Neuro Exam Vocabulary and Practice Questions

Stroke

A sudden attack of weakness or paralysis that occurs when blood flow to an area of the brain is interrupted, resulting in death of brain cells

Dysarthria

Muscles used for speech are weak and have difficulty controlling them, causing slow/slurred speech

Vasogenic cerebral edema increases intracranial pressure by A. Shifting fluid in the gray matter B. Altering the endothelial lining of the cerebral capillaries C. Leaking molecules from the intercellular fluid to the capillaries D. Altering the osmotic gradient flow into the intravascular component

B. Altering the endothelial lining of the cerebral capillaries

Subarachnoid hemorrhage

Bleeding into the subarachnoid space, where the cerebrospinal fluid circulates.

Platelets

Blood cell involved in clotting

Thrombosis

Clotting of blood in circulatory system

Dissection

Creation of false lumen between inner lining and middle layer of arterial wall

Depression

Mental health disorder characterized by persistently depressed mood or loss of interest

Common psychosocial reactions of the stroke patient to the stroke include (select all that apply) a. depression. b. disassociation. c. intellectualization. d. sleep disturbances. e. denial of severity of stroke.

a. depression. d. sleep disturbances. e. denial of severity of stroke.

Possible social effects of a chronic neurologic disease include (select all that apply) a. divorce. b. job loss. c. depression. d. role changes. e. loss of self-esteem.

a. divorce. b. job loss. c. depression. d. role changes. e. loss of self-esteem.

A patient is suspected of having a brain tumor. The signs and symptoms include memory deficits, visual changes, weakness of right upper and lower extremities, and personality changes. The nurse determines that the tumor is most likely located in the... a. frontal lobe b. parietal lobe c. occipital lobe d. temporal lobe

a. frontal lobe

the nurse identifies the concept of intracranial regulation disturbance in a client diagnosed with Parkinson's disease. Which priority intervention should the nurse implement? a. keep the bed low and call light in reach b. provide a regular diet of three meals per day c. obtain an order for home health to see the client d. perform the Braden scale skin assessment

a. keep the bed low and call light in reach

Which priority goal would the nurse identify for a client diagnosed with Parkinson's disease? a. the client will be able to maintain mobility and swallow without aspiration b. the client will verbalize feelings about the diagnosis of Parkinson's disease c. the client will understand the purpose of medications administered for the disease d. the client will have a home health agency for monitoring at home

a. the client will be able to maintain mobility and swallow without aspiration

Post stroke fatigue

arrives without warning; physical, mental, and emotional exhaustion

The client newly diagnosed with Parkinson's disease asks the nurse, "Why can't I control these tremors?" Which is the nurse's best response? a. "You can control the tremors when you learn to concentrate and focus on the cause." b. "The tremors are caused by a lack of dopamine in the brain; medication may help." c. "You have too much acetylcholine in your brain, causing the tremors, but they will get better with time." d. "You are concerned about the tremors? If you want to talk, I would like to hear how you feel."

b. "The tremors are caused by a lack of dopamine in the brain; medication may help."

Which phrase describes why a lumbar puncture is preformed when meningitis is suspected? a. To identify the presence of blood b. To determine the causative agent c. To reduce the intracranial pressure d. To measure the spinal fluid glucose level

b. To determine the causative agent

Which assessment would the nurse perform specific to the safe administration of intravenous mannitol? a. Body weight daily b. Urine output hourly c. Vital signs every 2 hours d. Level of consciousness every 8 hours

b. Urine output hourly

Which patient has the highest risk for having a stroke? a. an obese 45 year old Native American b. a 65 year old black man with hypertension c. a 35 year old Asian American woman who smokes d. a 32 year old white woman taking oral contraceptives

b. a 65 year old black man with hypertension

The client diagnosed with atrial fibrillation reports numbness and tingling of her left arm and leg. The nurse assesses facial drooping on the left side and slight slurring of speech. Which nursing intervention should the nurse implement first? a. schedule STAT MRI of the brain b. call a code STROKE c. notify the HCP d. have the client swallow a glass of water

b. call a code STROKE

A nursing measure that can reduce the potential for seizures and increased intracranial pressure in the patient with bacterial meningitis is... a. administering codeine for relief of head and neck pain b. controlling fever with prescribed drugs and cooling techniques c. maintaining strict bed rest with the head of the bed slightly elevated d. keeping the room dark and quiet to minimize environmental stimulation

b. controlling fever with prescribed drugs and cooling techniques

A nurse plans care for a patient with increased intracranial pressure with the knowledge that the best way to position the patient is to... a. keep the head of the bed flat b. elevate the head of the bed to 30 degrees c. maintain patient on the left side with the head supported on a pillow d. use a continuous rotation bed to continuously change the patient's position

b. elevate the head of the bed to 30 degrees

Which clinical finding would the nurse expect when assessing a client with myasthenia gravis? a. partial improvement of muscle strength with mild exercise b. fluctuating weakness of muscles innervated by the cranial nerves c. dramatic worsening in muscle strength with anticholinesterase medication d. minimal changes in muscle strength regardless of the therapy initiated

b. fluctuating weakness of muscles innervated by the cranial nerves

For a patient who is suspected of having a stroke, one of the most important pieces of information that the nurse can obtain is a. time of the patient's last meal. b. time at which stroke symptoms first appeared. c. patient's hypertension history and management. d. family history of stroke and other cardiovascular diseases.

b. time at which stroke symptoms first appeared.

Aneurysm

ballooning of a weakened portion of an arterial wall

Intracerebral hemorrhage

bleeding into the brain as a result of a ruptured blood vessel within the brain

Transient Ischemic Attack (TIA)

brief episode of loss of blood flow to the brain, usually caused by a partial occlusion that results in temporary neurologic deficit (impairment); often precedes a CVA

Atherosclerosis

buildup of plaque or fatty paste inside arterial walls, causing narrowing of vessels

The client with which National Institutes of Health Stroke Scale (NIHSS) score would the receive priority nursing care first? a. 0 for dysarthria b. 1 for lumb ataxia c. 3 for facial palsy d. 0 for level of consciousness

c. 3 for facial palsy

Which possible cause would the nurse suspect in a client with a head injury who has a fixed, dilated right pupil, responds only to painful stimuli, and exhibits flexion (decorticate) posturing? a. Meningeal irritation b. Subdural hemorrhage c. Cerebral compression d. Medullary compression

c. Cerebral compression

Four clients who sustained head injuries are presented here. Which client has the lowest score on the Glasgow Coma Scale? a. Patient A- able to open eyes spontaneously, localize pain, and able to respond to verbal commands b. Patient B- able to open eyes to sound, sensation and localized pain, and conversation is confused c. Patient C- able to open eyes to pain stimulus, normal flexion to pain, with inappropriate words d. Patient D- able to open eyes to pain stimulus, localize pain, with confused verbal response

c. Patient C

How would the nurse describe the clonic phase of a tonic-clonic seizure? a. Generalized rigidity b. Loss of consciousness c. Rhythmic body jerking d. Tremors of upper extremities

c. Rhythmic body jerking

The nurse on the clinical unit is assigned to four patients. Which patient should she assess first? a. patient with a skull fracture whose nose is bleeding b. an elderly patient with a stroke who is confused and whose daughter is present c. a patient with meningitis who is suddenly agitated and reporting a HA of 10 on a 0 to 10 scale d. a patient who had a craniotomy for a brain tumor who is now 3 days postoperative and has had continued emesis

c. a patient with meningitis who is suddenly agitated and reporting a headache of 10 on a 0 to 10 scale

The 80 year old male client on an Alzheimer's unit is agitated and asking the nurse to get his father to come and see him. Which is the nurse's best response? a. tell the client his father is dead and cannot come to see him b. give the client the phone and have him attempt to call his father c. ask the client to talk about his father with the nurse d. call the family so they can tell the client why his father cannot come to see him

c. ask the client to talk about his father with the nurse

Nursing management of a patient with a brain tumor includes (select all that apply) a. discussing with the patient methods to control inappropriate behavior b. using diversion techniques to keep the patient stimulated and motivated c. assisting and supporting the family in understanding any changes in behavior d. limiting self-care activities until the patient has regained maximum physical functioning e. planning for seizure precautions and teaching the patient and the caregiver about anti-seizure drugs

c. assisting and supporting the family in understanding any changes in behavior e. planning for seizure precautions and teaching the patient and the caregiver about anti-seizure drugs

Bladder training in a male patient who has urinary incontinence after a stroke includes a. limiting fluid intake. b. keeping a urinal in place at all times. c. assisting the patient to stand to void. d. catheterizing the patient every 4 hours.

c. assisting the patient to stand to void.

The nurse is alerted to a possible acute subdural hematoma in the patient who a. has a linear skull fracture crossing a major artery b. has focal symptoms of brain damage with no recollection of a head injury c. develops decreased level of consciousness and a headache within 48 hours of a head injury d. has an immediate loss of consciousness with a brief lucid interval followed by decreasing level of consciousness

c. develops decreased level of consciousness and a headache within 48 hours of a head injury

A patient is having word finding difficulty and weakness in his right arm. What area of the brain is most likely involved? a. brainstem b. vertebral artery c. left middle cerebral artery d. right middle cerebral artery

c. left middle cerebral artery

The nurse explains to the patient with a stroke who is scheduled for angiography that this test is used to determine the a. presence of increased ICP. b. site and size of the infarction. c. patency of the cerebral blood vessels. d. presence of blood in the cerebrospinal fluid.

c. patency of the cerebral blood vessels.

A patient having TIAs is scheduled for a carotid endarterectomy. The nurse explains that this procedure is done to... a. decrease cerebral edema b. reduce the brain damage tht occurs during a stroke in evolution c. prevent a stroke by removing atherosclerotic plaques blocking cerebral blood flow d. provide a circulatory bypass around thrombotic plaques obstructing cranial circulation

c. prevent a stroke by removing atherosclerotic plaques blocking cerebral blood flow

A 65 year old woman was just diagnosed with Parkinson's disease. The priority nursing intervention is... a. searching the internet for educational videos b. helping the caregiver explore respite care options c. promoting physical exercise and a well balanced diet d. teaching about the benefits and risks of ablation surgery

c. promoting physical exercise and a well balanced diet

The nurse is caring for a client diagnosed with ICP and secretions pooled in the throat. Which intervention should the nurse implement first? a. set the ventilator to hyperventilate the client in preparation for suctioning b. assess the client's lung sounds and check for peripheral cyanosis c. turn the client to the side to allow the secretions to drain from the mouth d. suction the client using the in-line suction, wait 30 seconds, and repeat

c. turn the client to the side to allow the secretions to drain from the mouth

CSF

clear, colorless liquid that fills the ventricles and canals of CNS

The nurse is reinforcing teaching with a patient newly diagnosed with amyotrophic lateral sclerosis (ALS) . Which statement would be appropriate to include in the teaching? a. "Even though the symptoms you have are severe, most people recover with treatment." b. "ALS results from excess chemicals in the brain, so symptoms can be controlled with medication." c. "You need to consider advance directives now, because you will lose cognitive function as the disease progresses." d. "This is a progressing disease that eventually results in permanent paralysis, though you will not lose any cognitive function."

d. "This is a progressing disease that eventually results in permanent paralysis, though you will not lose any cognitive function."

The nurse observes abnormal rigidity with pronation of the arms and plantar flexion while assessing a client. Which condition would the nurse record in the assessment findings? a. Decortication b. Pronator drift c. Babinski sign d. Decerebration

d. Decerebration

Which goal would the nurse include in the plan of care to address dysarthria in a client after a stroke? a. Routine hygiene b. Balanced nutrition c. Prevention of aspiration d. Effective communication

d. Effective communication

The nurse is performing a GCS assessment on a client diagnosed with a problem with intracranial regulation. The client's GCS 1 hours ago was scored at a 10. Which data indicate the client is improving? a. GCS rating of 3 b. GSC rating of 9 c. GCS rating of 10 d. GCS rating of 12

d. GCS rating of 12

Initially after a stroke, the client's pupils are equal and reactive to light. Four hours later, the nurse identifies that one pupil reacts more slowly than the other and client's systolic blood pressure is increasing. For which condition would the nurse prepare to intervene? a. Spinal shock b. Brain herniation c. Hypovolemic shock d. Increased intracranial pressure

d. Increased intracranial pressure

Which clinical finding is consistent with an increase in intracranial pressure? a. thready, weak pulse b. Narrowing pulse pressure c. Regular, shallow breathing d. Lowered Level of Consciousness

d. Lowered Level of Consciousness

A patient with intracranial pressure monitoring has a pressure of 12 mmHg. The nurse understands that this pressure reflects... a. a severe alteration in the production of cerebrospinal fluid b. an alteration in the production of cerebrospinal fluid c. the loss of auto regulatory control of intracranial pressure d. a normal balance among brain tissue, blood, and cerebrospinal fluid

d. a normal balance among brain tissue, blood, and cerebrospinal fluid

The factor related to cerebral blood flow that most often determines the extent of cerebral damage form a stroke is the... a. O2 content of the blood b. amount of cardiac output c. level of CO2 in the blood d. degree of collateral circulation

d. degree of collateral circulation

The ICU nurse is admitting a client diagnosed with a TBI. Which HCP medication order would the nurse question? a. dexamethason b. 0.9% NS c. nicotine patch d. morphine sulfate

d. morphine sulfate narcotics are contraindicated until is is known that the patient is neurologically stable

The nurse finds an 87 year old patient is continually rubbing, flexing, and kicking her legs throughout the day. The night shift reports this same behavior escalates at night, preventing her from obtaining sleep. The next step the nurse should take is to... a. ask the provider for a daytime sedative for the patient b. request soft restraints to prevent her from falling out of her bed c. ask the provider for a nighttime sleep medication for the patient d. perform an assessment, suspecting a disorder such as restless leg syndrome

d. perform an assessment, suspecting a disorder such as restless leg syndrome

The concept for intracranial regulation is identified for a client diagnosed with a brain tumor. Whcih intervention should the nurse include in the client's plan of care? a. tell the client to remain on bedrest b. maintain the IV rate at 150mL/hr c. provide a soft, bland diet with three snacks per day d. place the client on seizure precautions

d. place the client on seizure precautions

Information provided by the patient that would help distinguish a hemorrhagic stroke from a thrombotic stroke includes... a. sensory changes b. a history of hypertension c. presence of motor weakness d. sudden onset of severe headache

d. sudden onset of severe headache

Dysphagia

difficulty swallowing

Cerebrovascular disease

disorder resulting from a change within one or more blood vessels of the brain

DVT (deep vein thrombosis)

formation of a blood clot in a deep vein of the body, occuring most commonly in the legs or thighs

Aphasia

impairment of language, usually caused by left hemisphere damage either to Broca's area (impairing speaking) or to Wernicke's area (impairing understanding).

Apraxia

inability to perform particular purposive actions, as a result of brain damage.

Stenosis

narrowing

Central Stroke Pain (Central Pain Syndrome)

neurological disorder caused by damage to the sensory pathways of the CNS

Hemorrhagic stroke

occurs when a blood vessel in the brain leaks or ruptures; also known as a bleed

Hemiplegia

paralysis of one side of the body

hemiparesis

slight paralysis or weakness affecting one side of the body

Cardio-embolic stroke

stroke resulting from a source of the heart.

Agnosia

the inability to recognize familiar objects.

The 28 year old client is on the rehab unit post SCI at level T10. Which collaborative team members should participate with the RN at the case conference? - OT - PT - registered dietician - rehab physician - social worker - patient care tech

- OT - PT - registered dietician - rehab physician - social worker

Which intervention should the nurse implement to decrease ICP for a client on a ventilator? - position the client with the HOB up 30 degrees - cluster activities of care - suction the client every 3 hours - administer soapsuds enemas until clear - place the client in Trendelenburg position

- position the client with the HOB up 30 degrees - cluster activities of care

The male client is admitted to the ED following a motorcycle accident. The client was not wearing a helmet and struck his head on the pavement. The nurse identifies the concept as impaired intracranial regulation. Which interventions should the nurse implement in the first 5 minutes? - stabilize the client's neck and spine - contact the organ procurement organization to speak with the family - elevate the HOB to 30 degrees - perform a GCS assessment - ensure the client has a patent peripheral venous catheter in place - check the client's driver's license to see if he will accept blood

- stabilize the client's neck and spine - perform a GCS assessment - ensure the client has a patent peripheral venous catheter in place

Which diagnostic evaluation tool would the nurse use to assess the client's cognitive functioning? - the geriatric depression scale - the St. Louis university mental status scale - the mini-mental status examination scale - the manic depression vs elderly depression scale - the functional independence measurement scale

- the St. Louis university mental status scale - the mini-mental status examination scale

embolus

A clot that breaks lose and travels through the bloodstream.

Hypoxia

Lack of blood supply causing surrounding nerve cells to be cut off from nutrients and oxygen

Ischemic stroke

Inadequate blood flow to the brain from partial or complete occlusion of artery or vein

Acute stroke

Stroke, a sudden neurologic deficit of presumed vascular origin, is a clinical syndrome rather than a single disease.

carotid artery

The major artery that supplies blood to the head and brain.

Cognitive impairment

When a person has trouble remembering, learning new things, concentrating, or making decisions that affect everyday life

Seizure

Transient uncontrolled electrical discharge of neurons in the brain that interrupts normal function

Which intervention would the nurse perform first for the client admitted with a closed head injury and increased intracranial pressure (ICP)? a. Place the head and neck in neutral alignment b. Obtain a prescription for 100 mg of pentobarbital IV c. Administer 1 g mannitol intravenously (IV) as prescribed d. Increase the ventilator's respiratory rate to 20 breaths/minute

a. Place the head and neck in neutral alignment

Which nursing action would the nurse implement immediately when providing care to a trauma client whose primary survey indicates a Glasgow Coma Scale (GCS) score of 7? a. Prepare for intubation b. Observe for chest wall trauma c. Cover the client with a blanket d. Apply direct pressure to the client's wound

a. Prepare for intubation

Which clinical indicators would the nurse expect to find when assessing a client with Parkinson disease? Select all that apply. a. Resting tremors b. Flattened affect c. Muscle flaccidity d. Tonic clonic seizures e. Slow voluntary movements

a. Resting tremors b. Flattened affect e. Slow voluntary movements

Which type of impairment does the nurse expect the client who has expressive aphasia to exhibit? a. Speaking or writing b. Following instructions c. Understanding speech or writing d. Recognizing words for familiar objects

a. Speaking or writing

Which action would the nurse take when a client admitted to the hospital after an accident has clear drainage oozing from the ear? a. Test the fluid for glucose and apply a sterile dressing b. Position the client so that the unaffected ear is dependent c. Cover the area with sterile gauze while applying slight pressure d. Clean the client's outer ear with normal saline and insert a cotton ball

a. Test the fluid for glucose and apply a sterile dressing

A 50 year old man reports recurring headaches. He describes them as sharp, stabbing, and around his left eye. He says his left eye seems to swell and get teary when these headaches occur. Based on this history, you suspect he has... a. cluster headaches b. tension headaches c. migraine headaches d. medication overuse headaches

a. cluster headaches

Cholesterol

a fatty substance that travels through the blood and is found in all parts of the body

Embolic stroke

a type of ischemic stroke that causes a clot to travel to the brain, mostly from the left side of the heart

Which instruction about phenytoin will the nurse provide during discharge teaching to a client with epilepsy who is prescribed phenytoin for seizure control? a. "Anti seizure medications will probably be continued for life." b. "Phenytoin prevents any further occurrence of seizures." c. "This medication needs to be taken during periods of emotional stress." d. "Your anti seizure medication usually can be stopped after a year's absence of seizures."

a. "Anti seizure medications will probably be continued for life."

Which action would the nurse classify as a priority when caring for a client with tonic-clonic seizures? a. Ensuring patent airway b. Administering intravenous fluids c. Monitoring level of consciousness d. Protecting the client from injury during seizures

a. Ensuring patent airway

A client has a brain attack (stroke) that involves the right cerebral cortex and cranial nerves. Which area of paralysis would the nurse expect to find upon assessment? Select all that apply. a. Left leg b. Left arm c. Right leg d. Right arm e. Left side of face

a. Left leg b. Left arm e. Left side of face

Which finding would the nurse expect when completing an admission physical for a client with Parkinson disease? Select all that apply. a. Muscle rigidity b. Blank facial expression c. Leaning toward the affected side d. Intention tremors with movement e. Hyperextension of the affected extremity

a. Muscle rigidity b. Blank facial expression

During admission of a patient with a severe head injury to the emergency department the nurse places the highest priority on assessment for a. Patency of airway b. Presence of neck injury c. Neurologic status with Glasgow coma scale d. Cerebrospinal fluid leakage from the ears or nose

a. Patency of airway