Chapter 60: Assessment of Neurologic Function

how will you prepare a patient for MRI scan?

1) Ask patient if he has a history of working with metal fragments. 2) Mo object is to be in the room. including medical bracelet.

how will you prepare a patient for a cerebral angiography?

1) check patient BUN, Crt level. 2) Patient is allowed to have clear liquid up to the time of the procedure. 3) Patient must void immediately before the test. 4) ask for alergy.

how will you prepare a patient for CT scan?

1) have IV line available if contrast is been use. 2) Ask patient if allergic to shellfish because Iodine will be use. 3) Educate patient to not speak during the procedure. 4) Patient must fast 4 hrs before the procedure. 5) monitor kidney function( Labs), and encourage water intake.

A 53-year-old man presents to the emergency department with a chief complaint of inability to form words, and numbness and weakness of the right arm and leg. Where would you locate the site of injury? A)Right frontoparietal region B)Left frontoparietal region C)Left temporal region D)Left basal ganglia

B

What part of the brain controls and coordinates muscle movement?

Cerebellum

Which cerebral lobe allow expressive speaking?

Inferior-posterior frontal areas

Which method should help the nurse assess for neck rigidity correctly?

Moving the head and chin toward the chest

what neurological disease affect the CNS?

Multiple sclerosis ( M.S.) Parkinsons Alzheimer Huntington disease

what neurological disease affect the PNS?

Myasthenia Gravis (M.G.) Amyotrophic Lateral Sclerosis( A.L.S) Guillain Barre Syndrome( G.B

Which cranial nerve is responsible for muscles that move the eye and lids?

Oculomotor

complication of lumbar puncture with treatment.

Post-Lumbar Puncture Headache(Spinal headache) : TRX include analgesic agents, encouraging hydration, ingestion of caffeine, and lying supine.

Which cerebral lobe allow expressive writing?

Posterior frontal area

Which neurotransmitter helps control mood and sleep?

Serotonin

Which cerebral lobe contains the auditory receptive areas?

Temporal lobe.

What is myelography ? PT teaching after myelography procedure?

a radiographic study of the spinal cord after the injection of a contrast medium through a lumbar puncture. 1) lies in bed with the head of the bed elevated 30 to 45 degrees.. 2)remain in that position for 4 to 24hrs after the procedure. 3)Monitor vitals. 4) void prior to the procedure

When do we use MRI( Magnetic resonance imaging)?

it is useful in the diagnosis of brain tumor, stroke, and multiple sclerosis and does not involve ionizing radiation.

Define ataxia

lack of muscle coordination leading to difficulty walking

Which cerebral lobe contains the visual areas?

the occipital lobe

Which cerebral lobe contains the tactile areas?

the parietal lobe

what are the symptoms of neurologic disorders?

visual disturbance, seizure, muscle weakness, dizziness, vertigo, and abnormal sensation

A patient comes to the emergency department with severe pain in the face that was stimulated by brushing the teeth. What cranial nerve does the nurse understand can cause this type of pain? V III VI IV

A

What is agnosia? A. Failure to recognize familiar objects perceived by the senses B. Inability to express oneself or to understand language C. Inability to perform previously learned purposeful motor acts on a voluntary basis D. Impaired ability to coordinate movement, often seen as a staggering gait or postural imbalance

A

The critical care nurse is giving end-of-shift report on a client. The nurse uses the Glasgow Coma Scale (GCS) to assess the level of consciousness (LOC) of a female client and reports to the oncoming nurse that the client has an LOC of 6. What does an LOC score of 6 in a client indicate? Comatose Normal Somnolence Stupor

A Rational: A normal response is 15. A score of 7 or less is considered comatose.

A nurse is assisting during a lumbar puncture. How should the nurse position the client for this procedure? A)Lateral, with right leg flexed B)Lateral recumbent, with thighs flexed C)Prone, with the head turned to the right D)Supine, with the knees raised toward the chest

B

A nurse is performing a neurologic assessment on the client and notes a positive Romberg test. This test for balance is related to which of the following cranial nerves? X VIII VII III

B Rational : CN VIII is the acoustic nerve. Test hearing ability

A comatose client is being cared for by a critical care nurse who documents that the client responds only to very painful stimuli by fragmentary, delayed reflex withdrawal. The nurse knows that reflexes in the body are centered where? A)In the midbrain B)In the pons C)In the spinal cord D)In the medulla oblongata

C

A patient has difficulty interpreting his awareness of body position in space. Which lobe is most likely to be damaged? a)Temporal b)Frontal c)Parietal d)Occipital

C Rational: The parietal lobe is the primary sensory cortex. It is essential to a person's awareness of his body in space, as well as orientation in space and spatial relations.

A client is scheduled for an EEG after having a seizure for the first time. Client preparation for this test should include which instruction? "Avoid thinking about personal matters for 12 hours before the test." "Don't shampoo your hair for 24 hours before the test." "Don't eat anything for 12 hours before the test." "Avoid stimulants and alcohol for 24 to 48 hours before the test."

D

A patient arrives to have an MRI done in the outpatient department. What information provided by the patient warrants further assessment to prevent complications related to the MRI? 1)"I have been trying to get an appointment for so long." 2)"I have not had anything to eat or drink since 3 hours ago." 3)"My legs go numb sometimes when I sit too long." 4)"I am trying to quit smoking and have a patch on."

D

Which lobe of the brain is responsible for spatial relationships? A)Occipital B)Temporal C)Frontal D)Parietal

D Rational: The parietal lobe is essential to a person's awareness of body position in space, size and shape discrimination, and right-left orientation.

Define hemiplegia, paraplegia, Tetraplegia (quadriplegia)

paralysis of one side of the body. paralyzed below the waist paralysis of all four limbs

what is Electroencephalography (EEG)? PT teaching before EEG?

procedure used to detect seizure, sleep disorder, coma, AMS, brain death. 1) Avoid coffe, tea, chocolate, cola drinks before the exam. 2) Anticonvulsant agents, tranquilizers, stimulants, and depressants should be withheld 24 to 48 hours. 3) Patient is required to not sleep the night before. 4) wash your hair prior to procedure.

what is cerebral angiography?

procedure used to examine blood vessels in the brain. During this procedure, a catheter is placed at the femoral artery( groin).

What is a lumbar puncture? Nursing care

procedure used to examine patient's cerebrospinal fluid. The CSF should be clear and colorless.. 1) increase fluid intake 2) monitor sign of severe leak. 3) Patient should lie flat for severe hour after this.

What are the two major parts of the nervous systems? what are the subcategories of each?

the central nervous system (CNS), including the brain and spinal cord. the peripheral nervous system, which includes the 12 cranial nerves, spinal nerves, and autonomic nervous system.

A nurse is discussing a lumbar puncture with a nursing student who observed the procedure. The student noticed that the cerebrospinal fluid was blood tinged and asks what that means. The correct reply is which of the following? A)"It can mean the spinal cord was damaged or a traumatic puncture." B)"It can mean a traumatic puncture or a subarachnoid bleed." C)"It can mean a bleed around the hypothalamus or damage from the needle." D)"It can mean a subarachnoid bleed or damage to the spinal cord."

B Rational: The needle is inserted below the level of the spinal cord, which prevents damage to the cord. The cerebral spinal fluid (CSF) should be clear and colorless. Pink or bloody CSF may indicate a subarachnoid bleed or local trauma from the puncture.

The nurse is assessing the throat of a client with throat pain. In asking the client to stick out the tongue, the nurse is also assessing which cranial nerve? Cranial nerve XI Cranial nerve I Cranial nerve V Cranial nerve XII

D Rational: Assessment of the movement of the tongue is related to cranial nerve XII, the hypoglossal nerve. Cranial nerve XI is the spinal or accessory nerve responsible for head and shoulder and shoulder movement.

Which anatomic part supplies cerebrospinal fluid to the subarachnoid space and down the spinal cord on the dorsal surface? A)Lateral ventricle B)Third ventricle C)Arachnoid villus D)Fourth ventricle

D Rational: Cerebrospinal fluid (CSF), produced in the ventricles, is circulated around both the brain and the spinal cord by the ventricular system. The fourth ventricle supplies CSF to the subarachnoid space and down the spinal cord on the dorsal surface. The third and fourth ventricles connect via the aqueduct of Sylvius. The arachnoid villus is the area in the brain where CSF is absorbed.

The nurse is performing a neurologic assessment on a client diagnosed with a stroke and cannot elicit a gag reflex. This deficit is related to which of the following cranial nerves? X VIII III VII

A Rational: CN X is the vagus nerve and has to do with the gag reflex. Ask the patient to swallow and speak; note hoarseness