Adult Health II Final Exam
A 34-year-old patient is diagnosed with relapsing-remitting multiple sclerosis. The nurse explains to the patient's family that they should expect:
Acute attacks with full recovery or residual deficit upon recovery
A patient has been diagnosed with amyotrophic lateral sclerosis (ALS). The nurse practitioner prescribes a medication that has been found to show modest improvement in symptoms. Which of the following is the medication described in this scenario?
Rilutek
A ringing sound in the ear
Tinnitus
A woman who had a mastectomy for breast cancer 5 years ago was recently diagnosed with a secondary brain tumor. Which of the following is the best statement that the nurse can say to the patient in this situation?
"Secondary brain tumors, which can result from previous breast cancer, are usually malignant."
Astrocytoma
...
Dermoid
...
Ependymoma
...
Glioblastoma multiforme
...
Medulloblastoma
...
Meningioma
...
Oligodendrocytoma
...
Pituitary adenoma
...
Primary progressive multiple sclerosis
...
Guillain-Barre syndrome can progress rapidly, leading to neuromuscular respiratory failure. Therefore a nurse should evaluate a range of respiratory signs and symptoms in a Guillain-Barre syndrome patient. Which of the following is the vital capacity reading that would alert a nurse that mechanical ventilation is needed for a 90 kg patient?
1,300 mL
The intravenous administration of phenytoin (Dilantin) is used for treating status epilepticus. The recommended dose is 10 to 15 mg/kg to be given at a rate not to exceed 50 mg/min. Therefore, the nurse should give IV Dilantin to a 70 kg adult over:
14 to 20 minutes
Episodes of orthostatic hypotension occur in the first 2 weeks after a spinal cord injury. Compare the two blood pressure measurement for each answer. The blood pressure reading obtained when the patient was sitting, is in the left column for comparison. Which of the following shows the blood pressure measurement indicative of orthostatic hypotension? 140/110 --> 130/110 140/100 --> 120/90 130/90 --> 125/85 130/80 --> 120/80
140/100 --> 120/90.
Hyperglycemia for a patient with traumatic brain injury may worsen the outcome of recovery. Select a serum glucose level that is considered critical.
180 mg/dL
A score of 15 on the Glascow coma scale indicates
A fully alert and oriented patient
First step in the pathophysiology of a traumatic brain injury
A traumatic brain injury with bleeding or swelling causes an increase in intracranial volume.
Functional abilities of a T6 to T10 injury
Abdominal muscle control
A 65-year old man is diagnosed with a grade IV glioblastoma multiforme. The nurse explains that this tumor is:
Aggressive in its growth and most likely malignant
What should the nurse be alert for with a traumatic brain injury?
Altered level of consciousness; confusion; pupillary abnormalities such as changes in shape, size, and response to light; sudden onset of neurological deficits; changes in vital signs such as altered respiratory pattern, widened pulse pressure, bradycardia, tachycardia, hypothermia or hyperthermia; vision and hearing impairment; sensory dysfunction; headache; seizures
Impaired coordination of movements and tremor.
Ataxia
Seizures characterized by sudden loss of muscle tone, resulting in falls or a "drop" to the ground, with rapid recovery.
Atonic seizures
A premonitory or warning sensation that a seizure will occur.
Aura
What clinical significance is seen with tapping of patellar and biceps tendons in an unconscious patient?
Brisk response may have localizing value. Asymmetric response in paralysis. Absent in deep coma.
When the patient's neck is flexed after ruling out cervical trauma or injury, flexion of the knees and hips are produced.
Brudzinski's sign
Drug or drugs that increase the action of levodopa
Comtam and Tasmar
A mild traumatic brain injury
Concussion
Fifth step in the pathophysiology of a traumatic brain injury
Continued increase in intracranial pressure will cause the brain to herniate resulting in ischemia, infarction, irreversible brain damage, and brain death
A severe injury that involves bruising of the brain, with possible surface hemorrhage
Contusion
A provider prescribes a disease-modifying drug for a patient with relapsing-remitting multiple sclerosis. The nurse advises the patient that the drug has to be taken subcutaneously on a daily basis, and it may take 6 months for evidence of any response. Which of the following is the medication most likely prescribed in this scenario?
Copaxone
Posturing that involves extreme extension of the upper and lower extremities
Decerebrate
Third step in the pathophysiology of multiple sclerosis
Demyelination interrupts nerve impulses
List five risk factors for developing post-traumatic seizures.
Depressed skull fracture, penetrating head wound; epidural, subdural, or intracerebral hemorrhage; Glascow Coma Scale score < 10; cortical contusion
Orthostatic hypotension
Drop in systolic blood pressure of at least 20 mm Hg or a drop in diastolic pressure of at least 10 mm Hg.
The inability to execute voluntary movements.
Dyskinesia
A patient is admitted to the emergency room with a skull fracture. The nurse notes a blood stain, surrounded by a yellowish ring, on the linens on the stretcher. The patient's respiratory system was stabilized at the site of the accident. Which of the following nursing interventions describes the immediate nursing action that needs to be taken?
Elevate the head of the bed 30 degrees to reduce intracranial pressure and promote spontaneous closure of the leak.
The name for the seventh cranial nerve
Facial
The most disabling symptom of multiple sclerosis is
Fatigue
Functional abilities of a L4 to L5 injury
Flexion and ankle dorsilfexion
Functional abilities of a T1 to T5 injury
Full hand and finger control
During assessment of a patient who has been taking Dilantin for seizure management for 3 years, the nurse notices one of the side effects that would be reported. What is that side effect?
Gingival hyperplasia
The most common and aggressive malignant brain tumor is:
Glioblastoma multiforme
A health care provider asks the nurse to assess a patient being evaluated for septic meningitis for a positive Brudzinski's sign. Which of the following actions should the nurse take?
Help the patient flex his neck and observe for flexion of the hips and knees
What clinical significance is seen with equal or unequal diameter pupils in an unconscious patient?
Helps determine location of lesion
Weakness on one side of the body
Hemaparesis
A nurse assesses a patient who has been diagnosed with having a pituitary adenoma that is pressing on the third ventricle. The nurse looks for associated sign/symptoms. What is that sign/symptom?
Increased intracranial pressure
Third step in the pathophysiology of a traumatic brain injury
Increased pressure causes vasoconstriction and a decrease in blood flow to the brain.
Third step in the pathophysiology of meningitis
Inflammation causes increased intracranial pressure
Second step in the pathophysiology of multiple sclerosis
Inflammation destroys myelin and the oligodendroglial cells that produce myelin in the central nervous system
Second step in the pathophysiology of a traumatic brain injury
Intracranial pressure increases due to an increase in intracranial volume within the rigid cranial vault.
The most common surgical procedure that is used to decompress or stabilize the spinal column is
Laminectomy
A nurse assesses an unconscious patient's pattern of respirations. She documents the presence of Cheyne-Stokes breathing, aware that this clinical manifestations is primarily consistent with which of the following diagnoses?
Lesions deep in both hemispheres
Functional abilities of a C2 to C3 injury
Limited head and neck sensation; some neck control
Functional abilities of a C1 injury
Little or no sensation or control of head and neck
A patient was admitted to a rehabilitation unit for treatment of a spinal cord injury. The admitting diagnosis is central cord syndrome. During an admissions physical, the nurse expects to find:
Loss of motor power and sensation in the upper extremities
A patient was recently diagnosed with Guillain-Barre syndrome. The nurse knows to assess the part of the body where symptoms primarily begin. What is the most likely area of the body for the nurse to begin this assessment?
Lower extremities
List two primary sites of cancer that commonly metastasize to the brain.
Lung and breast cancer
Name the diagnostic test that is considered the gold standard for detecting brain tumors
Magnetic resonance imaging
What test is considered the most accurate, especially for diagnosing spinal cord compression?
Magnetic resonance imaging scan
The most important nursing priority of treatment for a patient with an altered level of consciousness is to
Maintain a clear airway to ensure adequate ventilation
Name the most common brain tumor, representing 33% of all primary brain tumors:
Meningioma
Another term used for a tumor or a lesion
Neoplasm
Headache pain with a cerebellar tumor
Pain located in the suboccipital region at the back of the head
This cerebral structure is responsible for hormones, growth, and fertility.
Pituitary gland
Fourth step in the pathophysiology of multiple sclerosis
Plaques appear on demyelinated axons, further interrupting the transmission of impulses
A health care provider needs help in identifying the precise location of a brain tumor. To measure brain activity, as well as to determine structure, the nurse expects the health care provider to order which of the following tests?
Positron-emission tomography (PET)
Identify the new promising therapy for reducing cerebral edema that has shown substantial improvement in outcomes:
Progesterone
A patient is prescribed radiation therapy for treatment of a meningioma. The nurse understands that the patient will receive radiation therapy that can precisely localize the dosage and result in less exposure to normal brain tissue. What is this type of therapy called?
Proton therapy
Drug or drugs that are effective for treating depression but may aggravate the symptoms of Parkinson's disease
Prozac
Drooping of the eyelids
Ptosis
Which of the following is a clinical manifestation of pupillary changes that indicate increasing intracranial pressure?
Pupils are showing progressive dialation
Describe the objectives for preoperative nursing management for spinal cord compression.
Recognition of neurologic changes through ongoing assessments, pain control, and the management of altered activities of daily living. The nurse assesses for weakness, muscle wasting, spasticity, sensory changes, bowel and bladder dysfunction, and potential respiratory problems, especially if a cervical tumor is present. The patient is also evaluated for coagulation deficiencies.
There are seven potential complications for the patient with altered level of consciousness. What are they?
Respiratory failure, pneumonia, pressure ulcers, aspiration, venous stasis, musculoskeletal deterioration, and disturbed gastrointestinal functioning
The escape of cerebrospinal fluid from the nose
Rhinorrhea
Episodes of abnormal motor, sensory, autonomic, or psychic activity.
Seizures
First step in the pathophysiology of multiple sclerosis
Sensitized T cells remain in the central nervous system and promote infiltration of other agents that damage the immune system
Name the two major potential complications for patients with epilepsy
Status epilepticus and medication side effects or toxicity
List the five options for surgical management of a brain tumor
Stereotactic biopsy, open biopsy, crainotomy with debulking, subtotal tumor resection, total tumor resection
Nuchal rigidity
Stiff neck
A college student is admitted to the emergency room to be evaluated for septic meningitis. The nurse knows that the most serious infecting organism (34% mortality rate) is:
Streptococcus pneumoniae
What clinical significance is seen with stiff neck in an unconscious patient?
Subarachnoid hemorrhage, meningitis
Drug or drugs that reduce bradykinesia and postural changes
Symmetrel
This cerebral structure is responsible for language, behavior, memory, hearing, and emotions.
Temporal lobe
What clinical significance is seen when the cornea is touched with a wisp of clean cotton and blink response is normal in an unconscious patient?
Tests Cranial nerves V and VII; helps determine location of lesions if unilateral, absence in deep coma.
First step in the pathophysiology of meningitis
The causative organism enters the bloodstream, crosses the blood-brain barrier, and proliferates in the cerebrospinal fluid
Fifth step in the pathophysiology of meningitis
Thickened cerebrospinal fluid interferes with its absorption, resulting in hydrocephalus
Name the four cardinal signs of Parkinson's disease.
Tremor, rigidity, akinesia/bradykinesia, and postural disturbances
An agent that causes immediate improvement in muscle strength.
Trensilon
Symptoms of increased intracranial pressure result from compression of the brain caused by:
Tumor enlargement and edema
Functioning pituitary tumors
Tumors that can produce one or more hormones, normally by the anterior pituitary gland.
Headache pain with a frontal tumor
Usually produce a bilateral frontal headache
The name for the tenth cranial nerve
Vagus
Side effects of Dilantin
Visual problems, hirstuism, gingival hyperplasia, arrhythmias, dysarthria, and nystagmus
What types of diagnostic studies would the nurse expect a health care provider to order for a spinal cord compression?
X-rays, radionuclide bone scans, computed tomographic scans, biopsy, and an magnetic resonance imaging scan.
Status epilepticus is defined as
a series of generalized seizures that occurs without full recovery of consciousness between attacks
Clinical manifestations of neurogenic shock
decrease in cardiac output; venous pooling in the extremities; peripheral vasodilation resulting in mild hypotension, bradycardia, and warm skin.
The most common cause of death from trauma in the United States is
head injury
An early sign of meningitis that occurs in 30 to 70% of patients is
nuchal rigidity
The earliest sign of serious impairment of brain circulation related to increased intracranial pressure is
A change in consciousness
A gamma-aminobutyric acid agonist, is the medication of choice for treating spasticity. It can be administered orally or by intrathecal injection.
Baclofen
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?
Basilar
List the six most common infectious agents associated with Guillain-Barre syndrome.
Campylobacter jejuni, cytomegalovirus, Epstein-Barr virus, Mycoplasma pneumoniae, Haemophilus influenzae, and HIV
The grade of a tumor is based on three criteria:
Cellular density, cell mitosis, appearance
Fourth step in the pathophysiology of meningitis
Cellular materials from affected meningeal tissues enter and accumulate in the subarachnoid space
These changes result from compression or infiltration of brain tissue, whether a tumor is benign or malignant.
Central nervous system changes
This cerebral structure is responsible for balance, coordination, and fine muscle control.
Cerebellum
The leading cause of secondary brain injury is:
Cerebral edema
A clinical state of unarousable unresponsiveness
Coma
Seizure characterized by complex symptoms with the impairment of consciousness
Complex partial seizure
A patient has been diagnosed with a lipoma. The nurse explains to the patient that this tumor is located in the part of the brain known as the:
Corpus callosum
List the nine symptoms found in post-concussive syndrome
Headache, dizziness, lethargy, irritability, anxiety, photophobia, phonophobia, difficulty concentrating, and memory difficulties
Type of symptoms most often found with increased intracranial pressure.
Headache, nausea, with or without vomiting, and papilledema. Personality changes and a variety of focal deficits; including motor and sensory and cranial nerve dysfunction, are common. Late signs are related to Cushing's triad.
A patient has recently been diagnosed with an acoustic neuroma. The nurse helps the patient understand that:
Hearing loss usually occurs
Which of the following symptoms are indicative of a rapidly expanding acute subdural hematoma?
Hemiparesis, Decreased reactivity of the pupils, Bradycardia, and Coma
The most common viral cause of encephalitis in the United States is
Herpes simplex virus
A patient with Parkinson's disease has been taking Azilect, a monoamine oxidase inhibitor for several months. The nurse knows to assess the patient for the common side effect of:
Hypertensive crisis
One defining characteristic of a complex partial seizure versus simple partial seizure is the presence of which of the following?
Impaired consciousness
Describe the clinical picture of an individual experiencing a generalized seizure.
Intense rigidity of the entire body may occur, followed by alternating muscle relaxation and contraction. The simultaneous contractions of the diaphragm and chest muscles may produce a characteristic epileptic cry. The tongue is often chewed, and the patient is incontinent of urine and feces. After 1 or 2 minutes, the convulsive movements begin to subside; the patient relaxes and lies in a deep coma, breathing noisily. The respirations are chiefly abdominal. In the after seizure state, the patient is often confused and hard to arouse and may sleep for hours. Many patients report headache, sore muscles, extremity weakness, fatigue and depression.
Decerebrate posturing
Involves extreme extension of the upper and lower extremities and indicates severe damage to the brain at the lower midbrain and upper pons
Osmotic diuretics are an essential intervention for reducing cerebral edema. Which of the following is most frequently prescribed for this situation?
Mannitol
How do osmotic diuretics work to decrease cerebral edema?
May be administered to dehydrate the brain tissue and reduce cerebral edema. They work by creating a gradient that draws water across intact membranes, thereby reducing the volume of the swollen brain. They also reduce blood viscosity and hematocrit and enhance cerebral blood flow.
Hypomagnesmia
May lower the seizure threshold and cause secondary brain injury
A nurse begins an assessment interview of a patient with a brain tumor. The patient describes her headaches. The nurse expects to hear specific terms that describe her symptoms. Which of the following best describe the symptoms of her headache?
Occurs most frequently in the morning, is made worse with coughing and sudden movement, is unrelenting, and may improve with vomiting
Autonomic dysreflexia is an acute emergency that occurs with spinal cord injury as a result of exaggerated autonomic responses to stimuli. Which of the following is the initial nursing intervention to treat this condition?
Raise the head of the bed and place the patient in a sitting position.
Malignant tumor
Rapidly growing in nature, can spread to surrounding tissue, and are considered life threatening.
Degenerative changes that occur in a disk and adjacent vertebral bodies.
Spondylosis
What clinical significance is seen with equal, normally reactive pupils in an unconscious patient?
Suggests that coma is toxic or metabolic in origin
A patient has been diagnosed with a brain tumor, a glioblastoma multiforme. The nurse met with the family after the diagnosis to help them understand that:
Surgery can improve survival time but the results are not guaranteed.
Second step in the pathophysiology of meningitis
The cerebrospinal fluid thickens due to released neutrophils and the meninges become inflamed
What is the current five criteria used for a diagnosis of brain death?
The condition is irreversible with a known cause; the patient has apnea; the patient has no brainstem reflexes; the core body temperature is greater than 90 degrees Fahrenheit; there is no neuroimaging evidence of catastrophic central nervous system damage
Primary head injury
The initial damage to the brain that results from the traumatic event. This may include contusions, lacerations, and torn blood vessels due to impact, acceleration/deceleration, or foreign object penetration.
Nonfunctioning pituitary tumors
Tumors that do not produce hormones
The leading cause of seizures in the elderly is
cerebrovascular disease
Relapsing-remitting multiple sclerosis
...
Secondary progressive multiple sclerosis
...
Seizures characterized by jerking movements, which involve muscles on both sides of the body.
Clonic seizures
Drug or drugs that counteracts the action of the neurotransmitter acetylholine
Cogentin and Artane
Name the three cardinal findings that are used to determine brain death.
Coma or unresponsiveness, absence of brainstem reflexes, and apnea
A brain tumor arising from supporting structures
Neuroma
Rotary oscillation of the eyes.
Nystagmus
What clinical significance is seen with level of responsiveness or consciousness in an unconscious patient?
Obeying commands is a favorable response and demonstrates a return to consciousness.
This cerebral structure is responsible for vision
Occipital lobe
Because myasthenia gravis is a chronic disease and most patients are managed on an outpatient basis, health education is a major component of nursing care management. Which of the following are teaching points that a nurse should advise the patient to follow?
Rest before mealtime to reduce muscle fatigue. Schedule meals during the peak effectiveness of the anticholinesterase medications. Learn stress reduction techniques to avoid a potential crisis.
Consider the following laboratory values. Identify a critical result for a patient with a traumatic brain injury. Serum osmolality of 300 mOsm/ Urine specific gravity of 1.01 Serum magnesium of 1.4 mg/dL Hematocrit of 44%
Serum magnesium of 1.4 mg/dL
A score of 3 on the Glascow coma scale indicates
Severe impairment of neurologic function, deep coma, brain death, or pharmacologic inhibition of the neurologic response.
A glascow coma scale score of 3 to 8 is classified as
Severe traumatic brain injury
A nurse completes the Glascow coma scale on a patient with traumatic brain injury. Her assessment results in a score of 6, which is interpreted as
Severe traumatic brain injury
After a seizure, the nurse should place the patient in which of the following positions to prevent complications?
Side-lying, to facilitate drainage of oral secretions
What clinical significance is seen in facial asymmetry such as sagging, or decrease in wrinkles in an unconscious patient?
Sign of paralysis
Seizure that occurs without impairment of consciousness
Simple partial seizure
The nurse is aware that, when assessing a patient for symptoms of a brain tumor, the symptom most frequently found is:
Simple to generalized seizures
List four disorders of the hypothalamus that can result from a pituitary adenoma:
Sleep, appetite, temperature, and emotions
Benign tumor
Slow growing and can occur in a vital area where they can grow large enough to cause serious effects.
Functional abilities of C4 injury
Some shoulder elevation and diaphragm movement
Describe the pathophysiology of Guillain-Barre syndrome.
The result of a cell-mediated and humoral immune attack on peripheral nerve myelin proteins that cause inflammatory demyelination. The immune system cannot distinguish between the two proteins and attacks and destroys peripheral nerve myelin. The exact location of the immune attack within the peripheral nervous system is the ganglioside GM1b. With the autoimmune attack, there is an influx of macrophages and other immune-mediated agents that attack myelin, cause inflammation and destruction, and leave the axon unable to support nerve conduction.
Functional abilities of a C5 injury
Full head and neck control; elbow flexion
Functional abilities of a S1 to S5 injury
Full leg, foot, and ankle control
Functional abilities of a C6 injury
Fully innervated shoulder; wrist extension or dorsiflexion
A 37-year-old mother of three has just been diagnosed with a grade I meningioma. As part of patient education, the nurse tells the patient that:
Growth is slow and symptoms are caused by compression rather than tissue invasion.
Typically begins with muscle weakness and diminished reflexes of the lower extremities. Hyporeflexia and weakness may progress to tetraplegia or paralysis of all four limbs. The classic clinical features include areflexia and ascending weakness.
Guillain-Barre syndrome
Elevated intracranial pressure is most commonly associated with head injury. Which of the following are clinical signs of increased intracranial pressure that a nurse should evaluate?
Respiratory irregularities, slow bounding pulse, widened pulse pressure
A patient is diagnosed with an aggressive, primary, malignant brain tumor. The nurse is aware that the glioma:
Originated within the brain tissue
The escape of cerebrospinal fluid from the ears
Otorrhea
Drug reduces the rate of relapse in the relapsing-remitting course of multiple sclerosis. It decreases the number of plaques noted on an MRI and increases the time between relapses. Administered subcutaneously daily. Acts by increasing the antigen-specific suppressor T cells. May take 6 months for evidence of an immune response to appear.
Copaxone
Mestinon is an anticholinesterase medication that is the first line of therapy to treat myasthenia gravis. It works by:
inhibiting the breakdown of acetylcholine and increasing the relative concentration of available acetylcholine at the neuromuscular junction
Seizures that refer to short episodes of staring and loss of awareness
Absence or petit mal seizures
What clinical significance is seen with drooling versus spontaneous swallowing in an unconscious patient?
Absent in coma, paralysis of cranial nerves X and XII
What clinical significance is seen with observation of spontaneous movements in an unconscious patient?
Absent in deep coma
A sudden depression of reflex activity in the spinal cord
Areflexia
Explain the pathophysiology of Parkinson's disease.
Associated with decreasing levels of dopamine, resulting from destruction of pigmented neuronal cells in the substantia nigra in the basal ganglia region of the brain. The loss of dopamine stores in this area of the brain results in more excitatory neurotransmitters than inhibitory neurotransmitters, leading to an imbalance that affects voluntary movement.
What clinical significance is seen with firm pressure on a joint of the upper and lower extremity in an unconscious patient?
Asymmetric response in paralysis
Fourth step in the pathophysiology of a traumatic brain injury
Cerebral hypoxia and ischemia of brain tissue occurs
Sixth step in the pathophysiology of meningitis
Cerebrospinal fluid shows decreased glucose, increased protein, and increased white blood cells
Signs and symptoms of changes in the level of consciousness
Changes in the reactivity of the pupils, and hemiparesis.
The nurse reviews the patient's drug regimen for treatment of a brain tumor. She explains to the patient why one of the following drugs would not be prescribed, even though it might have therapeutic benefits. Which drug would not be prescribed for this patient?
Coumadin
A term used to describe double vision
Diplopia
Functional abilities of a C7 to C8 injury
Full elbow extension; some finger control
The name for the second cranial nerve
Optic
Bell's palsy (facial paralysis) is caused by:
unilateral inflammation of the seventh cranial nerve, which results in weakness or paralysis of the facial muscles
A patient has been diagnosed with myasthenia gravis. the nurse documents the initial and most common manifestation of:
Diplopia
Decorticate posturing
Involves abnormal flexion of the upper extremities and extension of the lower extremities and indicates damage to the upper midbrain
Headache pain with a pituitary gland tumor
Pain radiating between the two temples
Paralysis of the lower body
Paraplegia
Another term used to describe numbness
Paresthesias
List the three clinical signs found in Cushing's triad.
Bradycardia, hypertension, and bradypnea
The treatment that involves the implantation of radiation seeds close or into the brain tumor
Bradytherapy
This cerebral structure is responsible for breathing, blood pressure, heartbeat, and swallowing.
Brainstem
List the three most common cancers that metastasize to the spinal cord
Breast, prostate, and lung
This cerebral structure is responsible for telling right from left, calculations, sensations, reading, and writing.
Parietal lobe
What clinical significance is seen with decorticate posture in an unconscious patient?
Indicates damage to the upper midbrain
What clinical significance is seen with progressive dilation of pupils in an unconscious patient?
Indicates increasing intracranial pressure
What clinical significance is seen with fixed dilated pupils in an unconscious patient?
Indicates injury at level of midbrain
A patient with a head injury is being assessed for altered level of consciousness and increased intracranial pressure. The patient's last intracranial pressure reading was 16 mm Hg. The nurse understands that treatment for increased intracranial pressure will be initiated at a pressure greater than:
20 mm Hg
A nurse assessing urinary output as an indicator of diabetes insipidus knows what an output of what volume over 2 hours for an 80 kg adult may be a positive indicator?
250 mL/hour
Nutritional support following a traumatic brain injury is essential, especially for an unconscious patient. The nurse works with the nutritionist to ensure that the patient on a 1,500 calorie diet receives which of the following amounts of protein?
56 grams
A patient scheduled an office visit with his health care provider after receiving news that the magnetic resonance imaging of his brain indicated the presence of a primary tumor. The patient asks the nurse if he has cancer. Which of the following is the nurse's best response?
"Statistically, there is a 50% chance that is is benign."
Progressive relapsing multiple sclerosis
...
During a nursing interview, a patient with secondary progressive multiple sclerosis minimizes her visual problems, talks about remaining in school to attempt advanced degrees, requests information about full-time jobs in nursing, and mentions her desire to have several more children. The nurse recognizes these emotional response as being:
An example of inappropriate euphoria characteristic of the disease process
A score of 8 or less on the Glascow coma scale indicates
An unconscious patient
A brain tumor composed largely of abnormal blood vessels
Angioma
The brain's ability to change the diameter of its blood vessels automatically.
Autoregulation
Fifth step in the pathophysiology of multiple sclerosis
Axons begin to degenerate, causing permanent and irreversible damage
Drug or drugs inhibits dopamine breakdown
Azilect and Eldepryl
The nurse practitioner prescribes the medication of choice for a multiple sclerosis patient who is experiencing disabling episodes of muscle spasms, especially at night. Which of the following is the drug most likely prescribe in this scenario?
Baclofen
A patient was diagnosed with an astrocytoma located in the cerebellum. On assessment, the nurse would expect to see an alteration in:
Balance and coordination
Name three visual disturbances that are associated with papilledema.
Decreased visual acuity, diplopia, and visual field deficits
A nurse observes an abnormal posture response in an unconscious patient. She documents "extension and outward rotation of the upper extremities and plantar flexion of the feet." She is aware that his posture is a clinical indicator of which of the following?
Decerebrate posturing implying severe dysfunction and brain pathology
What clinical significance is seen with observation for posturing, spontaneous or in response to noxious stimuli in an unconscious patient?
Deep extensive brain lesion
A group of syndromes, characterized by unprovoked, recurring seizures.
Epilepsy
Secondary head injury
Evolves over the insuring hours and days after the initial injury and can be due to cerebral edema, ischemia, seizures, infection, hyperthermia, hypovolemia, and hypoxia
What clinical manifestations are seen in level of responsiveness or consciousness in an unconscious patient?
Eye opening; verbal and motor responses; pupils, size, equality, and reaction to light
Why should the nurse assess the temperature of a patient who complains of a severe headache?
Fever with a headache is associated with an infectious process such as meningitis or encephalitis, whereas headache without fever can be associated with a tumor or intracerebral bleeding.
What clinical significance is seen with firm pressure with blunt object on sole of foot, moving along lateral margin and crossing to the ball of the foot in an unconscious patient?
Flexion of the toes, especially the great toe, is normal except in the newborn. Dorisflexion of toes, especially the great toe, indicates contralateral pathologic of corticospinal tract, or the Babinski reflex. Helps determine location of lesion in brain.
Explain how herpes simplex type 1 causes encephalitis.
Followed by a retrograde intraneuronal path to the brain. The olfactory and trigeminal nerves are the most commonly involved paths. The latent virus in the brain tissue may reactivate and result in encephalitis. The invading organism causes cerebral edema and petechial hemorrhages of the brain and can directly invade the brain, damaging neurons.
What clinical significance is seen with absence of spontaneous neck movement in an unconscious patient?
Fracture or dislocation of cervical spine
This cerebral structure is responsible for movement, reasoning, behavior, memory, personality, planning, decision making, judgment, initiative, inhibition and mood.
Frontal lobe
In a spinal cord injury, neurogenic shock develops due to loss of the autonomic nervous system functioning below the level of the lesion. Which of the following indicators of neurogenic shock would the nruse expect to find?
Hypotension, venous pooling, tachypnea, hypothermia
A patient is diagnosed with Parkinson's disease. The nurse advises the patient and his family about the most effective medication. Which of the following drugs would most likely be prescribed for this patient?
Levodopa
The spread of cancer cells from their primary site
Metstatic
A glascow coma scale score of 13 to 15 is classified as
Mild traumatic brain injury
A glascow coma scale score of 9 to 12 is classified as
Moderate traumatic brain injury
A nurse helps a patient recently diagnosed with a pituitary adenoma understand that:
Most tumors produce too much of one or more hormones
Characteristics of a central cord injury
Motor deficits in the upper extremities compared to the lower extremities; sensory loss varies but is more pronounced in the upper extremities; bowel/bladder dysfunction is variable, or function may be completely preserved
The most common cause of spinal cord injury, which accounts for 42% of all cases is,
Motor vehicle accidents
Seizures that are bilaterally massive epileptic and are characterized by jerking movements of a muscle or muscle group, without loss of consciousness
Myoclonic seizures
What is the clinical significance of ataxic respiration with irregularity in depth/rate of respirations in an unconscious patient?
Ominous sign of damage to medullary center
It is important for a nurse to be able to differentiate between dementia and delirium. Which of the following are characteristics of dementia?
Onset is slow, the course is progressive and irreversible, no motor deficits early in the disease.
Drug or drugs that are used to postpone the initiation of levodopa therapy
Parlodel and Permax
Inflammation of the salivary glands
Parotitis
Which of the following drugs may be used after a seizure to maintain a seizure-free state?
Phenobarbital
Describe the expected medical management for spinal cord compression.
Radiation therapy can be used to decrease the size of the tremor. Because of the blood-brain barrier, chemotherapy for malignant spinal cord neoplasms is of limited benefit. Dexamethasone is used temporarily to reduce edema and improve neurologic function until other treatments can take effect.
Explain demyelination, a progressive disease of the central nervous system seen in multiple sclerosis.
Refers to the destruction of myelin, the fatty and proteinaceous material that surrounds certain nerve fibers in the brain and spinal cord; it results in impaired transmission of nerve impulses.
Describe Cushing's response.
Seen when cerebral blood flow decreases significantly. When ischemic, the vasomotor center triggers an increase in arterial pressure in an effort to overcome the increased intracranial pressure. A sympathetically mediated response causes an increase in the systolic blood pressure, with a widening of the pulse pressure and cardiac slowing. It is a late sign requiring immediate intervention; however, perfusion may be recoverable if it is treated rapidly.
What clinical significance is seen with flaccidity with absence of motor response in an unconscious patient?
Seen with cerebral hemisphere pathology and in metabolic depression of brain function.
A young adult has just been diagnosed with atonic seizures. The nurse practitioner explains to the patient that this type of seizure is characterized by:
Sudden loss of muscle tone that results in a fall.
What is the clinical significance of hyperventilation in an unconscious patient?
Suggests onset of metabolic problem or brain stem damage
How should a nurse assess the gag reflex?
The nurse should gently touch each side of the posterior pharyngeal wall with a cotton swab or suction catheter and note the strength of the gag. The nurse expects to observe a simultaneous elevation of the uvula and "gag" with stimulation of the posterior pharynx.
How should the nurse assess the patient postoperatively for spinal cord compression?
The patient is monitored for deterioration in neurologic status. A sudden onset of neurologic deficit is an ominous sign and may be due to vertebral collapse associated with spinal cord infarction. Frequent neurologic checks are carried out, with emphasis on movement, strength, and sensation in the upper and lower extremities. Staining of the dressing may indicate leakage of cerebralspinal fluid from the surgical site, which may lead to serious infection or to an inflammatory reaction in the surrounding tissues that can cause severe pain in the postoperative period.
A nurse practitioner is preparing to present information about brain tumors to a group of nursing students. Which of the following are correct statement about brain tumors?
The terms glioma and medulloblastoma are used to describe a primary tumor. Primary tumors can exhibit unrestrained growth. About 80% of malignant tumors are gliomas.
Explain the pathophysiology of myasthenia gravis.
There is a reduction in the number of acetylcholine receptor sites because antibodies directed at the acetylcholine receptor sites impair transmission of impulses across the neuromuscular junction. Fewer receptors are then available for stimulation, resulting in voluntary muscle weakness that escalates with continued activity.
Describe the expected surgical intervention for spinal cord compression.
Tumor removal is desirable but not always possible. The goal is to remove as much tumor as possible while sparing uninvolved portions of the spina cord to avoid neurologic damage. Microsurgical techniques have improved the prognosis for patients with intramedullary tumors. Prognosis is related to the degree of neurologic involvement.
