N332 Final Study: Management of Neurologic Dysfunction

. The five vertebrae most commonly involved in spinal cord injuries are the: _____________________, __________________, ___________________, ____________________, and ___________________ vertebrae.

5th cervical, 6th cervical, and 7th cervical; 12th thoracic and 1st lumbar

Recovery of vital organ functions resulting from spinal shock can take up to: a. 4 months. c. 2 years. b. 12 months. d. 4 years.

a. 4 months

Headaches classified as primary would include all of the following except: a. aneurysm. c. migraine. b. cluster. d. tension

a. aneurysm.

The majority of cases of epilepsy occur in those: a. younger than 20 years of age. c. approximately 45 years of age. b. 25-35 years of age. d. older than 60 years of age.

a. younger than 20 years of age.

The primary, lethal complication of ICP is: _____________________.

brain herniation resulting in death.

Initial compensatory vital sign changes with increased ICP include all of the following except: a. a slow, bounding pulse. c. a decreased temperature. b. an increased systemic blood pressure. d. respiratory rate irregularities.

c. a decreased temperature (VS changes include a slow, bounding pulse, an increased systemic blood pressure, and respiratory rate irregularities).

As ICP rises, the nurse knows that she may be asked to give _____, a commonly used osmotic diuretic. a. glycerin c. mannitol b. isosorbide d. urea

c. mannitol

Long-term use of anti-seizure medication in women leads to an increased incidence of: a. anemia. c. osteoporosis. b. osteoarthritis. d. obesity.

c. osteoporosis.

The leading cause of seizures in the elderly is: _____________________________________________.

cerebrovascular disease.

Comatose patients are mechanically ventilated to control intracranial pressure (ICP). Hypocapnia is a goal that can be achieved with a PaCO2 in the range of: a. 10 to 25 mm Hg. c. 30 to 35 mm Hg. b. 25 to 30 mm Hg. d. 35 to 40 mm Hg.

d. 35 to 40 mm Hg.

Intracranial pressure can be increased by a: a. decrease in venous outflow. c. rise in PaCO2. b. dilation of the cerebral blood vessels. d. change in all of the above.

d. change in all of the above.

The earliest sign of serious impairment of brain circulation related to increasing ICP is: a. a bounding pulse. c. hypertension. b. bradycardia. d. lethargy and stupor.

d. lethargy and stupor.

The most serious brain injury that can develop within the cranial vault is a: _______________________.

hematoma, either epidural, subdural, or intracerebral

A characteristic sign of a basal skull fracture is: _____________________.

leakage of cerebrospinal fluid from the ears and the nose.

A brain injury can cause serious brain damage because:

obstructed blood flow can decrease tissue perfusion, thus causing cellular death and brain damage

List three major potential complications in a patient with a depressed level of consciousness. _____________________, _____________________, and _____________________

pneumonia, aspiration, and respiratory failure

A major potential complication of epilepsy is: ______________________________________________.

status epilepticus.

Complications after traumatic head injuries can be classified according to: _____________________, _____________________, and _____________________.

systemic infections, neurosurgical infections, and heterotrophic ossification

Name three complications of intracranial surgery. _____________________, _____________________, and _____________________

〈 cerebral edema 〈 pain 〈 seizures 〈 increased ICP 〈 change in neurologic status

Three potential complications that may develop in spinal cord injury are: _____________________, _____________________, and _____________________

〈 deep vein thrombosis, orthostatic hypotension, and 〈 autonomic dysreflexia 〈 deep vein thrombosis, orthostatic hypotension, and autonomic dysreflexia

Match 1._____ Assist with daily active or passive range of motion. 2._____ Elevate the head of the bed 30 degrees. 3._____ Institute a bowel-training program. 4._____ Maintain dorsiflexion to affected area. 5._____ Place the patient in a lateral position. Column II a. Footdrop b. Incontinence c. impaired cough reflex d. keratitis e. paralyzed diaphragm f. paralyzed extremity

Column I 1._a & f_ Assist with daily active or passive range of motion. 2._c & e_ Elevate the head of the bed 30 degrees. 3.__b___ Institute a bowel-training program. 4.__a___ Maintain dorsiflexion to affected area. 5.__c___ Place the patient in a lateral position. Column II a. Footdrop b. Incontinence c. impaired cough reflex d. keratitis e. paralyzed diaphragm f. paralyzed extremity

Name the three criteria used to assess level of consciousness using the Glasgow Coma Scale. _____________________, _____________________, and _____________________

eye opening, verbal responses, and motor responses to verbal commands or painful stimuli

Potential collaborative problems for a patient with an altered level of consciousness would include:___________________, ___________________, ___________________, ___________________, and ___________________.

〈 Respiratory distress 〈 Pneumonia 〈 Aspiration 〈 Pressure ulcer 〈 Deep vein thrombosis 〈 Contractures

List six treatment goals for the prompt management of increased ICP. _____________________, _____________________, _____________________, _________________________, _____________________, and _________________________

〈 administer osmotic diuretics and corticosteroids 〈 restrict fluids 〈 drain cerebrospinal fluid 〈 maintain systemic blood pressure 〈 control fever 〈 reduce cellular metabolic demands

List six "triggers" known to cause migraine headaches. _____________________, _____________________, _____________________, _____________________, _____________________, and _____________________

〈 bright lights 〈 stress 〈 depression 〈 sleep deprivation 〈 fatigue 〈 foods containing tyramine, monosodium glutamate or nitrates 〈 aged cheese 〈 oral contraceptives

Identify four signs of a rapidly expanding, acute subdural hematoma that would require immediate surgical intervention. _____________________, _____________________, _____________________, and

〈 coma 〈 hypertension 〈 bradycardia 〈 bradypnea

List four common manifestations of pulmonary embolism. _____________________, _____________________, _____________________, and _____________________

〈 pleuritic chest pain, anxiety, and shortness of breath, 〈 abnormal blood gas values

The earliest sign of increased ICP is: ______________________________________________________.

a change in the level of consciousness (LOC).

Most victims of spinal cord injury are: a. 30 years of age or younger. c. 40 to 50 years of age. b. 30 to 40 years of age. d. 50 years of age or older.

a. 30 years of age or younger.

The earliest sign of serious impairment of brain circulation related to increasing ICP is: a. a bounding pulse. b. bradycardia. c. hypertension. d. lethargy and stupor

a. a bounding pulse.

Respiratory difficulty and paralysis of all four extremities occur with spinal cord injury: a. above C4. c. at C7. b. at C6. d. around C8.

a. above C4

Nursing care activities for a patient with increased ICP would not include: a. assisting the patient with isometric exercises. b. avoiding activities that interfere with venous drainage of blood from the head. c. use of a cervical collar. d. teaching the patient to exhale when being turned (to avoid the Valsalva manoeuvre).

a. assisting the patient with isometric exercises.

A common complication of immobility in a spinal cord injury is: a. pressure ulcers. c. urinary tract infections. b. deep vein thrombosis. d. pneumonia.

b. deep vein thrombosis

A nurse assessing urinary output as an indicator of diabetes insipidus knows that an hourly output of ______________ over 2 hours may be a positive indicator. a. 50-100 mL/hour c. 150-200 mL/hour b. 100-150 mL/hour d. more than 200 mL/hour

d. more than 200 mL/hour

The primary cause of spinal cord injuries is: a. gunshot wounds. c. sports activities. b. industrial accidents. d. motor vehicle crashes.

d. motor vehicle crashes.

Unconsciousness may have a ____ origin a. neurologic b. metabolic c. toxicologic d. multisystem involvement

d. multisystem involvement

List five collaborative problems that a nurse should assess for a patient with a brain injury. _____________________, _____________________, _____________________, _____________________, and_____________________

〈 decreased cerebral perfusion 〈 cerebral edema and herniation 〈 impaired oxygenation and ventilation; 〈 impaired fluid, electrolyte, and nutritional balance; 〈 risk of posttraumatic seizures

After concussion, a patient needs to know to seek medical attention if any of the following six symptoms occur: _____________________, _____________________, _____________________, _____________________, _____________________, and ______________________.

〈 difficulty in awakening 〈 difficulty in speaking 〈 confusion 〈 severe headache 〈 vomiting 〈 weakness on one side of the body.

Five symptoms of postconcussion syndrome are: _____________________, _____________________, _____________________, _____________________, and _____________________.

〈 headache 〈 dizziness 〈 lethargy 〈 irritability 〈 anxiety 〈 emotional lability 〈 fatigue 〈 poor concentration 〈 decreased attention span 〈 memory difficulties 〈 intellectual dysfunction

A nurse assess the patient's level of consciousness using the Glasgow Coma Scale. What score indicates severe impairment of neurologic function? a. 3 c. 9 b. 6 d. 12

a. 3

A seizure characterized by loss of consciousness and tonic spasms of the trunk and extremities, rapidly followed by repetitive generalized clonic jerking, is classified as a: a. focal seizure. c. Jacksonian seizure. b. generalized seizure. d. partial seizure.

b. generalized seizure.

In Canada, the number of new spinal cord injuries each year average approximately: a. 700 cases. c. 2,000 cases. b. 1,050 cases. d. 5,000 cases.

d. 5,000 cases.

Post-traumatic seizures that are classified as late occur more than ____ after the injury. a. 48 hours c. 4 to 6 days b. 72 hours d. 7 days

d. 7 days

To prevent decreased cerebral perfusion after brain injury, the nurse knows that cerebral perfusion pressure must be at a minimum reading of: a. 15 mm Hg. c. 50 mm Hg. b. 30 mm Hg. d. 70 mm Hg.

d. 70 mm Hg.

An indicator of compromised respiratory status significant enough to require mechanical ventilation for an average-weight adult patient with a neurologic dysfunction would be: a. an expiratory reserve volume of 1300 mL. c. a residual volume of 1400 mL. b. an inspiratory capacity of 3000 mL. d. a vital capacity of 1000 mL.

d. a vital capacity of 1000 mL.

Assessing the level of consciousness is an important nursing measure postinjury. Signs of increasing ICP include: a. bradycardia. c. widening pulse pressure. b. increased systolic blood pressure. d. all of the above.

d. all of the above (bradycardia, widening pulse pressure, and increased systolic blood pressure).

An indicator of elevated body temperature in a head-injured patient is: a. cerebral irritation from hemorrhage. c. infection. b. damage to the hypothalamus. d. all of the above.

d. all of the above (cerebral irritation from hemorrhage, infection, and damage to the hypothalamus)

. All of the following statements about the occurrence of head injuries are correct except: a. young males are at great risk. c. motor vehicle crashes are the primary cause. b. the very old are at risk. d. the majority of injuries occur in females.

d. the majority of injuries occur in females.

Irreversible neurologic dysfunction occurs when the cerebral perfusion pressure (CPP) is: a. less than 50 mm Hg. c. 75-95 mm Hg. b. 60-80 mm Hg. d. greater than 100 mm Hg.

a. less than 50 mm Hg.

The normal range of intracranial pressure (ICP) is: a. 5 to 8 mm Hg. c. 20 to 30 mm Hg. b. 10 to 15 mm Hg. d. 25 to 40 mm Hg.

b. 10 to 15 mm Hg.

The Glasgow Coma Scale is used to determine the level of consciousness. A score considered indicative of a coma is: a. 1. c. 5. b. 3. d. 7.

b. 3.

A popular drug used for the prevention of a migraine headache is: a. Cafergot. c. Sansert. b. Inderal. d. Seconal.

b. Inderal (beta-blocking agent).

High doses of this drug have been found to reduce swelling and disability if given within 8 hours of injury. a. Mannitol c. Naloxone b. Methylprednisolone d. Neomycin

b. Methylprednisolone

Orthostatic hypotension is a common problem for spinal cord injuries at the level of: a. C4. c. L4. b. T7. d. S1.

b. T7.

Nursing care for a patient who is experiencing a convulsive seizure includes all of the following except: a. loosening constrictive clothing. b. opening the patient's jaw and inserting a mouth gag. c. positioning the patient on his or her side with head flexed forward. d. providing for privacy.

b. opening the patient's jaw and inserting a mouth gag.

List three primary complications of increased ICP. _____________________, _____________________, and _____________________

brain stem herniation, diabetes insipidus, and syndrome of inappropriate antidiuretic hormone (SIADH)

Cerebral edema and swelling that peaks ____ after the injury is a common cause of increased ICP. a. 12 hours c. 2 to 3 days b. 12 to 24 hours d. 7 days

c. 2 to 3 days

A cerebral hemorrhage located within the brain is classified as: a. an epidural hematoma. c. an intracerebral hematoma. b. an extradural hematoma. d. a subdural hematoma.

c. an intracerebral hematoma.

Spinal cord injury can be classified according to the area of spinal cord damage. Motor deficits in the upper rather than the lower extremities, usually due to edema in the cervical area, is classified as __________ syndrome. a. anterior cord c. central cord b. Brown-Sequard d. peripheral

c. central cord

Neurologic and neurosurgical approaches to pain relief would include: a. stimulation procedures. c. interruption of nerve tracts that conduct pain. b. administration of intraspinal opiates. d. all of the above mechanisms.

d. all of the above mechanisms (stimulation procedures, interruption of nerve tracts that conduct pain, and administration of intraspinal opiates).

The first priority of treatment for a patient with altered level of consciousness is: a. assessment of pupillary light reflexes. b. determination of the cause. c. positioning to prevent complications. d. maintenance of a patent airway.

d. maintenance of a patent airway.

Loss of autonomic nervous system function below the level of the lesion causes _______shock. a. cardiac c. septic b. hypovolemic d. neurogenic

d. neurogenic

A nurse knows that a patient experiencing Cushing's triad would not exhibit: a. bradycardia. c. hypertension. b. bradypnea. d. tachycardia.

d. tachycardia (would exhibit the triad of bradycardia, hypertension, and bradypnea).

Postcraniotomy cerebral edema is at a maximum ____ after brain surgery. a. 6 hours c. 24 to 72 hours b. 12 to 20 hours d. 3 to 5 days

c. 24 to 72 hours