patho exam 7

The CT scan report identified that a client with a skull fracture has developed a hematoma that resulted from a torn artery. The report would be interpreted as:

Epidural hematoma

Based on assessment parameters for motor response on the Glasgow Coma Scale, to which client should the nurse assign a score of 5?

Localizes pain

The emergency room doctor suspects a client may have bacterial meningitis. The most important diagnostic test to perform would be:

Lumbar puncture

Which of the following diagnostic findings is likely to result in the most serious brain insult?

Mean arterial pressure (MAP) that equals intracranial pressure (ICP).

Select the tactile receptors that are sensitive to the movement of very light objects over the surface of the skin.

Meissner corpuscles

Which one of the following is the most common primary intracranial tumor in adults?

Neurogliomas or neoplasms of astrocytic origin

Hypoxic injury will result in which of the following effects on the brain?

Neuronal cell injury and death

The nurse is preparing a client for oculovestibular reflex assessment (cold caloric test). The nurse explains that the test is used to elicit which of the following?

Nystagmus

A client has developed hydrocephalus and asks the nurse what may have caused this to occur. The best response would be:

Overproduction of cerebrospinal fluid

A client begins to exhibit signs and symptoms of a stroke at a community health fair. Emergency care for the client includes:

going to the nearest stroke center.

Which of the following clients' signs and symptoms would allow a clinician to be most justified in ruling out stroke as a cause? An adult:

has had a gradual onset of weakness, headache and visual disturbances over the last two days.

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 which of the following?

"Because the skull sutures are not fused there may be no brain damage."

A patient is having difficulty with sleeping and has also been experiencing marital difficulties over the past couple of months. The patient tells the nurse at the physician's office that all this started after he had a car accident earlier that year. Which of the following would be the most important question for the nurse to ask?

"Did you sustain any injuries in the accident?"

A 9 year-old boy has been brought to the emergency department by his father who is concerned by his son's recent fever, stiff neck, pain and nausea. Examination reveals a petechial rash. Which of the following assessment questions by the emergency room physician is most appropriate?

"Has your son had any sinus or ear infections in the last little while?"

The nurse is educating parents of a child with arteriovenous malformation. The nurse determines that the parents need additional education when the parents state:

"It is a rare complication of concussions."

A patient discharged from the hospital 5 days ago following a stroke has come to the emergency department with facial droop that progressed with hemiplegia and aphasia. The patient's spouse is extremely upset because the physician stated that the patient cannot receive thrombolytic medications to reestablish cerebral circulation and the spouse asks the nurse why. Which of the following is the nurse's most accurate response?

"Thrombolytics may cause cerebral hemorrhage."

The spouse of a patient diagnosed with Alzheimer's disease asks the nurse why the patient often neglects to take a shower. The spouse states that the patient was always diligent with hygiene in the past; however, over the past few months that has not been the case. Which of the following is the nurse's best response?

"You should remind the patient to shower."

A 20 year-old has been diagnosed with an astrocytic brain tumor located in the brainstem. Which of the following statements by the oncologist treating the client is most accurate?

"Your prognosis will depend on whether we can surgically resect your tumor."

The family of an older adult reports increasing inability to perform basic activities of daily living. After evaluation, the client is diagnosed with Alzheimer's disease. What intervention will be implemented to slow cognitive decline?

Acetylcholinesterase inhibitors

A nurse is monitoring the intracranial pressure (ICP) of a client. The nurse would consider the client to have a normal reading when the results identify:

0 to 15 mm Hg

According to the Glasgow Coma Scale, opening one's eyes to only painful stimuli would receive which score?

2

Which of the following clients may be experiencing a sensory focal seizure that has sent an abnormal cortical discharge to the Autonomic Nervous System (ANS)?

56 year old complaining of tingling sensations and has both an elevated pulse and BP.

The regulation of cerebral blood flow is accomplished through both autoregulation and local regulation. This allows for the brain to meet its metabolic needs. What is the low parameter for arterial blood pressure before cerebral blood flow becomes severely compromised?

60 mm Hg

Which of the following hospital patients is most likely to be diagnosed with complex regional pain syndrome II (CRPS II)?

A man who has been admitted for treatment of continuing hyperalgesia after sustaining a nerve injury in a motor vehicle accident.

Which of the following individuals would be most likely to experience global ischemia to his or her brain?

A man who has entered cardiogenic shock following a severe myocardial infarction.

A 26 year-old female is resting after a one-minute episode during which she lost consciousness while her muscles contracted and extremities extended. This was followed by rhythmic contraction and relaxation of her extremities. On regaining consciousness, she found herself to have been incontinent of urine. What has the woman most likely experienced?

A tonic-clonic seizure.

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:

Administer IV tissue-type plasmin activator (tPA)

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 antibiotics

Global and focal brain injuries manifest differently. What is almost always a manifestation of a global brain injury?

Altered level of consciousness

The nurse is conducting a staff inservice on increased intracranial pressure. The nurse determines that the participants are understanding the information when they identify that blood pressure increases in increased intracranial pressure because of which of the following?

An attempt to increase cerebral perfusion

A nurse is teaching a client newly diagnosed with a seizure disorder about medications. The most important information for the nurse to provide would be:

Antiepileptic medications should never be discontinued abruptly.

What medication teaching should be done for a woman of childbearing age with a seizure disorder?

Antiseizure drugs increase the risk for congenital abnormalities.

The nurse caring for a client with an epidural hematoma recognizes that the bleeding is due to which of the following?

Arterial tear

The nurse is caring for a client with a brain tumor when the client begins to vomit. Which intervention should the nurse do first?

Assess for other signs/symptoms of increased intracranial pressure

The two main categories of glial tumors include which of the following?

Astrocytic

The nurse caring for a client with an aneurysmal subarachnoid hemorrhage understands that the most common cause of this condition is which of the following?

Berry aneurysm

Following a collision while mountain biking, the diagnostic work up of a 22 year-old male has indicated the presence of an acute subdural hematoma. Which of the following pathophysiological processes most likely underlies his diagnosis?

Blood has accumulated between the man's dura and subarachnoid space.

A teenager has been in a car accident and experienced 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?

Brain contusions and hematomas

A soccer player has been diagnosed with a brain contusion after being injured in a game. The best explanation of the injury by the nurse would be:

Bruising on the surface of the brain occurred.

A client has sustained a severe, diffuse brain injury that resulted in seriously compromised brain function. The client is at greatest risk for:

Brain death

Manifestations of brain tumors are focal disturbances in brain function and increased ICP. What causes the focal disturbances manifested by brain tumors?

Brain edema and disturbances in blood flow

When the suspected diagnosis is bacterial meningitis, what assessment techniques can assist in determining if meningeal irritation is present?

Brudzinski sign and Kernig sign

Intracranial aneurysms that rupture cause subarachnoid hemorrhage in the client. How is the diagnosis of intracranial aneurysms and subarachnoid hemorrhage made?

CT scan

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?

CT scan

An 80-year-old patient with a history of heavy alcohol use is being seen by his provider for drowsiness, confusion, and headache. His family states that he fell and hit his head "several weeks ago." Which type of hematoma does the provider suspect?

Chronic subdural

Which of the following clients is at least risk for rapid bleeding?

Client with a subdural hematoma

The nurse is working in the emergency room. One client's presenting symptoms include the worst headache ever, nuchal rigidity and nausea. Another client's presenting symptoms include fever, stiff back, and positive Kernig's sign. Which client should the nurse assess first?

Client with the worst headache, nuchal rigidity and nausea

A nurse on a neurology unit is assessing a female brain-injured client. The client is unresponsive to speech, and her pupils are dilated and do not react to light. She is breathing regularly but her respiratory rate is 45 breaths per minute. In response to a noxious stimulus, her arms and legs extend rigidly. What is her level of impairment?

Coma

Which type of seizure begins in a localized area of the brain but may progress rapidly to involve both hemispheres?

Complex partial

A patient who is diagnosed with seizures describes feeling a strange sensation before losing consciousness. The family members report that the patient has been smacking their lips prior to having a seizure. Which type of seizure disorder presents with these symptoms?

Complex partial or focal seizure with impairment of consciousness

Wernicke-Korsakoff syndrome is a dementia that is associated with chronic alcoholism. It is caused by a deficiency in thiamine (vitamin B12). What is the most distinctive sign or symptom of this syndrome?

Confabulation

The nurse knows that which of the following treatment plans listed below is most likely to be prescribed after a computerized tomography (CT) scan of the head reveals a new-onset aneurysmal subarachnoid hemorrhage?

Craniotomy and clipping of the affected vessel.

The nurse is caring for a 31-year-old trauma victim admitted to the neurologic intensive care unit. While doing the initial assessment, the nurse finds that the client is flexing the arms, wrists, and fingers. There is adduction of the upper extremities with internal rotation and plantar flexion of the lower extremities. How would the nurse describe this in the notes?

Decorticate posturing

The nurse observes that the upper extremities of a client with a brain injury are abducted while the lower extremities are internally rotated. The nurse communicates which of the following during hand-off reporting?

Decorticate posturing

A patient suffering global cerebral ischemia a week after a suicide attempt by hanging is in the intensive care unit receiving treatment. The parent asks the nurse why it is necessary to keep the patient paralyzed with medications and on the ventilator. The most appropriate response would be that these therapies do which of the following?

Decrease metabolic needs and increase oxygenation

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 do which of the following?

Decrease the likelihood of further neurological deficits

The health care provider is concerned that a client may be at risk for problems with cerebral blood flow. The most important data to assess would be:

Decreased level of oxygen

The provider is testing the patient's ability to identify the specific location of skin touch in two different areas. This ability is communicated through which pathway?

Discriminative

After evaluating the patient, the physician thinks that his elderly patient is exhibiting signs and symptoms of normal pressure hydrocephalus. Which of the following symptoms would be seen?

Disturbances in gait

A patient with Alzheimer's disease (AD) is forgetful and has started to lose interest in social activities. Which of the following treatment routines would be beneficial for the patient?

Donepezil (Aricept)

Stretch-sensitive receptors in the skin (Ruffini end organs, Pacinian corpuscles, and Merkel cells) help signal postural information and are processed through the:

Dorsal column-medial lemniscus pathway

Excessive activity of the excitatory neurotransmitters and their receptor-mediated effects is the cause of which type of brain injury?

Excitotoxic

The nurse assessing for the doll's head response (doll's eye response) in an unconscious client documents which of the following as an abnormal response?

Eyes turn right when head is turned right

An emergency room nurse receives a report that a client's Glasgow Coma Scale (GCS) is 3. The nurse prepares to care for a client with which of the following?

Flaccid motor response

A client who is diagnosed with seizures describes feeling confused after experiencing a seizure. The family members report that the client has been smacking his lips prior to having a seizure. The client most likely experienced which type of seizure?

Focal

A client with a history of a seizure disorder has been observed suddenly and repetitively patting his knee. After stopping this repetitive action, the client appears confused but is oriented to person and place but not time. What type of seizure did this client most likely experience?

Focal seizure with impairment to consciousness

Following surgery for a large malignant brain tumor, the nurse should anticipate discussing which further treatment option with the family that may ensure that any remaining cancer cells will be killed?

Gamma knife radiation

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 which of the following?

Generalized seizure

A college student has been experiencing frequent headaches that he describes as throbbing and complaining of difficulty concentrating while studying. Upon cerebral angiography, he is found to have an arteriovenous malformation. Which of the following pathophysiological concepts are likely responsible for his symptoms?

High pressure and local hemorrhage of the venous system.

A patient with memory loss is concerned about the possibility that it may be inherited. Which of the following disorders is an inherited dementia?

Huntington's disease

The nurse is planning an inservice on hypoxia versus ischemia in brain-injured clients. The nurse should include which of the following?

Hypoxia produces a generalized depressive effect on the brain.

A family brings a client to the emergency department with increasing lethargy and disorientation. They think the client had a seizure on the drive over to the hospital. The client has been sick with a "cold virus" for the last few days. On admission, the clients' temperature is 102°F. Which other clinical manifestations may lead to the diagnosis of encephalitis?

Impaired neck flexion resulting from muscle spasm

A patient admitted to the emergency department with a change in mental status and a history of AIDS and primary central nervous system (CNS) lymphoma becomes extremely combative with the medical personnel. A family member is very upset with the patient's behavior. The nurse explains that these behaviors are most likely caused by which of the following?

Recurrence of primary CNS lymphoma

A nurse at a long term care facility provides care for an 85 year-old man who has had recent transient ischemic attacks (TIAs). Which of the following statements best identifies future complications associated with TIAs? TIA's:

Resolve rapidly but may place the client at an increased risk for stroke.

A client has started having uncontrolled seizures that are not responding to usual medications. Nursing working with the client must pay special attention to which of the following priority aspects of this clients care? Assessment of:

Respiratory status and oxygen saturation

A parent brought her 8-year-old child to the emergent care center to be examined following a fall off a playground set, resulting in a head injury. On discharge, the nurse explains to the parent that some symptoms may continue, including the inability to remember what happened before the fall. Which of the following terms best describes the diagnosis?

Retrograde amnesia

The nurse is assessing a client and notes the client is now displaying decerebrate posturing. The position would be documented as:

Rigidity of the arms with palms of the hands turned away from the body and with stiffly extended legs and plantar flexion of the feet

The emergency department nurse is caring for a patient who fell and had a head injury. Which of the following assessments would be noted during the early stage of intracranial pressure increase?

Stable vital signs

The nurse taking a report on a client coming into the emergency room plans care for a client with brain dysfunction based on which of the following symptoms?

Stupor

What term is used to describe a level of consciousness that sees a client responding only to vigorous and repeated stimuli and has minimal or no spontaneous movement?

Stupor

The MRA scan of a client with a suspected stroke reports ruptured berry aneurysm. The nurse plans care for a client with which of the following?

Subarachnoid hemorrhage

The nurse is explaining how vasogenic brain edema occurs to a client's family. The most appropriate information for the nurse to provide would be:

The blood-brain barrier is disrupted, allowing fluid to escape into the extracellular fluid.

A patient suffering a thrombotic stroke is brought into the emergency department by ambulance and the health care team is preparing to administer a synthetic tissue plasminogen activator for which of the following purposes?

Thrombolysis

The most common cause of an ischemic stroke is which of the following?

Thrombosis

Children feel pain just as much as adults do. What is the major principle in pain management in the pediatric population?

Treat on individual basis and match analgesic agent with cause and level of pain.

A patient reports chronic pain. Assessment indicates it is located at the T6 dermatome. How will this information assist the nurse to develop an effective plan of care?

Treatment can be tailored to the specific location.

Global or diffuse brain injury is manifested by changes in the level of consciousness.

True

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:

automatisms.

As the nurse is performing a physical assessment of a client, the client begins to have seizure activity including loss of consciousness and limb jerking. The nurse's first priority is to:

protect the patient from injury.

The nurse observes a new nurse performing the test for Kernig's 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:

resistance should be provided with the knee in a flexed position.

The most common cause of ischemic stroke is:

thrombosis.

An 85-year-old patient with a medical history of diabetes, thrombocytopenia, and hypertension is on the cardiac step-down unit following the development of atrial defibrillation with a heart rate of 120-140. The atrial fibrillation was successfully cardioverted to a normal sinus rhythm and the patient was preparing to be discharged from the hospital when suddenly the patient developed right-sided hemiplegia and dysphasia. The nurse understands that this patient has many modifiable risk factors for stroke including which of the following? Select all that apply.

• Atrial fibrillation • Diabetes • Hypertension

A client may be at risk for the development of hypoxia. Select the conditions that would place a client at risk. Select all that apply.

• Carbon monoxide poisoning • Increased oxygenation by the lungs • Severe anemia

When trying to explain the difference between vasogenic versus cytotoxic cerebral edema, the physiology instructor mentions that cytotoxic edema displays which of the following functions in the brain? Select all that apply.

• Causes ischemia to build up lactic acid due to anaerobic metabolism • Allows cells to increase volume to the point of rupture, damaging neighboring cells

The nurse would consider which of the following factors when providing a client with education regarding modifiable risk factors for stroke? Select all that apply.

• Controlling blood pressure • Avoiding excessive alcohol use • Monitoring diabetes mellitus • Selecting low fat foods

The nurse reading the results of a lumbar puncture cerebral spinal fluid analysis anticipates that the client's meningitis will be self-limiting in nature because of which of the following findings? Select all that apply.

• Lymphocytes • Moderately increased protein

A nurse in the emergency room is assessing a client's level of consciousness. The client appears very drowsy but is able to follow simple commands and respond to painful stimuli appropriately. The nurse should document the client's level of consciousness as which of the following?

• Obtundation

A nurse is caring for a 30-year-old patient who experiences intense one-sided headaches. Which of the following additional characteristics would support a diagnosis of cluster headaches? Select all that apply.

• Pain behind the eye • Rhinorrhea on the same side as the headache

Which of the following factors influence pharmacologic choices for pain management in older adults? Select all that apply.

• Poor nutrition may lead to poor drug distribution. • Polypharmacy may cause drug interactions. • Organ function may be less efficient.

The nurse is caring for a client who has received tissue plasminogen activator (tPA). The nurse's plan of care should include education relating to which of the following? Select all that apply.

• Warfarin (Coumadin) therapy • Reduction of risk factors • Signs and symptoms of occurrence

The nurse is providing nonpharmacologic pain relief for a client who has a pain level of 2 in the leg. What intervention provided by the nurse would be considered distraction?

Sitting with the client and having a conversation

A nurse is preparing for a course in cardiopulmonary resuscitation (CPR) and realizes that ventricular fibrillation quickly disrupts blood flow to the brain that causes which of the following in a matter of seconds?

Global ischemia

A client has suffered a stroke that has affected his speech. The physician has identified the client as having expressive aphasia. Later in the day, the family asks the nurse to explain what this means. The most accurate response would be aphasia that is:

Characterized by an inability to easily communicate spontaneously or translate thoughts or ideas into meaningful speech or writing

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

Which one of the following would the nurse consider an ischemic stroke?

Lacunar infarct

The nurse assessing a patient with a traumatic brain injury assesses for changes in which of the following? Select all that apply.

• Cognition • Level of consciousness • Motor function • Sensory function

The nurse is completing a Glasgow Coma Scale assessment on a client with a traumatic brain injury. Which of the following should the nurse include in the assessment? Select all that apply.

• Eye opening response • Verbal utterances • Motor response

For seizure disorders that do not respond to anticonvulsant medications, the option for surgical treatment exists. What is removed in the most common surgery for seizure disorders?

Amygdala

The nurse is conducting a community education program on concussions. The nurse evaluates that the participants are understanding the education when they state that which of the following offers the brain protection from external forces?

Cerebral spinal fluid

A client who has been living with Alzheimer's disease and spouse are at the doctor's office and the spouse asks the nurse why the patient cannot remember much of anything from the past. The best response by the nurse is that Alzheimer's disease affects which of the following?

Cells located in the hippocampus

A teenager, exposed to West Nile virus a few weeks ago while camping with friends, is admitted with headache, fever, and nuchal rigidity. The teenager is also displaying some lethargy and disorientation. The nurse knows which of the following medical diagnoses listed below may be associated with these clinical manifestations?

Encephalitis.

A family is sitting with a patient in the intensive care unit who sustained significant head injuries in a motorcycle accident. They are questioning the nurse about why the patient's eyes open but do not stay open for long. The nurse explains that the patient is probably in which of the following states?

In a stuporous state due to a reticular activated system (RAS) injury

A client has developed global ischemia of the brain. The nurse determines this is:

Inadequate to meet the metabolic needs of the entire brain

While lecturing to a group of physiology students, the instructor asks, "What metabolic factors cause vasodilation of cerebral vessels thereby increasing cerebral blood flow to the brain?" The student with the best response would be:

Increased carbon dioxide level

Generalized convulsive status epilepticus is a medical emergency caused by a tonic-clonic seizure that does not spontaneously end, or recurs in succession without recovery. What is the first-line drug of choice to treat status epilepticus?

Intravenous lorazepam

A child has developed a brain tumor in the walls of the cerebellum. The health care provider would document this as:

Pilocytic astrocytomas

A patient in the intensive care unit who has a brain tumor has experienced a sharp decline. The care team suspects that water and protein have crossed the blood-brain barrier and been transferred from the vascular space into the client's interstitial space. Which of the following diagnoses best captures this pathophysiology?

Vasogenic edema

Hydrocephalus is caused by which of the following? Select all that apply.

• Decreased absorption of cerebral spinal fluid • Obstruction of cerebral spinal fluid

A traumatic brain injury client has developed extreme cerebral edema. The nurse is monitoring the client closely for signs of brain herniation. Which clinical manifestations would correlate to upward herniation of the midbrain from the infratentorial compartment? Select all that apply.

• Deep coma • Respiratory rate of 8 with intermittent sighs • Bilateral small, fixed pupils

The nurse planning a community education class on brain tumors and their prevention should include which of the following as risk factors? Select all that apply.

• High dose irradiation exposure • Acquired immune suppression

A 20 year-old has been admitted to a rehabilitation center after hospital treatment for an ischemic stroke. Which of the following aspects of the client's history would be considered to have contributed to his stroke? Select all that apply. The client:

• Is an African-American male. • Blood pressure has historically been in the range of 150's/90's. • Was diagnosed with type 2 diabetes 8 years ago.

An older adult is being evaluated for dementia. Which of the following assessments do not indicate normal aging? Select all that apply.

• Is easily agitated when routines are not followed • Is unable to explain the meaning of a proverb • Needs cues to perform hygiene activities

The nurse assessing a client for signs of meningeal irritation should assess for which of the following? Select all that apply.

• Kernig's sign • Brudzinski's sign

Which symptoms would support the diagnosis of a stroke involving the posterior cerebral artery? Select all that apply.

• Loss of central vision • Repeating of verbal responses

Following a car accident of a male teenage that did not have their seatbelt on; he arrived in the emergency department with a traumatic brain injury. He has severe cerebral edema following emergent craniotomy. Throughout the night, the nurse has been monitoring and reporting changes in his assessment. Which of the following assessments corresponds to a supratentorial herniation that has progressed to include midbrain involvement? Select all that apply.

• Pupils fixed at ~ 5 mm in diameter. • Respiration rate of 40 breaths/min. • Decerebrate posturing following painful stimulation of the sternum.

A patient with migraines asks the nurse about symptoms of an aura. Which of the following are characteristic of a migraine aura? Select all that apply.

• Seeing flickering lights or spots • Feeling numbness in fingers • Slurred speech

The nurse is providing discharge instructions on the antiseizure medication valproic acid to a woman of childbearing age. Which of the following should the nurse include? Select all that apply.

• The client should also take a folic acid supplement daily. • The medication may predispose her to osteoporosis. • The medication should be taken consistently. • The medication may interact with oral contraceptives.