Patho Exam 2 & 3 Ch 16
a
A child is being seen in the emergency department (ED) after ingesting crayons with lead in them. He is disoriented and having seizures. The provider suspects he has which of the following? Encephalitis Bacterial meningitis Meningioma Viral meningitis
b) Respiratory status and oxygen saturation Pg. 438 Motor Tonic-clonic status epilepticus is a medical emergency and, if not promptly treated, may lead to respiratory failure and death. Treatment consists of appropriate life support measures. Airway/breathing is always the priority in this emergency situation.
A client has started having uncontrolled seizures that are not responding to usual medications. Nurses working with the client must pay special attention to which priority aspects of this client's care? Assessment of: a) Urine output and continence b) Respiratory status and oxygen saturation c) ECG for arrhythmias d) Ability to grasp hands and squeeze on command
d) Encephalitis Pg. 434 Encephalitis Encephalitis is characterized by fever, headache, and nuchal rigidity, but more often clients also experience neurologic disturbances such as lethargy, disorientation, seizures, focal paralysis, delirium, and coma. Epilepsy is confined to recurrent seizures. An ischemic stroke would present with more focal symptoms and no fever, as would a hemorrhage.
An adult client is admitted to the emergency department reporting a headache, stiff neck and lethargy. Based on the intake interview, the nurse suspects that the client had a seizure the day before. The client's vital signs are within reference range with the exception of a heart rate of 102 bpm and oral temperature of 38.6°C (101.5°F). Which diagnosis is most likely? a) Epilepsy b) Subarachnoid hemorrhage c) Ischemic stroke d) Encephalitis
d) CT scan Pg. 429 Aneurysmal Subarachnoid Hemorrhage The diagnosis of subarachnoid hemorrhage and intracranial aneurysms is made by clinical presentation, CT scan, and angiography. An MRI is not necessary for the diagnosis of subarachnoid hemorrhage and intracranial aneurysm. Loss of cranial nerve reflexes is not diagnostic of subarachnoid hemorrhage and intracranial aneurysm, and neither is venography.
Intracranial aneurysms that rupture cause subarachnoid hemorrhage in the client. How is the diagnosis of intracranial aneurysms and subarachnoid hemorrhage made? a) Venography b) Loss of cranial nerve reflexes c) MRI d) CT scan
a) Thrombosis Pg. 428 Ischemic Stroke Thrombi are the most common cause of ischemic strokes, usually occurring in atherosclerotic blood vessels.
The most common cause of an ischemic stroke is which of the following? a) Thrombosis b) Intracerebral arterial vasculitis c) Vasospasm d) Cardiogenic embolus
c) Thrombosis Pg. 428 Ischemic Stroke Ischemic stroke includes those caused by large artery thrombosis (20%), small artery thrombosis (25%), cardiogenic embolism (20%) and cryptogenic (undetermined cause)(30%), making thrombosis the most common cause (45%).
The most common cause of ischemic stroke is: a) Arterial vasculitis b) Cryptogenesis c) Thrombosis d) Vasospasms
d) Subarachnoid hemorrhage Pg. 429 Aneurysmal Subarachnoid Hemorrhage The rupture of a berry aneurysm leads to a subarachnoid hemorrhage.
The MRA scan of a client with a suspected stroke reports ruptured berry aneurysm. The nurse plans care for a client with: a) Lacunar infarct b) Encephalitis c) Thrombotic stroke d) Subarachnoid hemorrhage
c) Generalized seizure Pg. 438 Generalized Seizures When seizure activity begins simultaneously in both cerebral hemispheres, it is considered a generalized seizure.
The chart of a client admitted because of seizures notes that the seizure activity began simultaneously in both cerebral hemispheres. The nurse should interpret this to mean that the client experienced: a) Focal seizure without impairment of consciousness b) Focal seizure with impairment of consciousness c) Generalized seizure d) Unknown type of seizure
a The diagnosis of bacterial meningitis is confirmed with abnormal CSF findings. Lumbar puncture findings, which are necessary for accurate diagnosis, include a cloudy and purulent CSF under increased pressure. The other options do not confirm the diagnosis. Reference: Norris, T. L., Porth's Essentials of Pathophysiology, 5th ed., Philadelphia, Wolters Kluwer, 2020, Chapter 16: Disorders of Brain Function, Diagnosis, p. 434
The emergency room doctor suspects a client may have bacterial meningitis. The most important diagnostic test to perform would be: Lumbar puncture CT of the head Sputum culture Blood cultures
a) Hemorrhage b) Focal lesions of laceration c) Contusion e) Diffuse axonal Pg. 423 Primary and Secondary Brain Injuries The primary, direct brain injuries include diffuse axonal injury and the focal lesions of laceration, contusion, and hemorrhage. A hypoxic brain injury is considered a secondary [not primary] type of injury.
There are several types of brain injuries that can occur. What are the primary (or direct) brain injuries? Select all that apply. a) Hemorrhage b) Focal lesions of laceration c) Contusion d) Hypoxic e) Diffuse axonal
a
What medication teaching should be done for a woman of childbearing age with a seizure disorder? Antiseizure drugs increase the risk for congenital abnormalities. Antiseizure drugs do not interact with oral contraceptives. Some antiseizure drugs can interfere with vitamin K metabolism. All women of childbearing age should be advised to take a vitamin C supplement.
a
Which intracranial volume is most capable of compensating for increasing intracranial pressure? Cerebrospinal fluid Intravascular blood Brain cell tissue Surface sulci fluid
b) Administer IV tissue plasminogen activator (tPA) Pg. 427-428 Stroke tPA administration is the treatment of choice for an ischemic stroke after confirmation that it is not a hemorrhagic stroke. Monitor vital signs and provide pain relief to prevent complications.
A client is brought to the emergency department and is diagnosed with an ischemic stroke confirmed by CT scan. The most important treatment for this client would be to: a) Administer analgesics for the relief of pain b) Administer IV tissue plasminogen activator (tPA) c) Prepare the client for emergency surgery d) Monitor vital signs closely for improvement
b) Inadequate to meet the metabolic needs of the entire brain Pg. 416 Global Ischemia Global ischemia occurs when blood flow is inadequate to meet the metabolic needs of the entire brain. The result is a spectrum of neurologic disorders reflecting diffuse brain dysfunction.
A client has developed global ischemia of the brain. The nurse determines this is: a) Inadequate perfusion of the right side of the brain b) Inadequate to meet the metabolic needs of the entire brain c) Inadequate perfusion of the nondominant side of the brain d) Inadequate perfusion to the dominant side of the brain
c) Brain death Pg. 415 Brain Death Severe brain injury that results in seriously compromised brain function can result in brain death.
A client has sustained a severe, diffuse brain injury that resulted in seriously compromised brain function. The client is at greatest risk for: a) Amnesia b) Paraplegia c) Brain death d) Confusion
b) Altered level of consciousness Pg. 413 Manifestations of Brain Injury In contrast to focal injury, which causes focal neurologic deficits without altered consciousness, global injury nearly always results in altered levels of consciousness ranging from inattention to stupor or coma. The other answers are manifestations of different types of brain injury, not a global injury.
Global and focal brain injuries manifest differently. What is almost always a manifestation of a global brain injury? a) Respiratory instability b) Altered level of consciousness c) Change in behavior d) Loss of eye movement reflexes
Nausea and vomiting Seizure activity Cognitive and personality changes The clinical manifestations of brain tumors depend on the size and location of the tumor. General signs and symptoms include headache, nausea, vomiting, mental changes, papilledema, visual disturbances (e.g., diplopia), alterations in sensory and motor function, and seizures. Tinnitus, ear pain, and epistaxis are not among the more common signs and symptoms of a brain tumor. Reference: Norris, T. L., Porth's Essentials of Pathophysiology, 5th ed., Philadelphia, Wolters Kluwer, 2020, Chapter 16: Disorders of Brain Function, Clinical Manifestations, p. 435
A client reports "the worst headache" of her life with associated blurred vision. Subsequent diagnostic testing has resulted in a diagnosis of an intra-axial brain tumor. What other clinical manifestations would be consistent with this diagnosis? Select all that apply. Nausea and vomiting Seizure activity Recurrent epistaxis (nosebleeds) Cognitive and personality changes Tinnitus and earaches, with no accompanying signs of infection
b
A client who is being seen in the outpatient clinic reports a single episode of unilateral arm and leg weakness and blurred vision that lasted approximately 45 minutes. The client is most likely experiencing: Thrombotic stroke Transient ischemic attack (TIA) Cardiogenic embolic stroke Lacunar infarct
a Thrombolytic therapy for the acute treatment of ischemic stroke consists of the intravenous administration of tPA. This drug would exacerbate a subarachnoid hemorrhage by inhibiting the clotting mechanism, and it is not relevant to the care of clients with encephalitis or status epilepticus. Reference: Norris, T. L., Porth's Essentials of Pathophysiology, 5th ed., Philadelphia, Wolters Kluwer, 2020, Chapter 16: Disorders of Brain Function, Ischemic Stroke, p. 428
A client's emergency magnetic resonance imaging (MRI) has been examined by the physician and tissue plasminogen activator (tPA) has been administered to the client. What was this client's most likely diagnosis? Ischemic stroke Subarachnoid hemorrhage Status epilepticus Encephalitis
c) Closed head injury opposite the area of impact Pg. 423 Primary and Secondary Brain Injuries In a contrecoup injury, the client experiences a rebound injury on the side of the brain opposite the site of external force.
A client's emergency room report includes the presence of a contrecoup injury. The nurse plans care for a client with which of the following? a) Infection resulting from exposed brain tissue b) Closed head injury in the area of impact c) Closed head injury opposite the area of impact d) Open spinal cord injury with complete severing of neurons
b Hydrocephalus represents a progressive enlargement of the ventricular system due to an abnormal increase in cerebrospinal fluid (CSF) volume. This increase in CSF volume can be resolved by the placement of a shunt to drain the offending fluid volume. Diuresis, hypertonic solution administration, and lumbar puncture are not usual treatment modalities. Reference: Norris, T. L., Porth's Essentials of Pathophysiology, 5th ed., Philadelphia, Wolters Kluwer, 2020, Chapter 16: Disorders of Brain Function, Hydrocephalus, p. 422
A client's recent computed tomography (CT) scan has revealed the presence of hydrocephalus. Which treatment measure is most likely to resolve this health problem? Lumbar puncture Placement of a shunt Aggressive diuresis Administration of hypertonic intravenous solution
c
A high school student sustained a concussion during a football game. The school nurse will educate the family about postconcussion syndrome and ask them to watch for and report which manifestations of its presence? recurrent nosebleeds and hypersomnia unilateral weakness and decreased coordination headaches and poor concentration neck pain and decreased neck range of motion
d) Brain contusions and hematomas Pg. 424 Hematomas Contusions (focal brain injury) cause permanent damage to brain tissue. The bruised, necrotic tissue is phagocytized by macrophages, and scar tissue formed by astrocyte proliferation persists as a crater. The direct contusion of the brain at the site of external force is referred to as an acceleration injury, whereas the opposite side of the brain receives the deceleration injury from rebound against the inner skull surfaces. As the brain strikes the rough surface of the cranial vault, brain tissue, blood vessels, nerve tracts, and other structures are bruised and torn, resulting in contusions and hematomas. TIAs and cerebral vascular infarction (stroke) are often caused by atherosclerotic brain vessel occlusions that cause ischemic injuries. In mild concussion head injury, there may be momentary loss of consciousness without demonstrable neurologic symptoms or residual damage, except for possible residual amnesia. Status epilepticus is not related to this situation.
A teenager has been in a car accident and experienced an acceleration-deceleration head injury. Initially, the client was stable but then started to develop neurological signs/symptoms. The nurse caring for this client should be assessing for which type of possible complication? a) TIAs and cerebrovascular infarction b) Momentary unconsciousness c) Status epilepticus d) Brain contusions and hematomas
a Excitotoxicity is a final common pathway for neuronal cell injury and death. It is associated with excessive activity of excitatory amino acid neurotransmitters (glutamate is the primary excitatory neurotransmitter). Hypoxic injury involves oxygen deprivation. Ischemic injury is caused by a decrease of blood flow. Increased intracranial pressure may result in all three but is not caused by the excitotoxic effects. Reference: Norris, T. L., Porth's Essentials of Pathophysiology, 5th ed., Philadelphia, Wolters Kluwer, 2020, Chapter 16: Disorders of Brain Function, Excitotoxic Brain Injury, p. 417
Overstimulation of glutamate receptors is the cause of which type of brain injury? excitotoxic increased intracranial volume and pressure hypoxic ischemic
a) Sensory function b) Level of consciousness c) Motor function d) Cognition Pg. 422 Traumatic Brain Injury Brain injuries can cause changes in level of consciousness and alterations in cognition, motor, and sensory function; therefore, the nurse assessing a client with a traumatic brain injury should assess for changes in these areas.
The nurse assessing a client with a traumatic brain injury assesses for changes in which neurologic component? Select all that apply. a) Sensory function b) Level of consciousness c) Motor function d) Cognition e) Metabolic function
a
The nurse explaining the causes of congenital hydrocephalus to the mother of a child born with hydrocephalus includes: Aqueductal stenosis Bacterial infection Hemorrhage Tumor
c
The nurse is caring for a client admitted to the emergency room with suspected meningitis. The nurse prepares to perform which nursing intervention upon physician orders, while diagnostic testing is being completed? Administration of TPN Administration of oxygen Administration of antibiotics Administration of pain medication
d) Automatisms Pg. 438-439 Seizures with Impairment of Consciousness or Awareness The nurse reports that the client exhibited automatisms, defined as repetitive nonpurposeful activities such as lip smacking, grimacing, patting and/or rubbing clothing.
The nurse is caring for a client experiencing a seizure. During the seizure the nurse notes that the client repetitively rubs his/her clothing. When contacting the client's physician, the nurse notes that the client exhibited: a) Myoclonic activity b) Hallucination c) Aura d) Automatisms
d) Assess for other signs/symptoms of increased intracranial pressure Pg. 418 Increased Intracranial Pressure The tumor may be causing increased intracranial pressure. Vomiting, with or without nausea, is a common symptom of increased intracranial pressure and/or brain stem compression. The nurse's first action is to assess for other signs/symptoms of increased intracranial pressure. Once the assessment is completed, the nurse should contact the physician if indicated by the findings.
The nurse is caring for a client with a brain tumor when the client begins to vomit. Which intervention should the nurse do first? a) Assess for signs/symptoms of cerebrovascular accident (stroke) b) Document the finding as it is an expected symptom c) Contact physician for anti-nausea medication orders d) Assess for other signs/symptoms of increased intracranial pressure
a) Muscle atrophy Pg. 431 Stroke-Related Motor Deficits Muscle atrophy can occur with prolonged immobilization following a chronic illness. The client suffering from hemiplegia will have paralysis and immobility. Muscular dystrophy is a genetic disorder characterized by muscle necrosis and increased muscle size. Pseudohypertrophy is associated with muscular dystrophy. Involuntary movements are associated with extrapyramidal tract disorders. Stroke is a pyramidal tract disorder with extrapyramidal tract disorder.
The nurse is caring for an older adult client with hemiplegia following a stroke. While planning the client's care, the nurse knows the client is at risk for developing which condition? a) Muscle atrophy b) Involuntary movements c) Muscular dystrophy d) Pseudohypertrophy
a To identify a bleeding source, conventional angiography, MRA, and helical computed tomography angiography are used. A head x-ray can detect fracture in the bones. A positron emission tomography is an imaging test that helps reveal how your tissues and organs are functioning. A lumbar puncture is the removal of spinal fluid from the spinal canal; the fluid is withdrawn through a needle and examined in a laboratory. This diagnostic procedure is only done to rule out conditions that may be affecting the brain and spinal cord. Reference: Norris, T. L., Porth's Essentials of Pathophysiology, 5th ed., Philadelphia, Wolters Kluwer, 2020, Chapter 16: Disorders of Brain Function, Diagnosis, p. 430
The nurse is preparing a client with a possible stroke for radiology. Which diagnostic procedure would be beneficial for this client? Helical computed tomography angiography Positron emission tomography Lumbar puncture Anterior and posterior X-ray
a) Resistance should be provided with the knee in a flexed position\ Pg. 434 Pathophysiology The test for Kernig sign for meningeal irritation is performed by providing resistance to flexion of the knees while the client is lying with the hip flexed at a right angle.
The nurse observes a new nurse performing the test for Kernig sign on a client. The new nurse performs the test by providing resistance to flexion of the knees while the client is lying with the hip flexed at a right angle. The nurse should explain to the new nurse that: a) Resistance should be provided with the knee in a flexed position b) The sign elicited was the Brudzinski sign c) The sign elicited was the obturator sign d) The client should be in a sitting position
b
The nurse reading a client's lumbar puncture results notifies the physician of findings consistent with meningitis when which sign/symptom is noted? Increased glucose Large number of polymorphonuclear neutrophils Decreased protein count Clear cerebrospinal fluid
Moderately increased protein Lymphocytes
The nurse reading the results of a lumbar puncture cerebrospinal fluid analysis anticipates that the client's meningitis will be self-limiting in nature because of which findings? Select all that apply. Polymorphonuclear neutrophils Reduced sugar count Moderately increased protein Lymphocytes
a) Stupor Pg. 414 Levels of Consciousness The most frequent sign of brain dysfunction is an altered level of consciousness such as stupor. Pupils that react to light, wheezing, and chest pain are not symptoms of brain function.
The nurse taking a report on a client coming into the emergency room plans care for a client with brain dysfunction based on which symptom? a) Stupor b) Pupils that react to light c) Chest pain d) Wheezing
d) CT scan Pg. 427 Stroke The nurse should anticipate that the client will be ordered a CT scan to rule out hemorrhagic stroke that would preclude the administration of tissue plasminogen activator (tPA).
The nurse working in an emergency room is caring for a client who is exhibiting signs and symptoms of a stroke. What does the nurse anticipate that the physician's orders will include? a) Intravenous antibiotics b) Pain medication c) MRI d) CT scan
d) "Because the skull sutures are not fused there may be no brain damage" Pg. 422 Hydrocephalus When hydrocephalus develops in utero, before the cranial sutures have fused, the head can swell and decrease intracranial pressure, thereby decreasing the amount of brain tissue that is compressed.
The parent of an infant who developed hydrocephalus while in utero is very concerned that the child will have significant intellectual dysfunction. The best response to the parent would be: a) "The cranial sutures are fused and decrease brain damage" b) "Infants never have symptoms from hydrocephalus" c) "Unfortunately, there usually is significant brain dysfunction" d) "Because the skull sutures are not fused there may be no brain damage"
c
The parents of an infant born with hydrocephalus are concerned about the size of the baby's head. The doctors are telling them that the infant needs the surgical placement of a shunt. The nurse caring for the infant in the neonatal intensive care unit explains that placement of a shunt will: increase intracranial pressure. reverse any neurologic deficits that are present. decrease the likelihood of further neurological deficits. not affect the size of the infant's head.
c) Assess the client for additional signs/symptoms of increased intracranial pressure Pg. 418 Increased Intracranial Pressure Since decreased alertness and/or drowsiness can be an early sign of increased intracranial pressure, the nurse should assess for additional signs/symptoms of increased intracranial pressure. Then, once the assessment is complete, the nurse should contact the physician as needed. There is no indication that the client will undergo EEG testing at this time and the spouse should not be instructed to keep the client awake.
The spouse of a client admitted to the hospital after a motor vehicle accident reports to the nurse that the client has become very drowsy. The nurse should: a) Prepare the client for EEG testing b) Contact the physician c) Assess the client for additional signs/symptoms of increased intracranial pressure d) Instruct the spouse not to let the client fall asleep until the physician has assessed the client