Med Surg - Chapter 45 - Care of Critically Ill Patients with Neurologic Problem

How many classifications exist for brain tumors? 1 2 2 3 3 6 4 9

1 2 There are two classifications for brain tumors: benign and malignant. There are not 3, 6, or 9 classifications.

The nurse is caring for four patients. Which patient does the nurse anticipate might receive fibrinolytic therapy within a 3- to 4.5-hour window as recommended by the American Stroke Association? 1 A patient who is 60 years old 2 A patient who has a history of both stroke and diabetes 3 A patient whose anticoagulation with an international normalized ratio is 1.7 or below 4 A patient whose Baseline National Institutes of Health Stroke Scale score is over 25

1 A patient who is 60 years old In 2009, the American Stroke Association recommended an expanded time interval from 3 to 4.5 hours to administer fibrinolytic therapy for patients who are under 80 years of age; therefore, the patient who is 60 years old falls into this category. These guidelines should not be followed for patients with a history of stroke and diabetes, whose anticoagulation with an international normalized ratio is 1.7 or below, or whose Baseline National Institutes of Health Stroke Scale score is over 25.

What is the most common type of pituitary tumor? 1 Adenoma 2 Sarcoma 3 Neuroma 4 Lymphoma

1 Adenoma Adenoma is the most common type of pituitary tumor. Sarcoma is a malignant tumor of connective or other nonepithelial tissue. Neuroma is a growth or tumor of nerve tissue. Lymphoma is a cancer of the lymphatic system.

Which factors contraindicate administering alteplase more than three hours after stroke onset? Select all that apply. 1 Age older than 80 years 2 History of both diabetes and stroke 3 Use of warfarin or other anticoagulants 4 Imaging evidence of middle cerebral artery involvement 5 National Institutes of Health Stroke Scale (NIHSS) score less than 25

1 Age older than 80 years 2 History of both diabetes and stroke 3 Use of warfarin or other anticoagulants 4 Imaging evidence of middle cerebral artery involvement The optimal time for administering alteplase is within three hours; however, in some cases that window can be extended to 4.5 hours. Factors precluding this extension include advanced age (over 80 years), imaging evidence of middle cerebral artery involvement, history of both diabetes and stroke, and treatment with anticoagulants. An NIHSS score of greater than, not less than, 25 also precludes this extension.

Which term is used to describe loss of balance in a patient with a brainstem or cerebellar injury? 1 Ataxia 2 Diplopia 3 Ovoid pupil 4 Papilledema

1 Ataxia Brainstem or cerebellar injuries cause ataxia (loss of balance), decreased or increased muscle tone, and weakness. Damage to the optic chiasm or optic tract may cause visual-field deficits or diplopia (double vision). Ovoid pupil is regarded as the midstage between a normal-size pupil and a dilated pupil in patients who encountered a brain injury. Papilledema, also known as a choked disc, is edema and hyperemia (increased blood flow) of the optic disc. This condition is always a sign of increased intracranial pressure.

Which therapy must be performed to open the skull and remove the tumor? 1 Craniotomy 2 Chemotherapy 3 Brachytherapy 4 Stereotactic radiation therapy

1 Craniotomy A craniotomy is the therapy performed to open the skull and remove the tumor, to improve symptoms related to the lesion, or to decrease the tumor size. Chemotherapy may also be used as an adjunctive therapy for tumors that have metastasized to the spinal cord from other primary sites. In brachytherapy radiation, the source comes into direct, continuous contact with the tumor for a specific time period. Stereotactic radiation therapy beams are widely dispersed over the surface of the head to prevent damage to the healthy brain tissue.

What are the most common causes of traumatic brain injuries (TBIs) in the United States? Select all that apply. 1 Falls 2 Violence 3 Collisions 4 Sports-related injuries 5 Motor vehicle accidents

1 Falls 5 Motor vehicle accidents The most common cause of TBIs in the United States are falls and motor vehicle crashes. Sports-related injuries, violence, and collisions are not as common.

A patient develops syndrome of inappropriate antidiuretic hormone (SIADH) following a craniotomy with brain tumor removal. What medical management should the nurse expect? 1 Fluid restriction 2 Low-sodium diet 3 Desmopressin (DDAVP) 4 Intravenous (IV) hetastarch (Hespan)

1 Fluid restriction SIADH occurs when the posterior pituitary gland releases too much antidiuretic hormone (ADH), causing water retention. Therefore, restricting fluid is appropriate. IV hetastarch is a volume expander and is contraindicated in SIADH. Desmopressin emulates the actions of endogenous human ADH and would further complicate SIADH. Patients with SIADH are hyponatremic so restricting sodium is not advised.

Which tool is used to measure the severity of a traumatic brain injury? 1 Glasgow Coma Scale 2 Visual analogue scale 3 Numerical rating scale 4 Geriatric depression scale

1 Glasgow Coma Scale The severity of a traumatic brain injury is determined by the result of the Glasgow Coma Scale score. The visual analog scale and numerical rating scale are both used in the assessment of pain. The geriatric depression scale is used to identify depression in older adults.

Which potential disorder should be ruled out before a patient's level of consciousness is attributed to stroke? 1 Hypoglycemia 2 Hyperkalemia 3 Hyponatremia 4 Hypertension

1 Hypoglycemia Hypoglycemia can present as a decreased level of alertness/consciousness. If this is the case, the condition is easily reversed. Hyperkalemia, hyponatremia, and hypertension do not alter consciousness.

Which terms are related to an open traumatic brain injury? Select all that apply. 1 Linear fracture 2 Laceration injury 3 Contusion injury 4 Contrecoup injury 5 Depressed fracture

1 Linear fracture 5 Depressed fracture Linear and depressed fractures correspond with an open traumatic brain injury. Laceration, contusion, and contrecoup injuries are related to a closed traumatic brain injury.

Which statement best describes the symptoms of a transient ischemic attack (TIA)? 1 They resolve within 60 minutes. 2 They are limited to the speech area. 3 They manifest in the upper extremities. 4 They last longer than 24 hours but less than a week.

1 They resolve within 60 minutes. By definition, symptoms of a TIA resolve typically within 30-60 minutes. TIA symptoms can manifest as weakness in the arms, hands, or legs, and gait disturbance is typical. Speech deficits (aphasia, dysarthria) can result from TIA, but symptoms are not limited to this area.

Which type of stroke syndrome would most likely cause a coma in a patient? 1 Vertebrobasilar artery strokes 2 Internal carotid artery strokes 3 Middle cerebral artery strokes 4 Anterior cerebral artery strokes

1 Vertebrobasilar artery strokes Vertebrobasilar artery strokes occur when blood flow through the vertebrobasilar region is reduced or stopped. This may lead to a coma. The internal carotid artery strokes, middle cerebral artery strokes, and anterior cerebral artery strokes may not lead to coma. The internal carotid artery supplies blood to the brain. The middle cerebral artery supplies blood to the cerebrum. The anterior cerebral artery supplies oxygenated blood to most of the portions of the frontal lobes and superior medial parietal lobes.

Which symptoms can be present with a transient ischemic attack (TIA)? Select all that apply. 1 Vertigo 2 Anosmia 3 Aphasia 4 Epistaxis 5 Blurred vision

1 Vertigo 3 Aphasia 5 Blurred vision Symptoms of a TIA include blurred vision, vertigo, and aphasia. Sense of smell is not affected, so anosmia is not a symptom. Epistaxis (a nosebleed) is not part of the symptom profile for TIA.

How does a deceleration injury occur? 1 When the moving head is suddenly stopped or hits a stationary object. 2 When the skull is fractured or when it is pierced by a penetrating object. 3 When a mechanical force is applied either directly or indirectly to the brain. 4 When an external force makes contact with the head, suddenly placing the head in motion.

1 When the moving head is suddenly stopped or hits a stationary object. A deceleration injury occurs when the moving head is suddenly stopped or hits a stationary object. Closed traumatic brain injuries are caused by blunt force. Usually, brain injuries occur when a mechanical force is applied either directly or indirectly to the brain. An open traumatic brain injury occurs when the skull is fractured or when it is pierced by a penetrating object. An acceleration injury is caused by an external force contacting the head that suddenly places the head in motion.

The nurse is teaching a patient and family about home care after a stroke. Which statement made by the patient's spouse indicates a need for further teaching? 1 "My husband may get depressed." 2 "I should spend all my time with my husband in case I'm needed." 3 "My husband must take his medicine every day to help prevent another stroke." 4 "The physical therapist will show us how to use the equipment so my husband can climb the stairs and get into and out of bed."

2 "I should spend all my time with my husband in case I'm needed." Family members can start to feel socially isolated when caring for a loved one. The family may need to plan for regular respite care in a structured daycare respite program or through relief provided by a friend or neighbor. The life changes associated with stroke often cause a change in the patient's self-esteem. The patient who has had a stroke should maintain a regular medication regimen, such as anticoagulant therapy, to prevent another stroke. Once the home health nurse has assessed the home environment, he or she will notify the health care provider of the need for ancillary services, such as a physical therapist. The physical therapist will identify adaptive equipment needs, will request them, and then will instruct the patient about their use, along with developing an exercise program.

A patient who sustained a transient ischemic attack (TIA) is admitted to the emergency department. The nurse is teaching the student nurse about methods to prevent another TIA. Which statement made by the student nurse indicates a need for further teaching? 1 "Aspirin should be given to the patient." 2 "The patient should be placed on a liquid diet." 3 "Antihypertensive medications should be given to the patient." 4 "Oral hypoglycemic medications should be given to the patient."

2 "The patient should be placed on a liquid diet." It is not necessary for the patient to maintain a liquid diet. The patient can eat any food that is healthy for the heart. Aspirin is an antiplatelet drug that prevents platelet aggregation and clot formation. Patients who sustain a TIA have high blood pressure; therefore, it is important to give antihypertensive medications in order to maintain a normal blood pressure. Oral hypoglycemic medications should be given to the patient to maintain blood sugar levels in the normal range, thereby preventing another attack.

A registered nurse is providing care for a patient admitted with status epilepticus who has a recent history of craniotomy. What is a craniotomy? 1 Stereotactic radiosurgery 2 An incision into the cranium 3 Placement of a wafer into the cranium 4 Placement of a catheter into the cerebral ventricle

2 An incision into the cranium Craniotomy is an incision into the cranium and may be performed to remove a brain tumor or to decrease tumor size (debulk). Placement of a wafer into the cranium is called interstitial chemotherapy. Placement of a catheter into the cerebral ventricle is called ventriculostomy. Stereotactic radiosurgery (SRS) is an alternative to traditional surgery in which ionizing radiation, accelerated x-rays, beams of protons, or isotope seeds may be implanted into a tumor site.

Which patient complication is most commonly associated with dysphagia? 1 Choking 2 Aspiration 3 Vomiting 4 Respiratory arrest

2 Aspiration Aspiration is a frequent complication for patients with dysphagia. Many of these aspirations are "silent" and are not recognized until pulmonary complications occur. Choking and vomiting can occur with dysphagia, but are not as common as aspiration. Respiratory arrest is not a direct complication of dysphagia.

The nurse receives a patient in the emergency department (ED) who experienced a stroke. The patient is alert and requests something to eat from the nurse. Which is the best action the nurse can take? 1 Provide thickened fluids to the patient. 2 Assess the swallowing ability of the patient. 3 Obtain a prescription to give intravenous fluids. 4 Assess the level of consciousness in the patient.

2 Assess the swallowing ability of the patient. Patients may have varying degrees of neurological deficits after a stroke. The patient may have trouble swallowing even if the patient seems to be alert; therefore, the nurse should check the patient's swallowing ability before giving anything orally. This helps prevent aspiration and respiratory complications. Once the patient's swallowing ability is ascertained, thickened fluids can be provided, as they are easy to swallow. Providing intravenous fluids may not serve to fulfill the patient's request. Assessment of the level of consciousness is important in patients with a stroke; however, it may not help in fulfilling the patient's request.

The nurse is assessing a patient admitted with a stroke. What assessment finding would indicate that the patient experienced a stroke to the right hemisphere? 1 Slowness 2 Denial of the illness 3 Anger and frustration 4 Deficit in the right visual field

2 Denial of the illness The patient who has a right hemisphere stroke is often unaware of any deficits and may be disoriented to time and place. Deficit in the right visual field, slowness, and anger and frustration are the symptoms of a left hemisphere stroke.

Which factor has been shown to delay stroke intervention? 1 Age 2 Gender 3 Ethnic background 4 Religious affiliation

2 Gender Studies have shown that although women have a better understanding of stroke symptomology, they may not seek care as quickly as men do. Strokes tend to be more prominent in older people, but does not necessarily lead to a delay in treatment. Ethnic background and religious affiliation have no direct bearing on timing of seeking stroke treatment.

Which are physical findings of a patient who has a mild traumatic brain injury (TBI)? Select all that apply. 1 Irritability 2 Headache 3 Dizziness 4 Fatigue 5 Depression

2 Headache 3 Dizziness 4 Fatigue Physical findings for mild TBIs include headache, dizziness, and fatigue. Irritability and depression are emotional changes, not physical findings, associated with mild TBI.

A patient gradually becomes weak, lethargic, and confused following a craniotomy. What electrolyte alteration may be causing the patient's status change? 1 Hypermagnesemia 2 Hyponatremia 3 Hypocalcemia 4 Hyperkalemia

2 Hyponatremia Weakness, alterations in level of consciousness, and confusion following a craniotomy are signs of hyponatremia. Symptomatic hypermagnesemia is rare and usually occurs with renal failure, antacid or laxative abuse, or with low calcium levels. Hypocalcemia may be caused by hypoparathyroidism, renal failure, pancreatitis, calcium channel blocker overdose, rhabdomyolysis, tumor lysis syndrome, or medications such as bisphosphonates. Hyperkalemia often accompanies renal failure.

Which condition damages a patient's brain tissue and contributes to cerebral vasodilation and increased intracranial pressure (ICP)? 1 Hematoma 2 Hypoxemia 3 Hypotension 4 Cerebral edema

2 Hypoxemia Hypoxemia is an abnormally low concentration of oxygen in the blood; this condition can damage brain tissue and contribute to cerebral vasodilation and increased intracranial pressure. A hematoma is a localized collection of blood outside the blood vessels, usually in liquid form within the tissue. When blood volume is too low, hypotension can be so critical that vital organs are not perfused with oxygen and become hypoxic. Cerebral edema results from changes in capillary endothelial tissue permeability that allows plasma to seep into the extracellular spaces.

Which terms are related to a closed traumatic brain injury? Select all that apply. 1 Linear fracture 2 Laceration injury 3 Contusion injury 4 Contrecoup injury 5 Depressed fracture

2 Laceration injury 3 Contusion injury 4 Contrecoup injury Laceration, contusion, and contrecoup injuries are related to a closed traumatic brain injury. Linear and depressed fractures are related to an open traumatic brain injury.

What is the most common type of benign brain tumor? 1 Astrocytoma 2 Meningioma 3 Glioblastoma 4 Medulloblastoma

2 Meningioma The most common type of benign brain tumor arises from the meningeal covering of the brain and is called meningioma. Medulloblastoma is a malignant tumor. Astrocytoma is an aggressive, malignant tumor. Glioblastoma is another term for astrocytoma. Medulloblastomas, astrocytomas, and glioblastomas are less common than meningiomas.

Which stroke syndrome has clinical features such as perpetual, spatial, and visual field deficit? 1 Internal carotid artery strokes 2 Middle cerebral artery strokes 3 Anterior cerebral artery strokes 4 Posterior cerebral artery strokes

2 Middle cerebral artery strokes Perpetual, spatial, and visual deficits are key features of middle cerebral artery strokes. Contralateral hemiparesis, hemianopsia, blurred vision, and blindness are key features of internal carotid artery strokes. Contralateral hemiparesis, aphasia, and amnesia are clinical features of anterior cerebral artery strokes. Loss of deep sensation, decreased touch sensation, aphasia, and amnesia are clinical features of posterior cerebral artery strokes.

Which hemorrhage results from venous bleeding into the space beneath the dura and above the arachnoid? 1 Epidural hematoma 2 Subdural hematoma 3 Intracerebral hemorrhage 4 Subarachnoid hemorrhage

2 Subdural hematoma A subdural hematoma results from venous bleeding into the space beneath the dura and above the arachnoid. An epidural hematoma results from arterial bleeding into the space between the dura and the inner skull. Traumatic intracerebral hemorrhage is the accumulation of blood within the brain tissue caused by the tearing of small arteries and veins in the subcortical white matter. A subarachnoid hemorrhage results from bleeding into the subarachnoid space. It is usually caused by a ruptured aneurysm, arteriovenous malformation, or trauma.

The nurse documents that a patient with a brain tumor has developed papilledema. What is papilledema? 1 Swelling of the tongue 2 Swelling of the optic disk 3 Swelling of the thyroid gland 4 Swelling of the acoustic nerve

2 Swelling of the optic disk Papilledema is swelling of the optic disc, indicating increased intracranial pressure. Swelling of the acoustic nerve may accompany acoustic neuroma. Swelling of the thyroid gland is termed goiter. Swelling of the tongue is sometimes referred to as glossitis and may occur as a result of an anaphylactic reaction.

A patient was involved in a car crash and sustained an injury to the left side of the head. The patient is experiencing a severe headache, nausea, and vomiting. The Glasgow Coma Score of the patient is 10. The patient underwent neurological assessments and tests which revealed diplopia, decrease in level of consciousness, and ovoid pupil. What would the nurse infer from the patient's condition? 1 The patient's pupils are dilated. 2 The patient's optic chiasma or optic tract is damaged. 3 The patient is suffering from severe traumatic brain injury. 4 The patient has motor dysfunction on the left side of the head.

2 The patient's optic chiasma or optic tract is damaged. The neurological assessment revealed that the patient had diplopia, which means that the patient has visual-field deficits. The visual-field deficits occur when there is damage to the optic chiasma or optic tract. The patient's pupils were ovoid (stage between normal and dilated), which indicates the brainstem dysfunction at the level of the pons. The patient's Glasgow Coma Score is 10, indicating the patient experienced a mild traumatic brain injury. In mild traumatic brain injury, the Glasgow Coma Score ranges between 9 and 12. The motor dysfunction always occurs on the opposite side of the injured portion. Therefore, the patient will have motor dysfunction on the right portion of the head, not the left side.

Which diagnostic technique is used to measure the integrity of the cerebral vessels in a patient who sustained a traumatic brain injury? 1 Radiography 2 Ultrasonography 3 Electrocardiogram 4 Electroencephalography

2 Ultrasonography In a patient who sustained a traumatic brain injury, the integrity of the cerebral vessels is measured by using ultrasonography. Radiography and computed tomography (CT) scanning of the cervical spine and skull are used to rule out fractures and dislocations. An electrocardiogram (ECG) is a routine part of every cardiovascular evaluation. The electrical activity of the cerebral hemispheres is recorded by the electroencephalography.

The daughter of a patient who has had a stroke asks the nurse for additional resources. What is the nurse's best response? 1 "Call hospice." 2 "Check the Internet." 3 "Go to the National Stroke Association website." 4 "The charge nurse at the desk has all of the information."

3 "Go to the National Stroke Association website." The National Stroke Association is a specific and reliable resource that can be recommended. Hospice applies only to the patient who will be requiring palliative end-of-life care. The Internet is too broad; unless the nurse recommends a specific website, the patient's daughter may not find quality information. The nurse caring for the patient is responsible for obtaining information that is readily available or for procuring a request from the health care provider for a consultation with the social worker.

Alteplase should be given within how many hours from the onset of symptoms of stroke? 1 6 2 12 3 4.5 4 1.5

3 4.5 The most important factor in whether or not to give alteplase is the time between symptom onset and time seen in the stroke center. The American Stroke Association recommends fibrinolytic therapy started within 4.5 hours of symptom onset for most patients.

A patient has a brain tumor classified as supratentorial. Where is the tumor located? 1 At the meninges 2 Below the tentorium 3 Above the tentorium 4 At the cerebellar pontine angle

3 Above the tentorium Supratentorial tumors are located within the cerebral hemispheres above the tentorium. Infratentorial tumors are located below the tentorium. Meningiomas arise from the coverings of the brain, the meninges. Tumors located at the cerebellar pontine angle are called acoustic neuromas.

Which stroke syndrome includes personality and behavior changes? 1 Middle cerebral artery 2 Internal carotid artery 3 Anterior cerebral artery 4 Vertebrobasilar artery

3 Anterior cerebral artery An anterior cerebral artery stroke includes personality and behavior changes as well as symptoms such as bladder incontinence, aphasia and amnesia, positive grasping and sucking reflex, and memory impairment. Middle cerebral artery, internal carotid artery, and vertebrobasilar artery strokes may have some component of cognition deficit, but they do not directly affect personality and behavior.

Damage to which cranial nerve (CN) would lead to facial paralysis in the patient? 1 CN IX 2 CN XII 3 CN VII 4 CN IX and X

3 CN VII Damage to CN VII (facial nerve) would be responsible for facial paralysis. Damage to CN IX interferes with the gag reflex. Damage to CN XII leads to impaired tongue movement. CN IX and X damage can cause an inability to swallow.

What imaging test is best used to confirm brain death? 1 Radiography 2 Ultrasonography 3 Cerebral angiography 4 Electrocardiography

3 Cerebral angiography Neuroimaging tests are not required to confirm brain death, but are desirable. These tests include cerebral angiography, bedside electroencephalography (EEG), and cerebral computed tomographic angiography (CTA). Radiography and computerized tomography (CT) scanning of the cervical spine and the skull are done to rule out fractures and dislocations. The integrity of the cerebral vessels is measured through the use of ultrasonography. An electrocardiogram (ECG) is not used to confirm brain death.

Which drug is considered an antithrombotic? 1 Warfarin 2 Heparin 3 Clopidogrel 4 Nimlodipine

3 Clopidogrel Clopidogrel is considered an antithrombotic. It helps prevent the formation of future clots. Warfarin and heparin are anticoagulants, which work in a different fashion than clopidogrel. Nimlodipine is a calcium channel blocker used to prevent cerebral vasospasm.

Abuse of which substance is most likely to result in a hemorrhagic stroke? 1 Heroin 2 Nicotine 3 Cocaine 4 Marijuana

3 Cocaine Cocaine and other stimulants can cause a sharp rise in blood pressure, which can result in a stroke. Heroin and marijuana cause a decrease in respiration and cardiac function. Although nicotine is a stimulant, it would have to be consumed in huge doses to cause a stroke.

What should be considered if the patient voids large amounts of very dilute urine with an increasing serum osmolarity and electrolyte concentration? 1 Polyuria 2 Neurohypophysis 3 Diabetes insipidus 4 Adrenal insufficiency

3 Diabetes insipidus Diabetes insipidus should be considered if the patient voids large amounts of very dilute urine with an increasing serum osmolarity and electrolyte concentration. Polyuria is excessive water loss through urination. Disorders of the neurohypophysis occur with deficiency or excess of the antidiuretic hormone (ADH). Adrenal insufficiency is a condition in which the adrenal glands do not produce adequate amounts of steroid hormones.

The nurse is assessing a patient with a history of mild traumatic brain injury. The patient reports sleep disturbances. Which findings should the nurse observe for in the patient? Select all that apply. 1 Amnesia 2 Irritability 3 Drowsiness 4 Nervousness 5 Sleeping for long hours

3 Drowsiness 5 Sleeping for long hours Drowsiness and sleeping for long hours may contribute to sleep disturbances in a patient with mild traumatic brain injury. Amnesia is a cognitive finding and is not related to sleep disturbance. Irritability and nervousness are emotional changes that occur after a brain injury.

The nurse is obtaining a history on a patient who has had several transient ischemic attacks. Which risk factor in this patient's history cannot be changed with appropriate management of care? 1 Cardiovascular disease 2 Diabetes 3 Head trauma 4 Sleep apnea

3 Head trauma Patients who have a history of head trauma have an increased risk of stroke; this risk factor does not change, even with appropriate treatment. The other risk factors of cardiovascular disease, diabetes, and sleep apnea can be altered with appropriate collaborative management.

Which initial site is the most common source of emboli for those experiencing embolic stroke? 1 Lung 2 Liver 3 Heart 4 Spleen

3 Heart Embolic strokes are caused by a thrombus or group of thrombi that break off from one area of the body and travel to the cerebral arteries via the carotid artery or vertebrobasilar system. The usual source of an emboli is the heart. Emboli that occur in the lungs can cause a pulmonary embolism. The liver and spleen are not typical sources of emboli.

Which assessment parameter is a priority in the management of a patient with a brain injury? 1 Intracranial pressure (ICP) 2 Complete blood count (CBC) 3 Level of consciousness (LOC) 4 Cerebrospinal fluid (CSF) leak

3 Level of consciousness (LOC) The most important variable to assess in any brain injury is LOC. The first sign of deterioration in neurological status is a decrease or change in LOC. Secondary assessments include ICP measurements, a CBC, and determination of the presence of a CSF leak.

The nurse suspects a patient has a brain tumor. What noninvasive test is most likely to be ordered to validate the presence of a brain tumor? 1 Skull x-rays 2 Computer tomography (CT) scan 3 Magnetic resonance imaging (MRI) scan 4 Magnetic resonance angiogram (MRA) scan

3 Magnetic resonance imaging (MRI) scan Diagnosis of a brain tumor is based on history, neurological assessment, clinical examination, and results of neurodiagnostic testing. MRI is most commonly used for initial diagnosis, as it is a more sensitive diagnostic tool. A CT scan is often used for follow-up during the course of the illness. The skull x-rays may be done to determine any bone involvement caused by the tumor, but not to confirm diagnosis. The MRA scan provides pictures specifically of blood vessels inside the body.

Which does the nurse teach the patient is a modifiable risk factor for stroke? 1 Age 2 Gender 3 Obesity 4 Family history of hypertension

3 Obesity Obesity is a modifiable risk factor for stroke; a patient can lose weight with certain lifestyle changes. Age, gender, and family history of hypertension are risk factors for stroke, but they are not modifiable.

Which describes secondary brain injuries? 1 Result in contusion 2 Caused by indirect forces 3 Occur after the initial injury 4 Cause additional injuries in the body

3 Occur after the initial injury Secondary brain injuries are injuries that occur after the initial injury and worsen the patient's outcome. They do not always result in contusion. Secondary injuries do not cause additional injuries, though they can negatively affect other physiological processes. Secondary brain injuries are not necessarily caused by indirect forces.

Which injury is characterized by a fractured skull? 1 Diffuse injury 2 Deceleration injury 3 Open traumatic brain injury 4 Closed traumatic brain injury

3 Open traumatic brain injury An open traumatic brain injury occurs when the skull is fractured or when it is pierced by a penetrating object. Diffuse injuries are characterized by damage throughout many areas of the brain. A deceleration injury occurs when the moving head is suddenly stopped or hits a stationary object. Closed traumatic brain injuries are caused by blunt force. The blunt force can either be direct or caused by a blast shockwave.

A patient is having difficulty understanding spoken and written words and is saying made-up words and meaningless speech. What would be the possible reason behind the patient's condition? 1 Mixed aphasia 2 Global aphasia 3 Receptive aphasia 4 Expressive aphasia

3 Receptive aphasia Receptive aphasia occurs due to injury in Wernicke's area in the temporoparietal area. This leads to the patient having difficulty understanding spoken and written words, creating made-up words, and using meaningless speech. Mixed aphasia is difficulty in expression and reception, which includes difficulty speaking and writing. Global aphasia occurs due to severe damage in the receptive and expressive skills. Expressive aphasia occurs due to difficulty speaking and writing.

What is considered a late postoperative complication following craniotomy? 1 Hematoma 2 Hydrocephalus 3 Wound infection or abscess 4 Increased intracranial pressure (ICP)

3 Wound infection or abscess A late postoperative complication following craniotomy is the development of a wound infection or abscess. Hematomas may occur in the subdural or epidural layers and are usually early complications. Hydrocephalus is an early postoperative complication. Increased ICP is also an early complication.

How many categories are on the National Institutes of Health Stroke Scale (NIHSS)? 1 8 2 9 3 10 4 11

4 11 There are 11 categories of the NIHSS including level of consciousness (LOC), LOC questions, and LOC commands; best gaze; visual; facial palsy; motor (arm); motor (leg); limb ataxia; sensory; best language; dysarthria; and extinction and inattention. There are more categories in the NIHSS than 8, 9, or 10.

An injury that is caused by an external force contacting the head, placing the head in sudden motion, is known as what? 1 Focal injury 2 Diffuse injury 3 Deceleration injury 4 Acceleration injury

4 Acceleration injury An acceleration injury is one in which an external force contacts the head and places the head in sudden motion. A deceleration injury occurs when the moving head is suddenly stopped or hits a stationary object. A focal injury is confined to a specific area of the brain. A diffuse injury is when many areas of the brain are damaged.

Which ethnic group has the highest prevalence of stroke? 1 Asians and Caucasians 2 Hispanic men and women 3 African-American men and women 4 American Indians and Alaskan Natives

4 American Indians and Alaskan Natives

Which abnormality occurs during embryonic development? 1 Aneurysm 2 Vasospasm 3 Atherosclerosis 4 Arteriovenous malformation

4 Arteriovenous malformation Arteriovenous malformation is very rare and occurs during embryonic development. Aneurysm occurs due to a condition that leads to weakening of artery walls such as atherosclerosis and hypertension. Vasospasm happens when bleeding occurs due to aneurysm or arteriovenous malformation. Atherosclerosis occurs due to decrease in blood supply because of thrombosis. These abnormalities are not limited to the embryonic development stage.

A patient hospitalized for hypertension presses the call light and reports "feeling funny." When the nurse gets to the room, the patient is slurring words and has right-sided weakness. What does the nurse do first? 1 Calls the provider 2 Performs a neurologic check 3 Assists the patient to a sitting position 4 Assesses airway, breathing, and circulation

4 Assesses airway, breathing, and circulation The patient must be evaluated within 10 minutes of having a stroke. The priority is assessment of ABCs: airway, breathing, and circulation. Calling the Rapid Response Team, not the provider, after assessing ABCs would be appropriate. A neurologic check may be performed later, but is not the priority in this situation. A sitting position is used for hyperreflexia in the patient with spinal cord injury to assist in lowering blood pressure.

The nurse is assessing a patient with a traumatic brain injury (TBI) after a skateboarding accident. Which symptom would concern the nurse the most? 1 Amnesia 2 Restlessness 3 Head laceration 4 Asymmetrical pupils

4 Asymmetrical pupils Asymmetric (uneven) pupils, loss of light reaction, or unilateral or bilateral dilated pupils are a sign of a severe traumatic brain injury. Pupil changes are treated as herniation of the brain from increased intracranial pressure (ICP) until proven differently. The nurse should report and document any changes in pupil size, shape, and reactivity to the health care provider immediately because they could indicate an increase in ICP. Amnesia, a head laceration, and restlessness can be symptoms of mild traumatic brain injuries.

A patient is diagnosed with an acoustic neuroma. Which cranial nerve (CN) is affected by an acoustic neuroma? 1 CN I 2 CN V 3 CN X 4 CN VIII

4 CN VIII Acoustic neuromas arise from the sheath of Schwann cells in the peripheral part of CN VIII, resulting in hearing and balance difficulties. Damage to CN I may result in the inability to smell, a distortion in the sense of smell, or lack or distortion of taste. CN V is the trigeminal nerve responsible for sensation in the face and motor functions such as biting and chewing. CN X is the vagus nerve which interfaces with the parasympathetic control of the heart, lungs, and digestive tract.

Which brain injury is caused by blunt force? 1 Acceleration injury 2 Deceleration injury 3 Open traumatic brain injury 4 Closed traumatic brain injury

4 Closed traumatic brain injury Closed traumatic brain injuries are caused by blunt force, which can either be direct or a result of a blast shockwave. An acceleration injury is caused by an external force contacting the head, suddenly placing the head in motion. A deceleration injury occurs when the moving head is suddenly stopped or hits a stationary object. An open traumatic brain injury occurs when the skull is fractured or pierced by a penetrating object.

A patient experienced a stroke that caused damage to Broca's area. The nurse expects the patient to experience what phenomenon as a result of this injury? 1 Stuttering 2 Dysarthria 3 Receptive aphasia 4 Expressive aphasia

4 Expressive aphasia The patient with damage to Broca's area will experience expressive aphasia, which is the result of damage to Broca's area of the frontal lobe; it is a motor speech problem in which the patient generally understands what is being said but cannot communicate verbally. Writing skills are also affected. Rote speech and automatic speech such as responses to a greeting are often intact. Receptive aphasia is due to injury involving Wernicke's area in the temporoparietal area; patients cannot understand the spoken and often the written word, and language is often meaningless. Dysarthria is due to a loss of motor function to the tongue or to the muscles of speech, causing facial weakness and slurred speech. Patients with damage to Broca's area will not experience stuttering.

A patient with a brain tumor is experiencing increased intracranial pressure (ICP) resulting from obstruction of the flow of cerebral spinal fluid. What is this complication called? 1 Tinnitus 2 Decorticate 3 Decerebrate 4 Hydrocephalus

4 Hydrocephalus Increased ICP due to obstruction of the flow of cerebral spinal fluid is called hydrocephalus. Decerebrate is a term used to describe abnormal body posturing that involves the arms and legs being held straight out, the toes being pointed downward, and the head and neck being arched backward. Tinnitus is ringing in the ears. Decorticate is a term used to describe abnormal body posturing with the arms flexed or bent inward on the chest, hands clenched into fists, and the legs extended and feet turned inward.

Which treatment beams are widely dispersed over the surface of the head to prevent damage to healthy brain tissue? 1 Brachytherapy 2 Chemotherapy 3 Interstitial radiation therapy 4 Stereotactic radiation therapy

4 Stereotactic radiation therapy Stereotactic radiation therapy beams are widely dispersed over the surface of the head to prevent damage to the healthy brain tissue. Chemotherapy may also be used as an adjunctive therapy for tumors that have metastasized to the spinal cord from other primary sites. In brachytherapy radiation, source comes into direct, continuous contact with the tumor for a specific time period. Interstitial radiation therapy is another name for brachytherapy radiation.

If a patient has a traumatic brain injury (TBI) with ataxia, what does that mean? 1 The patient has hypotension. 2 The patient has a blood clot. 3 The patient cannot see colors. 4 The patient has a loss of balance.

4 The patient has a loss of balance. Ataxia means loss of balance. Ataxia does not mean that the patient has hypotension, a blood clot, or an inability to see colors.

A patient with a brain tumor is prescribed lansoprazole (Prevacid). What is the purpose of lansoprazole for this patient? 1 To control nausea and vomiting 2 To decrease the blood pressure 3 To increase gastric acid secretion 4 To prevent development of stress ulcers

4 To prevent development of stress ulcers The purpose of prescribing lansoprazole (Prevacid), a proton-pump inhibitor (PPI), for a patient with a brain tumor is to decrease acid secretion and prevent development of a stress ulcer. Antiemetic agents such as ondansetron (Zofran) are used to control nausea and vomiting. PPIs do not increase gastric acid secretion; rather, they decrease gastric acid secretion. Thiazide diuretics, beta blockers, and calcium channel blockers are among the classes of drugs that treat hypertension; PPIs are not in this group.