edema should the nurse evaluate this patient? A Anxiety B Hyperthermia C Impaired physical mobility D Increased intracranial pressure
d Increased intracranial pressure can occur as a potential complication related to cerebral hemorrhage and edema. Anxiety can result from an abrupt change in health status, being in a hospital environment, and having an uncertain future. Hyperthermia can occur due to increased metabolism, infection, and hypothalamic injury. Impaired physical mobility is related to a decreased level of consciousness. Test-Taking Tip: The most reliable way to ensure that you select the correct response to a multiple-choice question is to recall it. Depend on your learning and memory to furnish the answer to the question. To do this, read the stem, and then stop! Do not look at the response options yet. Try to recall what you know and, based on this, what you would give as the answer. After you have taken a few seconds to do this, then look at all of the choices and select the one that most nearly matches the answer you recalled. It is important that you consider all the choices and not just choose the first option that seems to fit the answer you recall. Remember the distractors. The second choice may look okay, but the fourth choice may be worded in a way that makes it a slightly better choice. If you do not weigh all the choices, you are not maximizing your chances of correctly answering each question. Text Reference - p. 1358
A patient is brought to the emergency room with a head injury and is at risk of developing increased intracranial pressure. Which is the most reliable indicator that the nurse should use for assessing the patient's neurologic status? A Dim vision B Papilledema C Body temperature D Level of consciousness
d The level of consciousness is the most sensitive and reliable indicator of the patient's neurologic status. Dim vision can occur due to dysfunction of cranial nerves. Papilledema, which is an edematous optic disc seen on retinal examination, can be noted and is a nonspecific sign associated with persistent increases in intracranial pressure (ICP). A change in body temperature may also occur because increased ICP affects the hypothalamus. Text Reference - p. 1360
