Neuro Questions- Textbook

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

1 Decerebrate posturing is the result of lesions at the midbrain and is more ominous than decorticate posturing. The described posturing results from cerebral trauma and is not normal. The patient has no motor function, is limp, and lacks motor tone with flaccid posturing. In decorticate posturing, the patient has flexion and internal rotation of the arms and wrists and extension, internal rotation, and plantar flexion of the feet.

Which of the following symptoms are indicative of a rapidly expanding acute subdural hematoma? Select all that apply. 1. Coma 2. Hypotension 3. Decreased reactivity of the pupils 4. Bradycardia 5. Tachypnea 6. Hemiparesis

1,3,4, 6 Signs and symptoms include changes in the level of consciousness (LOC), changes in the reactivity of the pupils, and hemiparesis (weakness on one side of the body). There may be minor or even no symptoms, with small collections of blood. Coma, increasing blood pressure, decreasing heart rate, and slowing respiratory rate are all signs of a rapidly expanding mass requiring immediate intervention.

A patient is admitted to the hospital with an ICP reading of 20 mm Hg and a mean arterial pressure of 90 mm Hg. What would the nurse calculate the CPP to be? 1. 60 mm Hg 2. 70 mm Hg 3. 80 mm Hg 4. 50 mm Hg

2. Changes in ICP are closely linked with cerebral perfusion pressure (CPP). The CPP is calculated by subtracting the ICP from the mean arterial pressure (MAP). For example, if the MAP is 100 mm Hg and the ICP is 15 mm Hg, then the CPP is 85 mm Hg. The normal CPP is 70 to 100 mm Hg (Hickey, 2009).

A nurse is teaching a community class that those experiencing symptoms of ischemic stroke need to enter the medical system early. The primary reason for this is which of the following? 1. A ruptured intracranial aneurysm must quickly be repaired. 2. Intracranial pressure is increased by a space-occupying bleed. 3. A ruptured arteriovenous malformation will cause deficits until it is stopped. 4. Thrombolytic therapy has a time window of only 3 hours.

4 Currently approved thrombolytic therapy for ischemic strokes has a treatment window of only 3 hours after the onset of symptoms. Urgency is needed on the part of the public for rapid entry into the medical system. The other three choices are related to hemorrhagic strokes.

The nurse explains to the client with projectile vomiting and severe headache that a medication is being prescribed to reduced edema surrounding the brain and lessen these symptoms. What medication is the nurse preparing to administer? 1. Temozolomide 2. Bevacizumab 3. Everolimus 4. Mannitol

4 Mannitol is an osmotic diuretic that is administered to decrease the fluid content of the brain, which leads to a decrease in intracranial pressure. Temozolomide is a chemotherapeutic agent which is commonly used to stop or slow cell growth in certain types of brain tumors. Bevacizumab and everolimus are immunotherapy agents that reduce the vascularization of tumors, thereby inhibiting tumor growth.

A client with cerebral metastasis suddenly experiences a seizure for which phenytoin 10 mg/kg intravenously is ordered as an initial loading dose. The client weighs 165 pounds. How many milligrams of phenytoin should the client receive?

750 mg First, change the client's weight in pounds to kilograms by dividing the weight by 2.2 (2.2 pounds = 1 kg). The client's weight is 75 kg. Next, set up a proportion: 10/1 = x/75; cross multiply and solve for x, which is 750.

An emergency department nurse is awaiting the arrival of a client with signs of an ischemic stroke that began 1 hour ago, as reported by emergency medical personnel. The treatment window for thrombolytic therapy is which of the following? 1. Three hours 2. Two hours 3. One hour 4. Six hours

1 Rapid diagnosis of stroke and initiation of thrombolytic therapy (within 3 hours) in clients with ischemic stroke leads to a decrease in the size of the stroke and an overall improvement in functional outcome after 3 months.

A patient is diagnosed with amyotrophic lateral sclerosis, also known as ALS or Lou Gehrig's disease. The nurse understands that the symptoms of the disease will begin in what way? 1. Weakness starting in the muscles supplied by the cranial nerves 2. Jerky, uncontrolled movements in the extremities 3. Ascending paralysis 4. Numbness and tingling in the lower extremities

1 The chief symptoms are fatigue, progressive muscle weakness, cramps, fasciculations (twitching), and incoordination. In about 25% of patients, weakness starts in the muscles supplied by the cranial nerves, and difficulty in talking, swallowing, and ultimately breathing occurs.

A client weighing 132 lb is brought to the emergency department in status epilepticus. The physician asks the nurse to prepare diazepam 0.25 mg/kg. How many milligrams will be given to this client?

15 mg

The nurse is caring for a patient postoperatively after intracranial surgery for the treatment of a subdural hematoma. The nurse observes an increase in the patient's blood pressure from the baseline and a decrease in the heart rate from 86 to 54. The patient has crackles in the bases of the lungs. What does the nurse suspect is occurring? 1. Infection 2. Exacerbation of uncontrolled hypertension 3. Increased ICP 4. Increase in cerebral perfusion pressure

3. Increased ICP and bleeding are life threatening to the patient who has undergone intracranial surgery. An increase in blood pressure and decrease in pulse with respiratory failure may indicate increased ICP.

A client who recently experienced a stroke tells the nurse that he has double vision. Which nursing intervention is most appropriate? 1. Instill artificial tears. 2. Turn out the lights in the room. 3. Alternatively patch one eye every 2 hours. 4. Encourage the client to close his eyes.

3. Patching one eye at a time relieves diplopia (double vision). Closing the eyes and making the room dark aren't the most appropriate options because they deprive the client of sensory input. Artificial tears relieve eye dryness but don't treat diplopia.

A patient is admitted via ambulance to the emergency room of a stroke center at 1:30 p.m. with symptoms that the patient said began at 1:00 p.m. Within 1 hour, an ischemic stroke had been confirmed and the doctor ordered tPA. The nurse knows to give this drug no later than what time? 1. 2:00 p.m. 2. 3:00 p.m. 3. 4:00 p.m. 4. 7:00 p.m.

3. Tissue plasminogen activator (tPA) must be given within 3 hours after symptom onset. Therefore, since symptom onset was 1:00 pm, the window of opportunity ends at 4:00 pm.

A patient is admitted to the emergency room with a fractured skull sustained in a motorcycle accident. The nurse notes fluid leaking from the patient's ears. The nurse knows this is a probable sign of which type of skull fracture? 1. Depressed 2. Simple 3. Comminuted 4. Basilar

4 Basilar skull fractures are suspected when cerebrospinal fluid (CSF) escapes from the ears (CSF otorrhea) and/or the nose (CSF rhinorrhea).

A client is being treated for increased intracranial pressure (ICP). The nurse should ensure that the client does not develop hypothermia because: 1. shivering in hypothermia can increase ICP. 2. hypothermia is indicative of severe meningitis. 3. hypothermia is indicative of malaria. 4. hypothermia can cause death to the client.

1. Care must be taken to avoid the development of hypothermia because hypothermia causes shivering. Shivering, in turn, can increase intracranial pressure.

The nurse is completing a neurologic assessment and uses the whisper test to assess which cranial nerve? 1. Acoustic 2. Facial 3. Vagus 4. Olfactory

1. Clinical examination of the acoustic nerve can be done by the whisper test. Having the client say "ah" tests the vagus nerve. Observing for symmetry when the client performs facial movements tests the facial nerve. The olfactory nerve is tested by having the client identify specific odors.

A nurse is reviewing a patient's laboratory test results. Which serum albumin level would lead the nurse to suspect that the patient is at risk for pressure ulcers? 1. 2.5 g/mL 2. 3.5 g/mL 3. 4.0 g/mL 4. 3.1 g/mL

1. Serum albumin is a sensitive indicator of protein deficiency. Levels below 3 g/mL are associated with hypoalbuminemic tissue edema and increased risk of pressure ulcers.

The nurse is caring for a client who is to have a lumbar puncture. What are the lowest vertebrae that contain the spinal cord? 1. Second lumbar vertebrae 2. Fifth lumbar vertebrae 3. Coccyx 4. Eleventh thoracic vertebrae

1. The spinal cord ends between the first and second lumbar vertebrae.

Which of the following is accurate regarding a hemorrhagic stroke? 1. Functional recovery usually plateaus at 6 months. 2. Main presenting symptom is an "exploding headache." 3. One of the main presenting symptoms is numbness or weakness of the face. 4. It is caused by a large-artery thrombosis.

2 One of hemorrhagic stroke's main presenting symptom is an "exploding headache." In ischemic stroke, functional recovery usually plateaus at 6 months; it may be caused by a large artery thrombosis and may have a presenting symptoms of numbness or weakness of the face.

Which term is used to describe edema of the optic nerve? 1. Scotoma 2. Papilledema 3. Angioneurotic edema 4. Lymphedema

2 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 collects neurologic data and determines that the client has significant visual deficits. A brain tumor is considered. Which area of the brain does the nurse consider to be most likely to contain the neurologic deficit? 1. Temporal 2. Occipital 3. Parietal 4. Frontal

2 The visual receiving area is in the occipital lobe; therefore, this is the area of the brain the nurse determines is affected for the client with significant visual deficits. The frontal lobe contains the written and motor speech areas. The parietal lobe is the primary sensory area of the brain. The temporal lobe is the auditory receiving and association area of the brain, and is responsible for speech comprehension (i.e., Wernicke area).

A client is about to be discharged after undergoing surgery for the treatment of a brain tumor and has a referral in place for medical and radiation oncology. Which component(s) should be included in the discharge teaching for this client? Select all that apply. 1. Electromyography 2. Appointments for chemotherapy or radiotherapy 3. Nutritional support 4. Adverse effects of chemotherapy or radiation and techniques for managing them 5. Medication regimen

2,3,4,5 The nurse should include the medication regimen, appointments for chemotherapy and radiotherapy, adverse effects of chemotherapy or radiation and techniques for managing them, and nutritional support as components of the discharge teaching for this client. Electromyography is used in amyotrophic lateral sclerosis (ALS) to validate weakness in the affected muscles and should not be included for the client being discharged after surgery for a brain tumor.

The nurse is assessing the client's pupils following a sports injury. Which of the following assessment findings indicates a neurologic concern? Select all that apply. 1. Pupil reacts to light 2. Pinpoint pupils 3. Absence of pupillary response 4. Pupil reaction quick 5. Unequal pupils

2,3,5 Normal assessment findings includes that the pupils are equal and reactive to light. Pupils that are unequal, pinpoint in nature, or fail to respond indicate a neurologic impairment.

The nurse is caring for a client recovering from a stroke. Which action will the nurse take to prevent adduction of the client's affected shoulder? Select all that apply. 1. Position the arm parallel to the torso. 2. Place a pillow in the axilla area. 3. Put a rolled towel in the affected hand. 4. Position the wrist higher than the elbow. 5. Situate the arm in a slightly flexed position.

2,4 To prevent adduction of the affected shoulder, a pillow is placed in the axilla when there is limited external rotation. Doing so keeps the arm away from the chest. A pillow is placed under the arm, and the arm is placed in a slightly flexed position. Distal joints are to be positioned higher than the more proximal joints, or the wrist positioned higher than the elbow. This helps to prevent edema and the resultant joint fibrosis that will limit range of motion when the client regains control of the arm. A hand roll is not used because it stimulates the grasp reflex. Postioning the arm parallel to the torso could increase edema.

A rehabilitation nurse is assisting a patient to cope with a disability. Which of the following would the nurse suggest? 1. Group any heavy work to be done at the same time. 2. Emphasize areas of strengths. 3. Avoid seeking help from others. 4. Stop any activity once fatigue occurs.

2. To assist a patient in coping with his or her disability, the nurse would encourage the patient to emphasize strengths, stop activities before fatigue occurs, distribute heavy work throughout the day or week, and recruit assistance from others, delegating when necessary.

Bone density testing will be completed for the client with post-polio syndrome. The nurse teaches the client bone density testing is used to identify what potential complication? 1. Pathologic fractures 2. Osteoarthritis 3. Low bone mass and osteoporosis 4. Calcification of long bones

3 Bone density testing in clients with post-polio syndrome has demonstrated low bone mass and osteoporosis. Thus, the importance of identifying risks, preventing falls, and treating osteoporosis must be discussed with clients and their families.

A client experienced a stroke that damaged the hypothalamus. The nurse should anticipate that the client will have problems with: 1. balance and equilibrium. 2. visual acuity. 3. body temperature control. 4. thinking and reasoning.

3 The body's thermostat is located in the hypothalamus; therefore, injury to that area can cause problems with body temperature control. Balance and equilibrium problems are related to cerebellar damage. Visual acuity problems would occur following occipital or optic nerve injury. Thinking and reasoning problems are the result of injury to the cerebrum.

A nurse completes the Glasgow Coma Scale on a patient with traumatic brain injury (TBI). Her assessment results in a score of 6, which is interpreted as: 1. Brain death. 2. Moderate TBI. 3. Mild TBI. 4. Severe TBI.

4 A score of 13 to 15 is classified as mild TBI, 9 to 12 is moderate TBI, and 3 to 8 is severe TBI. A score of 3 indicates severe impairment of neurologic function, deep coma, brain death, or pharmacologic inhibition of the neurologic response; a score of 8 or less typically indicates an unconscious patient; a score of 15 indicates a fully alert and oriented patient.

The nurse is evaluating the transmission of a report from a paramedic unit to the emergency department. The medic reports that a client is unconscious with edema of the head and face and Battle sign. What clinical picture would the nurse anticipate? 1. Edema to the head with a large scalp laceration 2. Edema to the head with fixed pupils 3. Edema to the head and a blackened eye 4. Edema to the head with bruising of the mastoid process

4 Battle sign is the presence of bruising of the mastoid process behind the ear. It is not related to periorbital bleeding, lacerations, or fixed pupils.