Neuro

A client preparing to undergo a lumbar puncture states he doesn't think he will be able to get comfortable with his knees drawn up to his abdomen and his chin touching his chest. He asks if he can lie on his left side. Which statement is the best response by the nurse? a) "Lying on your left side will be fine during the procedure." b) "I'll report your concerns to the physician." c) "There's no other option but to assume the knee-chest position." d) "Although the required position may not be comfortable, it will make the procedure safer and easier to perform."

"Although the required position may not be comfortable, it will make the procedure safer and easier to perform." The nurse should explain that the knee-chest position is necessary to make the procedure safer and easier to perform. Lying on his left side won't make the procedure easy or safe to perform. The nurse shouldn't simply tell the client there is no other option because the client is entitled to understand the rationale for the required position. Reporting the client's concerns to the physician won't meet the client's needs in this situation

A nurse knows that a patient exhibiting seizurelike movements localized to one side of the body most likely has what type of tumor? a) A frontal lobe tumor b) A motor cortex tumor c) A cerebellar tumor d) An occipital lobe tumor

A motor cortex tumor A tumor in the motor cortex of the frontal lobe produces hemiparesis and partial seizures on the opposite side of the body or generalized seizures. A frontal lobe tumor may also produce changes in emotional state and behavior, as well as an apathetic mental attitude. A cerebellar tumor causes dizziness; an ataxic or staggering gait with a tendency to fall toward the side of the lesion; marked muscle incoordination; and nystagmus (involuntary rhythmic eye movements), usually in the horizontal direction. An occipital lobe tumor produces visual manifestations: contralateral homonymous hemianopsia (visual loss in half of the visual field on the opposite side of the tumor) and visual hallucinations

You are caring for a male client who is scheduled for a neurologic examination that uses a radiopaque dye. Before the test, you assess the allergy history of the client and find the client is allergic to seafood. What does the nurse relate the allergy to seafood as? a) An allergy to antihistamines b) An allergy to iodine c) An allergy to morphine d) An allergy to radiation exposure

An allergy to iodine Because some contrast media contain iodine, the nurse checks the client's history for previous allergic reactions to radiographic dyes, iodine, or seafood. Seafood allergies indicate an allergy to iodine. Therefore, the nurse will have to manage the allergic reaction of the client by administering antihistamines or any other medications suggested by the physician. Alternatively, the physician may suggest another neurologic examination test that does not require the use of a radiopaque dye. Allergy to seafood does not indicate an allergy to morphine or radiation exposure.

A female patient has undergone a lumbar puncture for a neurological assessment. The patient is put under the postprocedure care of a nurse. Which of the following important postprocedure nursing interventions should be performed to ensure maximum comfort to the patient? a) Encourage a liberal fluid intake for the patient b) Help the patient take a brisk walk around the testing area c) Administer antihistamines according to the physician's prescription d) Keep the room brightly lit and play soothing music in the background

Encourage a liberal fluid intake for the patient The nurse should encourage the patient to take liberal fluids and inspect the injection site for swelling or hematoma. These measures help restore the volume of CSF extracted. The patient is administered antihistamines before a test only if he or she is allergic to contrast dye and contrast dye will be used. The room of the patient who has undergone a lumbar puncture should be kept dark and quiet. The patient should be encouraged to rest, because sensory stimulation tends to magnify discomfort.

Which of the following cerebral lobes is the largest and controls abstract thought? a) Temporal b) Occipital c) Frontal d) Parietal

Frontal The frontal lobe also controls information storage or memory and motor function. The temporal lobe contains the auditory receptive area. The parietal lobe contains the primary sensory cortex, which analyzes sensory information and relays interpretation to the thalamus and other cortical areas. The occipital lobe is responsible for visual interpretation

A nurse is caring for a client with lower back pain who is scheduled for myelography using metrizamide (a water-soluble contrast dye). After the test, the nurse should place the client in which position? a) Head of the bed elevated 45 degrees b) Prone c) Supine with the head lower than the trunk d) Supine with feet raised

Head of the bed elevated 45 degrees After a myelogram, positioning depends on the dye injected. When a water-soluble dye such as metrizamide is injected, the head of the bed is elevated to a 45-degree angle to slow the upward dispersion of the dye. The prone and supine positions are contraindicated when a water-soluble contrast dye is used. The client should be positioned supine with the head lower than the trunk after an air-contrast study.

A patient has recently been diagnosed with an acoustic neuroma. The nurse helps the patient understand that: a) Almost 80% of these tumors become malignant over time. b) Compression of the seventh cranial nerve is a side effect. c) Hearing loss usually occurs. d) Surgery is never needed; radiation has proven very effective.

Hearing loss usually occurs. An acoustic neuroma is a benign tumor of the eighth cranial nerve. About 50% can be treated with surgery. Hearing loss always occurs. Compression on the fifth cranial nerve can also cause facial paresthesia.

Which of the following areas of the brain are responsible for temperature regulation? a) Pons b) Thalamus c) Medulla d) Hypothalamus

Hypothalamus The hypothalamus also controls and regulates the autonomic nervous system and maintains temperature by promoting vasoconstriction or vasodilation. The thalamus acts primarily as a relay station for all sensation except smell. The medulla and pons are essential for respiratory function.

A patient with a brain tumor is complaining of headaches that are worse in the morning. What does the nurse know could be the reason for the morning headaches?

Increased intracranial pressure Headache, although not always present, is most common in the early morning and is made worse by coughing, straining, or sudden movement. It is thought to be caused by the tumor invading, compressing, or distorting the pain-sensitive structures or by edema that accompanies the tumor, leading to increased intracranial pressure.

What is the function of cerebrospinal fluid (CSF)? a) It cushions the brain and spinal cord. b) It acts as a barrier to bacteria. c) It produces cerebral neurotransmitters. d) It acts as an insulator to maintain a constant spinal fluid temperature.

It cushions the brain and spinal cord. CSF is produced primarily in the lateral ventricles of the brain. It acts as a shock absorber and cushions the spinal cord and brain against injury caused by sudden or extreme movement. CSF also functions in the removal of waste products from cerebral tissue. CSF doesn't act as an insulator or a barrier and it doesn't produce cerebral neurotransmitters.

A nurse is assisting during a lumbar puncture. How should the nurse position the client for this procedure? a) Prone, with the head turned to the right b) Lateral, with right leg flexed c) Lateral recumbent, with chin resting on flexed knees d) Supine, with the knees raised toward the chest

Lateral recumbent, with chin resting on flexed knees To maximize the space between the vertebrae, the client is placed in a lateral recumbent position with knees flexed toward the chin. The needle is inserted between L4 and L5. The other positions wouldn't allow as much space between L4 and L5.

A nurse helps a patient recently diagnosed with a pituitary adenoma understand that: a) Most tumors produce too much of one or more hormones. b) Most tumors are malignant (>90%). c) Transcranial surgery is usually necessary to remove the tumor. d) The cause is directly related to prior exposure to radiation.

Most tumors produce too much of one or more hormones. The majority of these tumors are benign. In rare cases, they may be malignant. Functioning tumors produce hormones, frequently in excessive amounts, resulting in conditions such as hyperthyroidism, Cushing's syndrome, and gigantism or acromegaly.

Which of the following cranial nerves is responsible for muscles that move the eye and lid? a) Facial b) Oculomotor c) Trigeminal d) Vestibulocochlear

Oculomotor The oculomotor (III) cranial nerve is also responsible for pupillary constriction and lens accommodation. The trigeminal (V) cranial nerve is responsible for facial sensation, corneal reflex, and mastication. The vestibulocochlear (VII) cranial nerve is responsible for hearing and equilibrium. The facial (VII) nerve is responsible for salivation, tearing, taste, and sensation in the ear

Which of the following cerebral lobes contains the auditory receptive areas? a) Parietal b) Temporal c) Frontal d) Occipital

Temporal The temporal lobe plays the most dominant role of any area of the cortex in cerebration. The frontal lobe, the largest lobe, controls concentration, abstract thought, information storage or memory, and motor function. The parietal lobe contains the primary sensory cortex, which analyzes sensory information and relays interpretation to the thalamus and other cortical areas. The occipital lobe is responsible for visual interpretation

A patient is actively hallucinating during an assessment. The nurse would be correct in documenting the hallucination as a disturbance in which of the following? a) Motor ability b) Thought content c) Intellectual function d) Emotional status

Thought content Hallucinations are a disturbance of thought content. They are not disturbances in motor ability, intellectual function, or emotional status.

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

"Avoid stimulants and alcohol for 24 to 48 hours before the test." For 24 to 48 hours before an EEG, the client should avoid coffee, cola, tea, alcohol, and cigarettes because these may interfere with the accuracy of test results. (For the same reason, the client also should avoid antidepressants, sedatives, and anticonvulsants.) To avoid a reduced serum glucose level, which may alter test results, the client should eat normal meals before the test. The hair should be washed before an EEG because the electrodes must be applied to a clean scalp. The client's thoughts don't affect the test results.

A patient recently noted difficulty maintaining his balance and controlling fine movements. The nurse explains that the provider will order diagnostic studies for the part of his brain known as the: a) Midbrain. b) Pons. c) Medulla oblongata. d) Cerebellum.

Cerebellum. The cerebellum is largely responsible for coordination of all movement. It also controls fine movement, balance, position (postural) sense or proprioception (awareness of where each part of the body is), and integration of sensory input.

After a plane crash, a client is brought to the emergency department with severe burns and respiratory difficulty. The nurse helps to secure a patent airway and attends to the client's immediate needs, then prepares to perform an initial neurologic assessment. The nurse should perform an: a) assessment of the client's gait. b) examination of the fundus of the eye. c) evaluation of the corneal reflex response. d) evaluation of bowel and bladder functions.

evaluation of the corneal reflex response. During an acute crisis, the nurse should check the corneal reflex response to rapidly assess brain stem function. Other components of the brief initial neurologic assessment usually include level of consciousness, pupillary response, and motor response in the arms and legs. If appropriate and if time permits, the nurse also may assess sensory responses of the arms and legs. Emergency assessment doesn't include fundus examination unless the client has sustained direct eye trauma. The client shouldn't be moved unnecessarily until the extent of injuries is known, making gait evaluation impossible. Bowel and bladder functions aren't vital, so the nurse should delay their assessment.

A patient is exhibiting bradykinesia, rigidity, and tremors related to Parkinson's disease. The nurse understands that these symptoms are directly related to what decreased neurotransmitter level? a) Serotonin b) Dopamine c) Acetylcholine d) Phenylalanine

Dopamine Parkinson's disease is associated with decreased levels of dopamine resulting from degeneration of dopamine storage cells in the substantia nigra in the basal ganglia region of the brain

The critical care nurse is giving report on a client they are caring for. The nurse uses the Glasgow Coma Scale (GCS) to assess the level of consciousness (LOC) of a female client and reports to the on-coming nurse that the client has an LOC of 6. What does an LOC score of 6 in a client indicate? a) Comatose b) Stupor c) Somnolence d) Normal

Comatose The GSC is used to measure the LOC. The scale consists of three parts: eye opening response, best verbal response, and best motor response. A normal response is 15. A score of 7 or less is considered comatose. Therefore, a score of 6 indicates the client is in a state of coma, and not in any other state such as stupor or somnolence. The evaluations are recorded on a graphic sheet where connecting lines show an increase or decrease in the LOC.

A nurse and nursing student are caring for a client recovering from a lumbar puncture yesterday. The client reports a headache despite being on bedrest overnight. The physician plans an epidural blood patch this morning. The student asks how this will help the headache. The correct reply from the nurse is which of the following? a) "The blood will replace the cerebral spinal fluid that has leaked out." b) "The blood provides moisture at the site, which encourages healing." c) "The blood can repair damage to the spinal cord that occurred with the procedure." d) "The blood will seal the hole in the dura and prevent further loss of cerebral spinal fluid."

"The blood will seal the hole in the dura and prevent further loss of cerebral spinal fluid." Loss of CSF causes the headache. Occasionally, if the headache persists, the epidural blood patch technique may be used. Blood is withdrawn from the antecubital vein and injected into the site of the previous puncture. The rationale is that the blood will act as a plug to seal the hole in the dura and preven further loss of CSF. The blood is not put into the subarachnoid space. The needle is inserted below the level of the spinal cord, which prevents damage to the cord. It is not a lack of moisture that prevents healing; it is more related to the size of the needle used for the puncture

A client with a suspected brain tumor is scheduled for a computed tomography (CT) scan. What should the nurse do when preparing the client for this test? a) Immobilize the neck before the client is moved onto a stretcher. b) Administer a sedative as ordered. c) Place a cap over the client's head. d) Determine whether the client is allergic to iodine, contrast dyes, or shellfish.

Determine whether the client is allergic to iodine, contrast dyes, or shellfish. Because CT commonly involves use of a contrast agent, the nurse should determine whether the client is allergic to iodine, contrast dyes, or shellfish. Neck immobilization is necessary only if the client has a suspected spinal cord injury. Placing a cap over the client's head may lead to misinterpretation of test results; instead, the hair should be combed smoothly. The physician orders a sedative only if the client can't be expected to remain still during the CT scan.

The nurse is performing an assessment for a patient in the clinic with Parkinson's disease. The nurse determines that the patient's voice has changed since the last visit and is now more difficult to understand. How should the nurse document this finding? a) Hypokinesia b) Dysphonia c) Dysphagia d) Micrographia

Dysphonia Dysphonia (voice impairment or altered voice production) may occur as a result of weakness and incoordination of the muscles responsible for speech.

Which of the following terms is used to describe edema of the optic nerve? a) Scotoma b) Angioneurotic edema c) Papilledema d) Lymphedema

Papilledema Papilledema is edema of the optic nerve. Scotoma is a defect in vision in a specific area in one or both eyes. Lymphedema is the chronic swelling of an extremity due to interrupted lymphatic circulation, typically from an axillary dissection. Angioneurotic edema is a condition characterized by urticaria and diffuse swelling of the deeper layers of the skin.

The nurse is caring for a patient with Huntington's disease in the long-term care facility. What does the nurse recognize as the most prominent symptom of the disease that the patient exhibits? a) Slow, shuffling gait b) Dysphagia and dysphonia c) Rapid, jerky, involuntary movements d) Dementia

Rapid, jerky, involuntary movements The most prominent clinical features of the disease are chorea rapid, jerky, involuntary, purposeless movements), impaired voluntary movement, intellectual decline, and often personality changes

The nurse is performing a neurological assessment of a client who has sustained damage to the frontal cortex. Which of the following deficits will the nurse look for during assessment? a) The inability to maintain steady balance for the Romberg test b) The inability to tell how a mouse and a cat are alike c) Absence of movement below the waist d) Intentional tremors

The inability to tell how a mouse and a cat are alike The client with damage to the fronal cortex will display a deficit in intellectual functioning. Questions designed to assess this capacity might include the ability to recognize similarities: for example, how are a mouse and dog or pen and pencil alike? The Romberg test assesses balance, which has to do with the cerebellar and basal ganglia influence on the motor system. Absence of movement below the waist suggests a deficit with the spinal cord. Intentional tremors have to do with deficits of the motor system

Which of the following diagnostic studies provides visualization of cerebral blood vessels? a) Computer-assisted stereotactic biopsy b) Cerebral angiography c) Cytologic studies of cerebrospinal fluid (CSF) d) Positron emission tomography (PET)

Cerebral angiography Correct Explanation: Cerebral angiography provides visualization of cerebral blood vessels and can localize most cerebral trauma. A PET scan measures the brain's activity and is useful in differentiating tumor from scar tissue or radiation necrosis. Cytologic studies of the cerebral spinal fluid (CSF) may be performed to detect malignant cells because central nervous system tumors can shed cells into the CSF. Computer-assisted stereotactic biopsy is being used to diagnose deep-seated brain tumors

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

Parietal 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.

Cushing's triad is a late sign of increased intracranial pressure (ICP). Which of the following clinical manifestations correlate with Cushing's triad? a) Widening pulse pressure b) Hypotension c) Tachycardia d) Tachypnea

Widening pulse pressure Late signs associated with rising ICP related to the vital signs (Cushing's triad) include hypertension with a widening pulse pressure, bradycardia, and respiratory depression.

A female client has undergone a lumbar puncture for a neurological assessment. The client is put under the post-procedure care of a nurse. Which of the following important post-procedure nursing interventions should be performed to ensure maximum comfort to the client? Choose all that apply. a) Shampoo the hair of the client with warm water. b) Keep the room brightly lit and play soothing music in the background. c) Position the client flat for at least three hours or as directed by the physician. d) Encourage a liberal fluid intake for the client.

• Position the client flat for at least three hours or as directed by the physician. • Encourage a liberal fluid intake for the client. The nurse should encourage the client to take liberal fluids and inspect the injection site for swelling or hematoma.