Neurosensory

A nurse assesses the left plantar reflexes of an adult client and notes the response shown in the photograph below. Which action should the nurse take next?

Contact the provider with the abnormal findings ( Babinski Sign )

A patient has been injured in a motorcycle accident and is presenting with signs and symptoms of increasing intercranial pressure. What is the most significant sign or symptom of increased cranial pressure?

Decrease in the level of consciousness

A nurse assesses a client who demonstrates a positive Romberg's sign with eyes closed but not with eyes open. Which condition does the nurse associate with this finding?

Difficulty with proprioception

A nurse obtained a focused health history for a client who is scheduled for magnetic resonance angiography. Which priority question should the nurse asked before the test?

Do you have allergies to iodine or Shellfish?

When documenting a seizure which information is most important to include initially?

Duration of the seizure

A nurse plans care for an 83-year-old client who is experiencing age related sensory perception changes. Which intervention should the nurse include in the clients plan of care?

Ensure that the pathway to the bathroom is free from equipment

A nurse cares for a client who is experiencing deteriorating neurologic function. The client states, I am worried I will not be able to care for my young children. How should the nurse respond?

Give me more information about what worries you, so we can see if we can do something to make adjustments

The nurse suspects that a patient is experiencing increasing intercranial pressure. What observations to the nurse make to come to this conclusion?

Headache, rise in temperature, dilated pupils on affected side, decreasing level of consciousness

After teaching a client who is scheduled for magnetic resonance imaging (MRI), the nurse assesses the clients understanding. Which client statement indicates a correct in understanding of the teaching?

I can return to my usual activities immediately after the MRI

A nurse assesses a client who is recovering from a lumbar puncture. Which complication of this procedure should alert the nurse to urgently contact the health care provider?

Nausea and vomiting

A newly admitted patient to the emergency room 30 minutes ago after a fall off the ladder has gradually decrease in consciousness and has slowly reacting pupils, a widening pulse pressure, and verbal responses that are slow and unintelligible. What is the most appropriate position for the patient?

Neck placed in a neutral position

The outer most membrane of the Mylan sheath is called the

Neurilemma

A nurse assesses a client recovering from a cerebral angiography via the clients right femoral artery. Which assessment should the nurse complete?

Palpate bilateral lower extremity pulses.

The night shift nurse has just finished giving report on for patient to have risk for increased Intercranial pressure. The healthcare provider is aware of their status. Which patient will go out coming nurse checked first?

Patient had a brief episode of cheyne stroke respirations

A family member of a patient who has suffered a tonic clonic Seizure is concerned about the patient deep sleep. What is this behavior called?

Postictal period

A nurse plans care for a client who has a hyper active response to a test of deep tendon reflexes. Which intervention should the nurse include in this clients plan of care?

Provide the client with assistance when ambulating

Which food may cause or worse than a migraine headache?

Ripened cheese

A nurse prepares a client for lumbar puncture. Which assessment findings should alert the nurse to contact the health care provider?

Shingles on the clients back

What is the cranial nerve that's supplies most of the organs in the drastic and abdominal cavity's and also carries motor fibers to glands that produce digestive juices and other secretions?

Vagus nerve

A home health nurse is reviewing the patient's medication list and sees that the patient takes phenytoin. Which question is a nurse most likely to ask?

When was the last time you had a seizure

START OF QUIZ 2

Yay

Which food should the person who suffers from migraines headaches avoid?

Yogurt, caffeine, marinated foods

A nurse cares for a client who is recovering from a single-photon emission computed tomography (SPECT) with a radiopharmaceutical agent. Which statement should the nurse include when discussing the plan of care with this client?

You may return to your previous activity level immediately.

Which nerve endings liberate norepinephrine

adrenergic

The central canal of the spinal cord contains

cerebrospinal fluid (CSF)

The vascular network that forms the Cerebrospinal fluid is called the

choroid plexus

What is the function of the CSF?

cushions the brain and spinal cord

The membrane surrounding an entire nerve is called the

epineurium

Glasgow Coma Scale

eyes, verbal, motor Max- 15 pts, below 8= coma

The physician prescribed intervenous mannitol for a patient who has a head injury and increased intercranial pressure. Which assessment finding indicates to the nurse that the patient is having a therapeutic response to the mannitol?

increased urinary output

The visual area of the cortex is in the

occipital lobe

The midbrain and the medulla oblongata are connected via the

pons

The nurse is observing a patient to determine if seizure activity is status epilepticus. For what length of time should seizure activity occurring for this diagnosis to be appropriate for the patient?

30 minutes

A nurse assesses a clients recent memory. Which client statement confirms that the clients remote memory is intact?

"I ate oatmeal with wheat toast and orange juice for breakfast."

A nurse teaches an 80 year old client with diminished touch sensation. Which statement should the nurse include in this clients teaching?

"Look at the placement of your feet when walking."

Patient is diagnosed with increased cranial pressure. What pressure measurement should the nurse expect to be associated with this diagnosis

A pressure measurement of 17 or higher because it is more than the normal range of 0 to 15

A nurse is teaching a client with cerebral function impairment. Which statement should the nurse include in this clients discharge teaching?

Ask a friend to drive you to your follow up appointment

What is the priority nursing intervention in the postictal phase of a seizure

Assess the client's breathing pattern

Fiber second of impulses away from the cell body are called

Axons

Which three symptoms are a characteristic of crushing try it associated with increased ICP?

Bradycardia, hypertension, and widening pulse pressure

A client was brought to the hospital due to seizure. Which of the following technique sure the nurse used to assess the clients people in response to light?

Briefly shine a pen light into the clients I bypassing the light from the outer edge of the eye towards the center of the eye

Before discharge, the nurse instructed the client who will take phenytoin sodium ( Dilantin) At home to perform which hygiene measure?

Brushing teeth at least twice daily

A nurse assesses a client and notes the clients position as indicated in the illustration below: what should the nurse document this finding? Question 17

Decorticate posturing

And unconscious patient has a diagnosis of ineffective cerebral tissue perfusion related to cerebral tissue swelling. Which nursing intervention will be included in the plan of care?

Keep the head of the bed elevated 30°

In caring for a patient with a headache, which instruction to the nearest give to the UAP

Keep the room quiet and dark

The nurse instructs a person taking phenytoin (Dilantin) That periodic blood test will be necessary. What is the physician monitoring for?

Liver damage

When implementing seizure precautions, which is an action is most appropriate?

Maintain the clients bed and the lowest position

The nurse is caring for an individual who has a tension headache. Which nursing interventions should be included in the patient's plan of care?

Massage moist heat

Vital center that regulates respiration and the heart rate are located in the

Medulla oblongata

Following a craniotomy for the removal of a brain tumor, the patient exhibit nuchal rigidity, Rash on the chest, headache, and a positive brudzinski sign. What do these assessment findings indicate to the nurse?

Meningitis

A nurse prepares to teach a client who has experience damage to the left temporal lobe of the brain. Which action should the nurse take when providing education about the newly prescribe medication's to this client?

Sit on the clients right side and speak into the right ear

A patient is recovering from an epidural bleed. And which part of the brain to the nurse explained to the family that the bleeding occurred?

Space between the Dura and the skull

A patient with a story about injury is experiencing increased intercranial pressure. Which intervention should the nurse used to help prevent further increasing intercranial pressure?

Space nursing care at intervals so that necessary care is distributed evenly throughout the shift

When the nurse monitors the clients neurologic status, which finding is most suggested that the clients intercranial pressure is increasing?

Systolic pressure increases and diastolic pressure decreases????

A nurse delegates care to the unlicensed assistive personnel (UAP) Which statement should the nurse include when delegating care for a client with cranial nerve II impairment?

Tell the client where food items are on the breakfast tray.

The patient who suffered brain injury has developed agnosis. Which intervention by the nurse is most helpful?

Telling the patient this is a spoon you are to eat with

A client who has difficulty forming words would indicate an injury to

The broca area

The part of the nervous system that consist of all the spinal nerves and the cranial nerves

The peripheral nervous system

Which symptom is specific to migraine headaches?

They are preceded by an aura

A patient is in continent during a seizure and sleeps for several hours afterwards. What type of seizure did the patient most likely experience?

Tonic-clonic

A nurse performed an assessment of pain discrimination on an older adult client. The client correctly identifies, with eyes closed, a sharp sensation on the right hand when touched with a pen. Which action should the nurse take next?

Touch the pin on the same area of the left hand