neuro 1

*22.* what kinds of recommendations you could make in educating your client on migraines

(1) avoidance of factors that trigger headaches (2) relaxation techniques, including biofeedback (3) maintenance of regular sleep patterns (4) medications to be used (including dosage, actions, and side effects) (5) the importance of follow-up care AHN 667

*51.* ICU for ICP, which diuretic will the doctor prescribe

*Mannitol (Osmitrol)* -hyperosmotic agent that increase intravascular pressure by drawing fluid from the interstitial spaces and from the brain cells -monitor renal function -diuresis is expected NCLEX 802 *osmotic diuretics* -begins to reduce increased ICP within 15 minutes -effects last for 5 to 6 hours *loop diuretics* furosemide (Lasix) bumetanide (Bumex) ethacrynic acid (Edecrin) *continuous infusions* midazolam (Versed) besylate (Tracrium) AHN 671

*29.* know what the therapeutic drug range for dilantin is

*Phenytoin (Dilantin)* 10-20 mcg/mL NCLEX 827

*18.* which cranial nerve would be affected if patient is having difficulty chewing and clenching his jaw

*V: trigeminal* sensations of face, scalp, and teeth chewing movements *spelling* AHN 657

*11.* patient that has ICP, what are one of the characteristic signs that there is a change in the patient's status

*altered LOC* most sensitive and earliest indication of increasing ICP NCLEX 801 *change in LOC* which is the earliest sign on increased ICP AHN 669

*50.* what ALS is

*amyotrophic lateral sclerosis* -loss of both upper and lower motoneurons is the major pathologic change -rare, progressive neurologic disease -usually leads to death in 2 to 6 years -onset is between 40 and 70 years of age -two times as many men as women are affected -motoneurons in the brainstem and spinal cord gradually degenerate -dead motoneuron cannot produce or transport VS to muscle -electrical and chemical messages originating in the brain do not reach the muscles to activate them -no cure AHN 693 1. lou gehrig's disease 2. progressive degenerative disease involving the motor system 3. the sensory and autonomic systems are not involved, and mental status changes do not result from the disease 4. the cause of the disease may be related to an exalting messages between the motor neurons 5. as the disease progresses, muscle weakness an atrophy develop until a flaccid quadriplegia develops 6. eventually the respiratory muscles become affected, leading to respiratory compromise, pneumonia, and death 7. no cure is known, and the treatment is symptomatic NCLEX 817

*37.* which medications are used to treat status epilectus seizures

*antiseizure drugs* phenytoin sodium (Dilantin) divalproex (Depakote) oxcarbazepine (Trileptal) phenobarbital (Luminal) primidoen (Mysoline) Ethosuximide (Zarontin) trimethadione (Tridiond) diazepam (Valium) carbamazepine (Tegretol) valproic acid (Depakene) clonazepam (Klonopin) mephenytoin (Mesantoin) gabapentin (Neurontin) lamotrigine (Lamictal) felbamate (Felbatol) fosphenytoin sodium (Cerebyx) topiramate (Topamax) tiagabine (Gabitril levetiracetam (Keppra) zonisamide (Zonegran) AHN 679 *anticonvulsant medication* *hydantoins* -treat partial and generalized tonic-clonic seizures -phenytoin also is used to treat dysrhythmias ethotoin (Peganone) fosphenytoin (Cerebyx) phenytoin (Dilantin) *barbiturates* -tonic-clonic seizures and acute episodes caused by status epileptics -also used as adjuncts to anesthesia amobarbital (Amytal) mephobarbital (Mebaral) phenobarbital (Luminal) *benzodiazepines* -treat absence seizures -diazepam and lorazepam treat status epileptics, anxiety and skeletal muscle spasms -clorazepate used as adjunctive therapy for partial seizures clonazepam (Klonopin) clorazepate (Tranxene) diazepam (Valium) lorazepam (Ativan) Zolpiden (Ambien) *succinimides* -treat absence seizures ethosuximide (Zarontin) methsuximide (Celontin) *oxazolidinedione* -absence seizures trimethadione (Troxidone) *valproates* -tonic-clonic, partial, myoclonic, and psychomotor seizures valproic acid (Depakene, Depacon) devalproex sodium (depakote ER) *iminostilbenes* -treat seizure disorders that have not responded to other antivonculsants -trigeminal neuralgia carbamazepine (Tegretol gabapentin (Neurontin) lamotrigine (Lamictal) levetiracetam (Keppra) oxcarbazepine (Trileptal) pregabalin (Lyrica) tiagabine (Gabitril Filmtab) topiramate (Topamax) zonisamide (Zonegran) vigabatrin (Sabril) NCLEX 827

*47.* medical term for slowness of voluntary movements and speech

*bradykinesia* slowing down in the initiation and execution of movement AHN 683 abnormal slowness of movement, and sluggishness of physical and mental responses *spelling* NCLEX 815

abnormal respirations

*cheyne-stokes* -rhythmic with periods of apnea -can indicate a metabolic dysfunction or dysfunction in the cerebral hemisphere or basal ganglia *neurogenic hyperventilation* -regular rapid and deep sustained respirations -indicates a dysfunciton in the middle or caudal pons *apneustic* -irregular respirations with pauses at the end of inspiration and expiration -indicates a dysfunction in the middle or caudal pons *ataxic* *cluster* -clusters of breaths with irregularly spaced pauses -indicates a dysfunction in the medulla and pons NCLEX 799

myasthenic crisis

*description* 1. acute exacerbation of the disease 2. caused by a rapid, unrecognized progression of the disease; an inadequate amount of medication; infection; fatigue; or stress *data collection* 1. increased pulse, respirations, and BP 2. respiratory distress and cyanosis 3. bowel and bladder incontinence 4. decreased urine output 5. absent cough and swallow reflex *interventions* 1. assess for signs of myasthenia crisis 2. increase anti cholinesterase medication, as prescribed NCLEX 815

cholinergic crisis

*description* 1. results in depolarization of the motor end plates 2. caused by overmedication with anticholinsterase *data collection* 1. abdominal cramps 2. nausea, vomiting, and diarrhea 3. blurred vision 4. pallor 5. facial muscle twitching 6. hypotension 7. pupillary miosis *interventions* 1. hold anticholinesterase medication 2. prepare to administer the antidote, atropine sulfate, if prescribed NCLEX 815

*4b.* aphasia

*expressive* 1. damage occurs in Broca's area of the frontal brain 2. the client understands what is said but is unable to communicate verbally *receptive* 1. the injury involves Wernicke's area in the temporoparietal area 2. the client is unable to understand the spoken and often the written work *global and mixed* language dysfunction occurs in expression and reception NCLEX 813 abnormal neurologic condition in which the language function is defective or absent because of an injury to certain areas of the cerebral cortex -Broca's area in the frontal love -Wernicke's area in the posterior part of the temporal lobe *sensory or receptive* -inability to comprehend the spoken work or written work -Wernicke's area is associated with language comprehension -pathologic conditions in this area result in receptive aphasia *motor* -inability to use symbols of speech (expressive) -Broca's area mediates motor speech -pathologic conditions in the area result in expression aphasia *global* -inability to understand the spoken world or to speak -pathologic conditions in Broca's and Wernicke's areas result in global aphasia AHN 659

*44.* what would be your nursing priority if you walked into a room and they were having a seizure

*if the client is having a seizure, maintain a patent airway; do not force the jaws open or place anything in the client's mouth* 1. note the time and duration of the seizure 2. assess behavior at the onset of the seizure; note if the client experienced an aura, a change in facial expression occurred, or a sound or cry occurred form the client 3. if the client is standing, place him or her on the floor and protect the head and body 4. support the ABCs-airway breathing, and circulation 5. administer oxygen 6. prepare to suction secretions from the airway 7. turn the client to the side, to allow secretions to drain, while maintaining the airway 8. prevent injury during the seizure 9. remain with the client 10. do not restrain the client 11. loosen restrictive clothing 12. note the type, character, and progression of the movements during the seizure 13. monitor for incontinence 14. administer IV medications as prescribed to stop the seizure 15. document the characteristics of the seizure 16. provide privacy, if possible 17. monitor behavior after the seizure, such as the state of consciousness, motor ability, and speech ability NCLEX 811 -protection from aspiration and injury -observation and recording of the seizure activity; what preceded, when occurred, length of each phase; what occurred in each phase -never leave patient alone -if sitting or standing, lower him or her to the floor in an area away from furniture and equipment -support and protect the head; if possible turn the head to the side to maintain airway -if there is time, loosen clothing around the neck -do not try to restrain -do not pry open the jaw to place a padded tongue blade -no objects should be placed in the mouth AHN 679

*36.* s/s of a jacksonian seizure

*incidence* occur almost entirely in patients with structural brain disease *characteristics* -depends on site of focus -may or may not be progressive *clinical signs* -commonly begin in hand, foot, or face -may end in tonic-clonic seizure *aura* yes numbness tingling crawling feeling *postictal period* yes AHN 677

*38.* what drug is approved for moderate to severe Alzheimer's

*memantine (Namenda)* 1. an NMDA (N-methyl-D-aspartate) receptor antagonist is indicated for moderate to severe Alzheimer's disease 2. side effects include dizziness, headache, confusion, and constipation 3. should not be used in combination with other NMDA antagonists such as amantadine (Wymmetrel) or ketmine (Ketalar); such combinations produce undesirable additive effects 4. sodium bicarbonate and other medications that alkalinize the urine can decrease renal excretion of memantine; accumulation to toxic levels can result NCLEX 960 *memantine (Namenda)* -is the first drug approved for the treatment of moderate to severe AD -does not prevent or slow neurodegeneration, but it was found in clinical studies to slow symptom progression AHN 689

*32.* one of the quickest way you can assess a client's mental status

*mental status* orientation (person, place, time and purpose) mood and behavior general knowledge (names of presidents) short and long-term memory attention span ability to concentrate *neurologic status* LOC is the earliest and most sensitive indicator AHN 658

*23.* know what MS is

*multiple sclerosis* -chronic, progressive, degenerative neurologic disease that affects many people -cause is unknown, although genetics have been implicated, since there is a higher rate of the disease among relatives -patients with first s/s of MS have a proliferation of a certain type of immune cell called gamma delta T cells in their spinal fluid (not found in patients who have had the disease for a long time) -T cells usually defend the body from outside attackers -In MS something goes wrong and induces the T cells to attack the body -Myelin damage occurs AHN 680 1. chronic, progressive, noncontagious, degenerative disease of the CNS characterized by demyelinization of the neurons 2. usually occurs between the ages of 20 and 40 and consists of periods of remissions and exacerbations 3. causes are unknown, but the diseases thought to be a result of an autoimmune response or viral infection 4. precipitating factors include pregnancy, fatigue, stress, infection, and trauma 5. EEG findings are abnormal 6. a lumbar puncture indicates increased gamma-globulin, but the serum globulin level is normal AHN 814

*28.* term that means slight paralysis or incomplete muscle power (typically seen in one limb)

*paresis* a lesser degree of movement deficit form partial or incomplete paralysis AHN 660

*2.* patient with ICP, what is the best position to put them into

-elevate the head of the bed to 30 to 45 degrees to promote venous return -place the neck in a neutral position (not flexed or extended) to promote venous drainage -positions the patient to avoid flexion of the hips, the waist, and the neck and rotation of the head, especially to the right -avoid extreme hip flexion because this position causes an increase in intraabdominal and intrathoracic pressures, which can produce a rise in ICP AHN 671 -for the client with increased ICP, elevate the head of the bed 30 to 40 degrees -avoid the Trendelenburg's position -prevent flexion of the neck and hips NCLEX 802

*19.* patient with ICP given osmotic diuretic, what is the action of this medication

-osmotic diuretic also called hyperosmolar drugs -draw water from the edematous brain tissue AHN 671 -Mannitol is a hyper osmotic agent the increases intravascular pressure by drawing fluid from the interstitial spaces and from the brain cells NCLEX 802

*6.* know what position your patient should be in for a lumbar puncture or a lumbar tap

-position the client in a lateral recumbent position and have the client draw the knees up to the abdomen and the chin onto the chest -the prone position may be required for radiologically guided punctures NCLEX 798 -the patient is usually positioned on the side with the knee and head flexed at an acute angle -this allows for maximal lumbar lexicon and separation of the interspinous spaces AHN 661

*33.* know what the Glasgow coma scale is

*score* 15: highest possible score *motor response points* 6: obeys a simple response 5: localizes painful stimuli 4: normal flexion (withdrawal) 3: abnormal flexion (decorticate) 2: extensor response (decerebrate) 1: no motor response to pain *verbal response points* 5: oriented 4: confused conversation 3: inappropriate words 2: responds with incomprehensible sounds 1: no verbal response *eye-opening points* 4: spontaneous 3: in response to sound 2: in response to pain 1: no response even to painful stimuli NCLEX 801 *eyes open* approach to bedside verbal command pain 4: spontaneous response 3: opening of eyes to name or common 2: lack of opening of eyes to previous stimuli but opening to pain 1: lack of opening of eyes to any stimulus U: untestable *best verbal response* verbal questioning with maximum arousal 5: appropriate orientation, conversant; correct identification of self, place, year, and mouth 4: confusion; conversant, but disorientation in one or more spheres 3: inappropriate or disorganized use of words (e.g., cursing), lack of sustained conversation 2: incomprehensible words, sounds (e.g., moaning) 1: lack of sound, even with painful stimuli U: untestable *best motor response* verbal command (e.g., "raise your arm, hold up two finger") pain (pressure on proximal nailbed) 6: obedience of command 5: localization of pain, lack of obedience but presence of attempts to remove offending stimulus 4: flexion withdrawal, flexion of arm in response to pain without abnormal flexion posture 3: abnormal flexion, flexing of arm at elbow and pronation, making a fist 2: abnormal extension, extension of arm at elbow usually adduction and internal rotation of arm at shoulder 1: lack or response U: untestable AHN 659

*42.* dilantin, know what the symptoms of an adverse reaction are

*toxic effects* ataxia vomiting nystagmus drowsiness rash fever gum hypertrophy lymphadenopathy AHN 679

*15.* the typical medications for migraine control

-*Acetylsalicylic acid (aspirin)* or *acetaminophen* may help relieve mild or moderate migraine pain -for moderate to severe headaches, the *triptans* have become the first line of the therapy AHN 666

*27.* know the s/s of Huntington's disease (Huntington's chorea)

-abnormal and excessive involuntary movements (chorea) -writhing, twisting movements of the face, limbs, and body -facial movements involving speech, chewing, and swallowing are affected and may cause aspiration and malnutrition -gait deteriorates -ambulation eventually becomes impossible -deterioration of menial functions -intellectual decline -emotional lability -psychotic behavior AHN 694

*15a.* triptans

-act on receptors in the extra cerebral, intracranial vessels that become dilated ruing a migraine attack -stimulating these receptors constricts cranial vessels, inhibits neuropeptide release, and reduces nerve impulse transmission along trigeminal pain pathways eletriptan (Replax) almotriptan (Axert) frovatriptan (Frova) naratriptan (Amerge) rizatriptan (Maxalt) sumatriptan (Imitrex) zolmitriptan (Zomig) -classified as selective serotonin receptor agonists -indicated to treat acute migraine -in addition to relieving headache pain, the puritans also relieve the nausea, vomiting, and photophobia associated with acute migraine attack AHN 666

*21b.* decerebrate

-all four extremities in rigid extension with hyperpronation of forearms and plantar extension of feet AHN 670 *extensor* -the client stiffly extends one or both arms and possible the legs -indicates a brainstem lesion NCLEX 800

*40.* which diagnostic test is used to diagnose MG

-basis of history and physical examination -have patient look upward for 2 to 3 minutes (if MG, eyelids will droop so that person can barely keep the eyes open) -can be made partly on the basis of EMG -IV antisholinesterase test is a reliable diagnostic test (muscle funciton improves dramatically) -serum testing for antibodies to acetylcholine receptors (present in 80% to 90% of patients) AHN 692

*1.* patient going to have a myelogram, what nursing actions do you need to take to get them ready for that

-before the procedure assess and document the patient's baselines of lower-extremity strength and sensation -tell the patient that the procedure takes about 2 hours -it may involve slight discomfort as the dura is entered -he or she may be asked to assume a variety of positions during the procedure -before the dye is injected, ask patients whether they have any allergies, specifically whether they have had any anaphylactic or hypotensive episodes from other dyes AHN 664 assess the need to withhold metformin (Glucophage) if iodinated contrast dye is used for a diagnostic procedure because of the risk for metformin-induced lactic acidosis NCLEX 798

absence seizure

-brief seizure lasts seconds, and the individual may or may not lose consciousness -no loss of change in muscle tone occurs -seizures amy occur several times during a day -the victim appears to be daydreaming -this type of seizure is more common in children NCLEX 811

myelogram

-commonly used to identify lesions in the intramural or extradural compartments of the spinal canal by observing the flow of radiopaque dye through the subarachnoid space -the most common lesion for which this test is used is a herniated or protruding intervertebral disk -other lesions include spinal tumors, adhesions, bony deformations, and arteriovenous malformations AHN 664

*13.* know what dysarthria

-difficult, poorly articulated speech that usually results from interference in control over the muscles of speech -general cause is damage to a central or peripheral nerve AHN 659

*7.* what nursing action would be appropriate right after receiving a myelogram

-observe the puncture site for any leakage of CSF -assess the strength and sensation of the lower extremities -headache is fairly common -it may be accompanied by nausea and occasionally by vomiting -the patient should be flat for a few hours -the patient usually undergoes a CT scan 4 to 6 hours after a myelogram AHN 664

*48.* what kind of patient teaching would you give a client who just found out they have MS, in regards to activity

-exercise regularly, but not to the point of fatigue -physical therapy sometimes improves neurologic dysfunction -exercise also helps daily functioning for patients not experiencing an exacerbation -exercise decreases spasticity, increases coordination, and retrains unaffected muscles to substitute for impaired ones -water exercise is an especially beneficial type of physical therapy; because buoyancy water gives to the body, the patient has more control over the body and is able to perform activities that would be impossible on land -daily rest periods may be helpful -during acute exacerbation, patients are often kept as quiet as possible; this includes bed rest -one side of the body is often more affected; must learn to stabilize the gait by leaning toward the less-involved side -if foot slaps, teach to put the foot down in a pronounced fashion and roll the weight forward on the side of the foot AHN 682 1. provide bed rest during exacerbation 2. establish a regular exercise and rest program 3. balance moderate activity with rest periods 4. assess the need for and provide assistive devices 5. initiate physical therapy 6. avoid fatigue, stress, infection, overheating, and chilling 7. safety measures r/t motor loss, avoiding the use of scatter rugs and using assistive devices NCLEX 814

*21a.* decorticate

-flexion of arms, wrists, and fingers with adduction in upper extremities -extension, internal rotation, and plantar flexion in lower extremities AHN 670 *flexor* -the client flexes one or both arms on the chest and may extend the legs stiffly -indicates a nonfunctioning cortex NCLEX 800

*14.* patient presents with a history of migraines, what subjective data should you be able to obtain from their history or during the exam

-knowledge of patient's perception of the effect of stress on the pain is important in planning effective interventions -patient's understanding of the headache -possible causes -any precipitating factors -what measures relieve the symptoms -location, frequency, pattern, and character of the pain -site of return of the headache, time of day, and intervals between headaches -initial onset of the headache -any symptoms that occur before the headache -associated symptoms -presence of allergies -any family history or similar headache patterns AHN 665

*12.* patient who's neuro status is changing rapidly after a craniotomy, what are some of the goals the nurse can establish to prevent that from getting any worse

-maintain mechanical ventilation and slight hyperventilation for the first 24 to 48 hours as prescribed to prevent increased ICP -check the HCP's prescriptions regarding client posturing -avoid extreme hip or neck flexion, and maintain the head in a midline neutral position NCLEX 805

*35.* s/s of a generalized tonic clonic seizure

-may begin with an aura -*tonic phase* involves the stiffening or rigidity of the muscles of the arms and legs and usually lasts 10 to 20 seconds, followed by loss of consciousness -*clonic phase* consists of hyperventilation and jerking of the extremities and usually lasts about 30 seconds -full recovery from the seizure may take several hours NCLEX 811 *incidence* most common *characteristics* -generalized -characterized by loss of consciousness and falling to the floor or ground is patient is upright -followed by stiffening of the body *(tonic phase)* for 10-20 seconds -subsequent jerking of the extremities *(clonic phase)* for another 30-40 seconds *clinical signs* -aura -cry -loss of consciousness -fall -tonic-clonic movements -incontinence, cyanosis, excessive salivation, tongue or cheek biting *aura* yes flashing lights smells spots before eyes (scotomata) vertigo *postictal period* -yes -need for 1-2 hours sleep -headache, muscle soreness commonly felt -may not feel normal for several hours of days after a seizure -no memory of a seizure AHN 677

*10.* taking care of a patient that is post op craniotomy, what data would you need to report to the doctor

-monitor VS and neurological status every 30 minutes to 1 hour -monitor for *increased ICP* -monitor for decreased LOC, motor weakness or paralysis, aphasia, visual changes and personality changes -maintain mechanical ventilation and slight hyperventilation for the first 24 to 48 hours as prescribed to prevent increased ICP -check the HCP's prescriptions regarding client posturing -avoid extreme hip or neck flexion, and maintain the head in a midline neutral position -provide a quiet environment -monitor the head dressing frequently for signs of drainage -mark any area of drainage at least once each nursing shift for baseline comparison -monitor the hemovac of jackson-pratt drain, which may be in place for 24 hours -monitor suction on the hemovac of jackson-pratt drain -measure drainage from the hemovac of jackson-pratt drain every 8 hours, and record the amount and color -*notify the HCP if drainage is greater than the normal of 30 to 50 mL per shift* -*notify the HCP immediately of excessive amounts of drainage or a saturated head dressing* -provide basic hygiene -record strict measurement of hourly intake and output -maintain fluid restriction at 1500 mL/day as prescribed -monitor electrolyte values -monitor for dysrhythmias, which may occur as a result of fluid and *electrolyte imbalance* -apply ice packs or cool compresses as prescribed; expect periorbital edema and ecchymosis of one or both eyes which is not an unusual occurrence -turn and position every 2 hours and provide ROM exercises every 8 hours -prevent development of DVT and place anti embolism stockings on the client as prescribed -administer analgesics such as codeine sulfate and acetaminophen (Tylenol) as prescribed for pain NCLEX 805 the patient may have residual motor or sensory problems as a result of the tumor or surgery AHN 708

*9.* what kinds of nursing interactions would you give to a patient who's scheduled for a CT of the head

-no special physical preparations is required for the test -a CT scan takes 20 to 30 minutes if done without contrast medium and about 60 minutes with contrast -this procedure is painless, except for the slight discomfort when an IV line is started for the injection of the contrast dye -the patient may also have some discomfort in lying still and possible feelings of claustrophobia from being positioned in the head holder -if contrast medium is used, document and report to the physician any history of allergy to iodine and seafood, since iodine is present in the contrast medium AHN 662 1. obtain an informed consent if a dye is used 2. assess for allergies to iodine, contrast dyes, or shellfish if a dye is used 3. instruct the client on the need to lie still and flat during the test 4. instruct the client to hold his or her breath when requested 5. initiate an IV line if prescribed 6. remove objects from the head, such as wigs, barrettes, earrings, and hairpins 7. inform the client that there may be a hot, flushed sensation and a metallic taste in the mouth when the dye is injected 8. note that some clients may be given the dye even if they report an allergy and are treated with an antihistamine and corticosteroids before the injection to reduce the severity of a reaction NCLEX 798

craniotomy positioning

-positions prescribed after craniotomy vary with the type of surgery and the specific postoperative HCP's prescriptions -always check the HCP's prescriptions regarding client positioning -incorrect positioning may cause serious and possible fatal complications *removal of a bone flap for decompression* to facilitate brain expansion, the client should be turned from the back to the nonoperative side, but not to the side of the operation *posterior fossa surgery* to protect the operative site from pressure and to minimize tension on the suture line, position the client on the side, with a pillow under the head for support and not on the back *infratentorial surgery* -infratentorial surgery involves surgery below the tentorium of the brain -the HCP may prescribe a flat position without head elevation or may prescribe the head of the bed to be elevated at 30 to 45 degrees -do not elevate the head of the bed in the acute phase of care after surgery without a HCP's prescription *supratentorial surgery* -supratentorial surgery involves surgery above the tentorium of the brain -the HCP may prescribe the head of the bed to be elevated at 30 degrees to promote venous outflow through the jugular veins -do not lower the head of the bed in the acute phase of care after surgery without a HCP's prescription NCLEX 805

lumbar puncture preparation

-procedure takes 10 to 15 minutes -light pain and pressure may be felt as the dura is entered -a sharp, shooting pain down one leg may be caused by the needle coming close to a nerve -put into position (see 6) -after anesthetizing the area with a local anesthetic, the physician inserts the needle below the level of the spinal cord, at the L4-L5 or L5-S1 interspace AHN 661

*31.* know what the medical and nursing care would be for someone with myasthenia gravis

-respiratory problems typically occur in patients with MG (aspiration precautions) -upper respiratory tract infections (seek medical attention at first sign) -assess the need for respiratory assistance -teach airway protective techniques during swallowing (chin tuck, double swallow) -suction as needed -feeding tube may be necessary -plan so that minimal energy is used in activities that are essential to remaining relatively self-sufficient -ROM -administer medications (at time prescribed and taking it early enough before eating or engaging in activities to obtain maximum relief) -avoid crowds in flu and cold season AHN 692 1. monitor respiratory status and ability to cough and deep breathe adequately 2. monitor for respiratory failure 3. maintain suctioning and emergency equipment at the bedside 4. monitor the VS 5. monitor speech and swallowing abilities to prevent aspiration 6. encourage the client to sit up when eating 7. assess muscle status 8. instruct the client to conserve strength 9. plan short activities that coincide with times of maximal muscle strength 10. monitor for myastenic and cholinergic crises 11. administer anticholinesterase medications as prescribed 12. instruct the client to avoid stress, infection, fatigue, and OTC medications 13. instruct the client to wear a Medic-Alert bracelet 14. inform the client about services from the Myasthenia Gravis Foundation NCLEX 815

*5.* know what the late symptoms are for ICP

-rise in systolic pressure and an unchanged diastolic pressure -widening pulse pressure -bradycardia -dilating pupils that respond slowly to light are a sign of impending herniation -abnormal respiration -Cushing's response (widened pulse pressure, increased systolic BP, and bradycardia) -hyperthermia AHN 669 9. late signs of increased ICP, including increased systolic BP, widened pulse pressure, and slowed heart rate 10. other late signs include changes in motor function from weakness to hemiplegia, a positive Babinski's reflex, decorticate or decerebrate posturing, and seizures. NCLEX 801

*41.* know what the adverse reactions are for levodopa

-taken with a monoamine oxidase inhibitor antidepressant can cause a hypertensive crisis -avoid excessive vitamin B6 intake to prevent medication reactions NCLEX 825

*17.* patient scheduled for electroencephalogram, what instructions would you give that patient

-the test requires no special preparation, but encourage the patient to be quiet and rest before the procedure -an exception is a sleep-deprived EEG, where the patient is kept awake the night before the test and the EEG is usually done first thing in the morning -usually takes about 1 hour to complete -patient's hair and scalp should be clean -electrodes are placed on the scalp with collodion in a set pattern to cover all scalp areas -painless AHN 663 1. wash the client's hair 2. inform the client that electrodes are attached to the head and that electricity does not enter the head 3. withhold stimulants, such as coffee, tea, and caffeine beverages; antidepressants; tranquilizers; and possible anticonvulsants for 24 to 48 hours before the test as prescribed 4. allow the client to have breakfast if prescribed 5. premedicate for sedation as prescribed NCLEX 799

migraine prevention meds

-topiramate (Topamax), taken daily, has been shown to be an effective therapy for migraine prevention in adults -beta-adrengergic blockers (e.g., propranolol [Inderal], atenolol [Tenormin]) -tricyclic antidepressants (e.g., amitriptylin [Elavil]) -selective serotonin reuptake inhibitors (e.g., fluoxetine [Prozac]) -calcium channel blockers (e.g., verapamil [Isoptin]) -divalproex (Depakote) -clonidine (Catapres) -thiazides AHN 666

*24.* what kind of objective data do you see with the patient that has parkinson's

-tremor (outstanding sign of the disease) -bradykinesia (with rigidity and loss of postural reflex) -masklike appearance of the face (from rigidity) -slowed, monotonous speech -drooling -dysphagia (common late complication) -constipation -scaly , erythematous rash (particularly near the ears and eyebrows and in the scalp and nasolabial folds) -moist, oily skin -postural hypotension AHN 685 1. bradykinesia 2. akinesia 3. monotonous speech 4. handwriting that becomes progressively smaller 5. tremors in hands and fingers at rest (pill rolling) 6. tremors increasing when fatigued and decreasing with purposeful activity or sleep 7. rigidity with jerky movements 8. restlessness and pacing 9. blank facial expression, masklike faces 10. drooling 11. difficulty swallowing and speaking 12. loss of coordination and balance 13. shuffling steps, stooped position, and propulsive gait NCLEX 816

*43.* patient with seizure disorder, what way do you need to do your vital signs

1. *objective data* include assessment of cranial nerves, LOC, pupils, motor function, cerebellar function, coordination, sensory function, and reflexes 2. *vital signs* check temperature, pulse, respirations, and BP; monitor for BP or pulse changes, which many indicate increased ICP 3. cranial nerves 4. LOC 5. pupils 6. motor function 7. cerebellar function 8. coordination 9 sensory function 10. deep tendon reflexes 11. plantar reflex NCLEX 343

craniotomy

1. a surgical procedure that involves an incision throughout eh cranium to remove accumulated blood or a tumor 2. complications of the procedure include increased ICP from cerebral edema, hemorrhage, or obstruction of normal flow of CSF 3. additional complications include hematomas, hypovolemic shock, hydrocephalus, respiratory and neurogenic complications, pulmonary edema, and wound infection 4. complications related to fluid and electrolyte imbalances include diabetes insipid us and inappropriate secretion of antidiuretic hormone NCLEX 804

*3.* know what the s/s of ICP are

1. altered LOC, which is the most sensitive and earliest indication of increasing ICP 2. headache 3. abnormal respirations 4. rise in BP with widening pulse pressure 5. slowing of pulse 6. elevated temperature 7. vomiting 8. pupil changes NCLEX 801 *subjective* -visual changes (diplopia) -change in personality -change in ability to think -nausea or pain -headache (increases in intensity with coughing, straining at stool, or stoping; present in the early morning) *objective* -change in LOC (earliest sign; disorientation, restlessness, and lethargy) -pupillary changes (reacts sluggishly) -increase BP -slowing pulse -widened pulse pressure -muscle weakness -Babinski's relfex -hyperreflexia -rigidity -seizures -vomiting (unexpected) -singultus (hiccups) -pailledema (choked disk) AHN 669

*52.* patient with ALS, which symptoms would you need to report to the doctor immediately

1. care is directed toward the treatment of symptoms 2. monitor the respiratory status 3. provide respiratory treatments 4. prepare to initiate respiratory support 5. assess for complications of immobility 6. provide the client and family with support NCLEX 817

craniotomy preoperative

1. explain the procedure to the client and family 2. ensure that an informed consent has been obtained 3. prepare to shave the client's head as prescribed (usually done in the operating room) and cover the head with appropriate covering 4. stabilize the client before surgery NCLEX 804

lumbar puncture

1. insert a spinal needle through the L3-L4 interspace into the lumbar subarachnoid space to check for CNS fluid or decrease pressure, or instill air, dye, or administer medications 2. the test is contraindicated in clients with ICP because the procedure will cause a rapid decrease in pressure within the CSF around the spinal cord, leading to brain herniation 3. may also be used in the treatment for idiopathic intracranial hypertension NCLEX 798 -often performed as part of the diagnostic workup of the patient who may have a neurologic problem -contraindicated in patients who might have increased ICP, since the withdrawal of fluid may cause the medulla oblongata to herniate downward into the foramen magnum -done to obtain CSF for examination, to relieve pressure, or to introduce dye or medication -common procedure, done in the patient's room or in the diagnostic imaging department AHN 661

*8.* just received a patient right after a lumbar patient, what observation would cause you concern where you might have to call the doctor

1. monitor VS, headache, and neurological signs that may indicate leakage of CSF; monitor injection site for leakage of CSF 2. position the client flat as prescribed 3. encourage fluids to replace CSF obtained from the specimen collection or from leakage 4. monitor I&O NCLEX 798 -after the procedure the patient lies flat in bed for several hours -assess the site of the puncture for any leakage, as evidenced by moisture on the bandage or around the puncture site -headache is fairly common and is thought to be caused by the loss of spinal fluid through the dura mater -it the headache develops, bed rest, analgesics, and ice to the head may help -opioids are usually not helpful AHN 662

*20.* what nursing interventions apply to a patient that has ICP

1. monitor respiratory status and prevent hypoxia 2. avoid the administration of morphine sulfate to prevent the occurrence of hypoxia 3. maintain mechanical ventilation as prescribed; maintaining the Paco2 at 30 to 35 mm Hg will result in vasoconstriction of the cerebral blood vessels, decreased blood flow, and therefore decreased ICP 4. maintain body temperature 5. prevent shivering which can increase ICP 6. decrease environmental stimuli 7. monitor electrolyte levels and acid-base balance 8. monitor intake and output 9. limit fluid intake to 1200 mL/day 10. instruct the client to avoid straining activities, such as coughing and sneezing 11. instruct the client to avoid Valsalva's maneuver NCLEX 801 -position -instruct the patient to avoid isometric or resistive exercises -restrict fluid intake -implement measures to help the patient avoid the Valsalva maneuver (any forced expiratory effort against a closed airway, such as straining to have a stool); avoid enemas and laxatives if possible -have a foley catheter in place if the patient is not alert because of the large amount of urine that is produced -perform suctioning only as necessary and for no longer than 10 seconds with administration of 100% oxygen before and after to prevent decreases in the Paco2 -administer oxygen via mask or cannula to improve cerebral perfusion -use a hypothermia blanket to control body temperature (increased body temperature increases brain damage) AHN 671

*45.* know what the appropriate nursing care is for a patient with MS

1. provide bed rest during exacerbation 2. protect the client from injury by providing safety measures 3. place an eye patch on the eye for diplopia 4. monitor for potential complications such as UTI, calculi, pressure ulcers, respiratory tract infections, and contractures 5. promote regular elimination by bladder and bowel training 6. encourage independence 7. assist the client to establish a regular exercise and rest program 8. instruct the client to balance moderate activity with rest periods 9. assess the need for and provide assistive devices 10. initiate physical and speech therapy 11. instruct the client to avoid fatigue, strew, infection, overheating, and chilling 12. instruct the client to increase fluid intake and eat a balanced diet, including low-fat, high-fiber foods and foods high in potassium 13. instruct the client on safety measures related to sensory loss, such as regulating the temperature of bath water and avoiding heating pads 14. instruct the client on safety measure related to motor loss, such as avoiding the use of scatter rugs and using assistive devices 15. instruct the client in the self-administration of prescribed medications 16. provide information about the national MS society NCLEX 814 *nutrition* -well-balanced diet with high-fiber foods and adequate fluids is important -no standard prescribed diet, a high-protein diet with supplemental vitamins is often recommended *skin care* -frequent turning to avoid skin impairment -devices to relieve pressure (eggcrate or air mattresses) -because of sensory involvement, the patient may not feel discomfort that signals the need to change position *activity* -exercise regularly, but not to the point of fatigue -physical therapy sometimes improves neurologic dysfunction -decreases spasticity, increases coordination, retrains unaffected muscles to substitute for impaired ones *control of environment* -avoid hot baths, increase weakness -summer travel during coolest part of day, where air-conditioned -do best in peaceful and relaxed environments AHN 682

CT postprocedure

1. provide replacement fluids because diuresis from the dye is expected 2. monitor for an allergic reaction to the dye 3. assess dye injection site for bleeding or hematoma, and monitor the extremity for color, warmth, and the presence of distal pulses NCLEX 798

*30.* know what the side effects are from valproic acid (depakene)

1. transient nausea, vomiting, and indigestion 2. sedation, drowsiness, and dizziness 3. pancreatitis 4. blood dyscrasia: decreased platelet count and decreased white blood cell count 5. heptotoxicity NCLEX 828 *toxic effects* nausea, vomiting indigestion sedation emotional disturbance weakness altered blood coagulation AHN 679

CT scan

1. type of brain scanning that may or may not require injection of a dye 2. used to detect intracraial bleeding, space-occupying lesions, cerebral edema, infarctions, hydrocephalus, cerebra atrophy, and shifts of brain structures NCLEX 797 -is to detect pathologic conditions of the cerebrum and spinal cord using a technique of scanning without radioisotopes AHN 662

electroencephalography postprocedure

1. wash the client's hair 2. maintain side rails and safety precautions, if the client was sedated NCLE 799 -after the test allow the patient to rest -assist the patient if necessary in washing the hair and removing the collodion from the scalp AHN 663

*46.* know what nursing intervention would be appropriate after a patient has a grand mal seizure, still in the post ictal phase

5. administer oxygen 6. prepare to suction secretions from the airway 7. turn the client to the side, to allow secretions to drain, while maintaining the airway 8. prevent injury during the seizure 9. remain with the client 10. do not restrain the client 11. loosen restrictive clothing 12. note the type, character, and progression of the movements during the seizure 13. monitor for incontinence NCLEX 811 -after the seizure the patient may require suctioning and oxygen AHN 679

*39.* patient with impairment of the 2nd cranial nerve, what precautions do you need to take

CN 2 *optic* vision -teaching the patient protective measures -deficit in one sense, her or she should learn to compensate with another -risk for injury r/t sensory or perceptual disturbances -safety -loss of ability to function independent is traumatic AHN 675

*49.* official diagnosis of parkinson's patient must have 2 out of 3 characteristic signs, what are the signs

a firm diagnosis can be made only when the patient has at least two signs of the classic triad -tremor -rigidity -bradykinesia AHN 684

electroencephalography

a graphic recording of the electrical activity of the superficial layers of the cerebral cortex NCLEX 799 -provides evidence of focal of generalized disturbances of brain function by measuring the electrical activity of the brain -among the cerebral diseases assessed are epilepsy, mass lesions (e.g., tumors, abscess, hematoma), cerebrovascular lesions, and brain injury AHN 663

akinesia

absence, loss, or impairment of the power of voluntary movement

*34.* most common adverse effects are for levodopa

aggressive behavior involuntary grimacing head and body movements depression suicidal tendencies orthostatic hypotension nausea vomiting darkened urine excessive and inappropriate sexual behavior AHN 687 dyskinesia involuntary body movements chest pain nausea and vomiting urinary retention constipation sleep disturbances, insomnia, or periods of sedation orthostatic hypotension and dizziness confusion mood changes, especially depression hallucinations dry mouth NCLEX 825

*4a.* ataxia

irregular and unpredictable breathing pattern with random, shallow, and deep breaths and occasional pauses AHN 669 totally irregular in rhythm and depth indicates a dysfunction in the medulla NCLEX 799

*26.* know what some of the early findings of Alzheimer's is

mild memory lapses difficulty using the correct word attention span is decreased disinterest in surroundings depression may occur AHN 689 *memory loss that affects job skills* -frequent forgetfulness or unexplainable confusion at home or in the workplace may signs that soothing is wrong -this type of memory loss goes beyond forgetting an assignment colleague;s name, deadline, or phone number *difficulty performing familiar tasks* -people with AD may cook a meal but then forget not only to serve it but also that they made it *problems with language* -may forget simple words or substitute inappropriate words, making their speech difficult to understand *disorientation to time and place* become lost on their own street, not knowing where they are, how they got there, or how to get back home *poor or decreased judgement* -dress inappropriately in more noticeable ways, such as wearing a bathrobe to the store or a sweater on a hot day *problems with abstract thinking* -beyond challenges such as balancing a checkbook; may have difficulty recognizing numbers or doing even basic calculations *misplacing things* =may put times in inappropriate places but have no memory of how they got there *changes in mood or behavior* -tend to exhibit more rapid mood swings for no apparent reason *changes in personality* -can change dramatically, either suddenly or over time (easygoing, becoming angry, suspicious, or fearful) *loss of initiative* -may become and remain uninterested and uninvolved in many or all of their usual pursuits AHN 690

*25.* what sign is a signal of early onset parkinson's

mild tremor *pill rolling* handwriting changes slight limp decreased arm swing AHN 684

postictal period

rest period of variable length feels groggy acts disoriented headache muscle aches AHN 676

*4c.* agnosia

total or partial loss of the ability to recognize familiar objects by sight, touch, or hearing or to recognize familiar people through sensory stimuli as a result of organic brain damage AHN 675 -inability to recognize familiar objects or persons NCLEX 794 -inability to recognize and use an object correctly NCLEX 812

*16.* patients that get migraines after eating, what foods are common for triggering a migraine

tyramine nitrates glutamates (e.g, monosodium glutamate [MSG]) vinegar chocolate yogurt alcohol fermented or marinated foods ripened cheese cured sandwich meat caffeine pork AHN 66