Neurology review

A home health nurse is seeing an elderly female client for the first time. During the physical assessment of the client's feet, the nurse notes several circular ulcers around the tips of the toes on both feet. The bases of the ulcers are pale, and the client reports the ulcers to be very painful. From these assessment findings, the nurse suspects that the cause of the ulcers is which of the following? 1.Arterial insufficiency 2.Venous insufficiency 3.Neither venous nor arterial 4.trauma

1

The nurse would include which of the following in a neurological assessment? 1.Ask the client to plantar flex the toes. 2.Capillary refill of the great toe. 3.Palpate the dorsalis pedis pulse. 4.Inspect the foot for edema

1 A neurological assessment evaluates sensation and motion. Assessing plantar flexion of the toes would be included in a neurological assessment. Capillary refill, palpation of pulses, and inspecting for edema would be included in a vascular assessment.

A client experiences a head injury in a motor vehicle accident. The client's level of consciousness is declining, and respirations have become slow and shallow. When monitoring a client's respiratory status, which area of the brain would the nurse realize is responsible for the rate and depth? 1.The pons 2.The frontal lobe 3.Central sulcus 4.Wernicke's area

1. the pons in the brainstem controls rate and depth of respirations. When injury occurs or increased intracranial pressure results, respirations are slowed.

When obtaining the vital signs of a client with multiple traumatic injuries, a nurse detects bradycardia, bradypnea, and systolic hypertension. The nurse must notify the physician immediately because these findings may reflect which complication? 1.Shock 2.Encephalitis 3.Increased intracranial pressure (ICP) 4.Status epilepticus

3

An osmotic diuretic, such as mannitol, is given to the patient with increased intracranial pressure (IICP) for which of the following reasons? 1.Control fever 2.Control shivering 3.To dehydrate the brain and reduce cerebral edema 4.Reduce cellular metabolic demands

3. Osmotic diuretics draw water across intact membranes, thereby reducing the volume of brain and extracellular fluid.

A patient is scheduled for a myelogram and the nurse explains to the patient that this is an invasive procedure, which assesses for any lesions in the spinal cord. The nurse should explain that the preparation is similar to which of the following neurologic tests? 1.Lumbar Puncture 2.MRI 3.Cerebral Angiography 4.EEG

A myelogram is an x-ray of the spinal subarachnoid space taken after the injection of a contrast agent into the spinal subarachnoid space through a lumbar puncture. Patient preparation for a myelogram would be similar to that for lumbar puncture. The other listed diagnostic tests do not involve lumbar puncture

fever in pt with icp

Antipyretics and a cooling blanket are used to control fever in the patient with increased ICP.

reduce cellular metabolic demands:

Barbiturates

Bell's palsy is a paralysis of which of the following cranial nerves? 1.Facial 2.Trigeminal 3.Optic 4.Otic

Bell's palsy (facial paralysis) is caused by unilateral inflammation of the seventh cranial nerve, which results in weakness or paralysis of the facial muscles on the ipsilateral, or same side, of the affected facial nerve.

Shivering in pts with ICP

Chlorpromazine (Thorazine) may be prescribed to control shivering in the patient with increased ICP.

When the nurse observes that the patient has extension and external rotation of the arms and wrists, and extension, plantar flexion, and internal rotation of the feet, she records the patient's posturing as which of the following? 1.Decerebrate 2.Normal 3.Flaccid 4.Decorticate

Decerebrate posturing is the result of lesions at the midbrain and is more ominous than decorticate posturing. The described posturing results from cerebral trauma and is not normal. External rotation

Cerebral Angiography

Diagnostic procedure that uses a special dye and imaging scans to see blood flow through brain.

Which of the following tests confirms the diagnosis of myasthenia gravis (MG)? 1.Tensilon test 2.CT scan 3.EMG 4.Serum studies

Edrophonium chloride (Tensilon) is an acetylcholinesterase inhibitor that stops the breakdown of acetylcholine. The drug is used because it has a rapid onset of 30 seconds and a short duration of 5 minutes. Immediate improvement in muscle strength after administration of this agent represents a positive test and usually confirms the diagnosis. The presence of acetylcholine receptor antibodies is identified in serum. Repetitive nerve stimulation demonstrates a decrease in successive action potentials. The thymus gland may be enlarged in MG, and a T scan of the mediastinum is performed to detect thymoma or hyperplasia of the thymus.

EEG

Electroencephalogram= a diagnostic test that is used to detect electrical activity of the brain. It has scalp electrodes attached that record the electrical activity.

The client is diagnosed with a right sided CVA and is complaining of a severe headache. Which intervention should Elizabeth implement first? Administer acetaminophen Prepare for a stat CT scan Notify the client's healthcare provider Assess the client's neurological status

Elizabeth must first assess the client to determine whether the client's neurological status is worsening and would require the physician to be notified or if headache is expected and analgesics need to be administered.

Which of the following terms refers to leg pain that is brought on walking and caused by arterial insufficiency? 1.Dyspnea 2.Orthopnea 3.Thromboangiitis obliterans 4.Intermittent claudication

Explanation: Intermittent claudication is leg pain that is brought on by exercise and relieved by rest. Dyspnea is the patient's subjective statement of difficulty breathing. Orthopnea is the inability of the patient to breathe except in the upright (sitting) position. Thromboangiitis obliterans is a peripheral vascular disease also known as Burger's disease

A patient exhibiting an altered level of consciousness (LOC) due to blunt-force trauma to the head is admitted to the ED. The physician determines the patient's injury is causing increased intracranial pressure (ICP). The nurse should gauge the patient's LOC on the results of what diagnostic tool? 1.Monro-Kellie hypothesis 2.Glasgow Coma Scale 3.Cranial Nerve Function 4.Mental Status Exam

LOC, a sensitive indicator of neurologic function, is assessed based on the criteria in the Glasgow Coma Scale: eye opening, verbal response, and motor response. The Monro-Kellie hypothesis states that because of the limited space for expansion within the skull, an increase in any one of the components (blood, brain tissue, cerebrospinal fluid) causes a change in the volume of the others. Cranial nerve function and the mental status examination would be part of the neurologic examination for this patient, but would not be the priority in evaluating LOC.

MRI

Magnetic Resonance Imaging= diagnostic test that uses magnetic fields and radio waves to make pictures of organs and bodily structures. It sets up a better visual field in some instances and may be utilized to see structures or problems with structures that plain films and CT scans can not.

Which actions should a nurse perform to prevent deep vein thrombosis when caring for a postsurgical patient? 1.Reinforce the need to perform leg exercises every hour when awake. 2.Administer prophylaxis high-dose heparin. 3.Instruct the patient to prop pillow under the knees. 4.Maintain bed rest.

Rationale: the nurse should reinforce the need to perform leg exercises every hour when awake. Maintaining bed rest increases the pooling of blood in the lower extremities, increasing the risk for deep vein thrombosis. The patient may be given low-dose heparin for prophylaxis treatment but not a high-dose heparin. The nurse should instruct the patient not to prop a pillow under the knees because the patient can constrict the blood vessels.

A nurse is evaluating a client's cranial nerves during a routine examination. To assess the function of cranial nerve XII (hypoglossal), the nurse should assess the client's ability to: 1.Smell and identify a nonirritating, aromatic disorder. 2.Read an eye chart from a distance of 20. 3.Elevate the shoulders, both with and without resistance. 4.Stick out tongue and move it rapidly from side to side and in and out.

To test cranial nerve XII, which controls tongue movement, the nurse should instruct the client to stick out the tongue and move it rapidly from side to side and in and out. The nurse would ask the client to smell and identify a nonirritating, aromatic odor when testing the function of cranial nerve I, the olfactory cranial nerve. Asking the client to read an eye chart is part of assessing cranial nerve II, the optic cranial nerve. Having the client elevate the shoulders with and without resistance is part of assessing cranial nerve XI, the spinal accessory cranial nerve that innervates the sternocleidomastoid muscle and the upper portion of the trapezius muscle.

The central sulcus is

a fold in the cerebral cortex called the central fissure.

Trigeminal neuralgia is

a paralysis of the trigeminal nerve (cranial nerve V).

The frontal lobe

completes executive functions and cognition.

Status epilecticus

continuous seizure activity, not change in vital signs

The vestibulocochlear nerve (cranial nerve VIII) functions in

hearing

Cushings triad

heart rate slows, respirations slow, and systolic blood pressure increases

venous insufficiency will be

irregular in shape, minimal pain if superficial (can be painful), and usually located around the ankles or the anterier tibial area.

arterial insufficiency ulcers include

location at the tips of the toes, extreme painfulness, and circular shape with pale to black ulcer bases.

Lumbar Puncture

minimally invasive, ultrasound needle guided procedure done in lower back to remove small amount of cerebrospinal fluid for diagnostic testing.

You are caring for a client in the clinic who has come in to have an EMG done. How would you prepare the client for this test? Tell the client the doctor will use fluoroscopy for this test tell the clinet the test in painless tell the client to expect soem discomfort tell the client they will have to lie flat afterwards

tell the client to expect some discomfort when undergoing a lumbar puncture, myelogram, EMG or nerve conduction studies. there is no fluoroscopy used for an EMG. It is not necessary to lie flat after an EMG

Encephalitis

temp rises and the heart rate and resp rate may increase from effects of fever on the metabolic rate.

The Wernicke's area is

the area linked to speech

decorticate posturing

the patient has flexion and internal rotation of the arms and wrists and extension, internal rotation, and plantar flexion of the feet

Shock

typically causes tachycardia, tachypnea, and hypotension

The optic nerve (cranial nerve II) functions in

vision

A client was running along an ocean pier, tripped on an elevated area of the decking, and struck his head on the pier railing. According to his friends, "He was unconscious briefly and then became alert and behaved as though nothing had happened." Shortly afterward, he began complaining of a headache and asked to be taken to the emergency department. If the client's intracranial pressure (ICP) is increasing, the nurse should expect to observe which sign first? 1.Pupillary asymmetry 2.Irregular breathing pattern 3.Involuntary posturing 4.Declining level of consciousness (LOC)

with a brain injury such as an epidural hematoma (a likely diagnosis, based on this client's symptoms), the initial sign of increasing ICP is a change in LOC. As neurologic deterioration progresses, manifestations involving pupillary symmetry, breathing patterns, and posturing will occur.