Patho Neuro Exam
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:
"Because the skull sutures are not fused there may be no brain damage."
A client 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 client's spouse is extremely upset because the physician stated that the client cannot receive thrombolytic medications to reestablish cerebral circulation and the spouse asks the nurse why. What is the nurse's most accurate response?
"Thrombolytics may cause cerebral hemorrhage."
The spouse of a client who has been in a long-term care facility for a few months due to a brain injury that caused a vegetative state asks the nurse why the client is still being fed through the gastrostomy tube. What is the nurse's best response?
"To avoid aspiration into the lungs."
Which would the nurse consider an ischemic stroke?
Lacunar infarct
An older adult is brought to the emergency department after experiencing some confusion, slurred speech, and a weak arm. Now the client is back to acting normally. Suspecting a transient ischemic attack (TIA), the health care provider prescribes diagnostic testing looking for which cause of this episode?
Atherosclerotic lesions in cerebral vessels
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
Which intracranial volume is most capable of compensating for increasing intracranial pressure?
Cerebrospinal fluid
The nurse assessing a client with a traumatic brain injury assesses for changes in which neurologic component? Select all that apply.
Cognition Level of consciousness Motor function Sensory function
Which physiologic principle can cause hydrocephalus? Select all that apply.
Decreased absorption of cerebrospinal fluid Obstruction of cerebrospinal fluid
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?
Muscle atrophy
Hypoxic injury will result in which effect on the brain?
Neuronal cell injury and death
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?
Placement of a shunt
A nurse at a long-term care facility provides care for a client who has had recent transient ischemic attacks (TIAs). What significance should the nurse attach to the client's TIAs?
TIAs, by definition, resolve rapidly, but they constitute an increased risk for stroke.
The nurse is explaining to a client's family how vasogenic brain edema occurs. 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 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:
Transient ischemic attack (TIA)
A client has been diagnosed with a cerebral aneurysm and placed under close observation before treatment commences. Which pathophysiologic condition has contributed to this client's diagnosis?
Weakness in the muscular wall of an artery
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 that:
bruising on the surface of the brain occurred.
Severe head trauma from a coup-contrecoup injury may result in which type of brain injury?
cerebral hematoma
A client 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 client paralyzed with medications and on the ventilator. The most appropriate response would be that these therapies:
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:
decrease the likelihood of further neurological deficits.
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:
generalized seizure.
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?
headaches and poor concentration
A client has developed global ischemia of the brain. The nurse determines this is:
inadequate to meet the metabolic needs of the entire brain.
A client has developed noncommunicating hydrocephalus and asks the nurse what may have caused this to occur. How will the nurse respond?
obstruction preventing the flow of cerebrospinal fluid (CSF)
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 MRA scan of a client with a suspected stroke reports ruptured berry aneurysm. The nurse plans care for a client with:
Subarachnoid hemorrhage
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
According to the Glasgow Coma Scale, opening one's eyes to only painful stimuli would receive which score?
2
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
The nurse developing a plan of care for a client with a cerebral cortex injury should include assessment for which of the following?
Difficulty concentrating
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
A client 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 purpose?
Thrombolysis
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:
resistance should be provided with the knee in a flexed position.
When the suspected diagnosis is bacterial meningitis, what assessment techniques can assist in determining if meningeal irritation is present?
Brudzinski sign and Kernig sign
After evaluating the client, the physician thinks that his older adult client is exhibiting signs and symptoms of normal pressure hydrocephalus. Which symptom would be seen?
Disturbances in gait
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 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
The nurse reading a client's lumbar puncture results notifies the physician of findings consistent with meningitis when which sign/symptom is noted?
Large number of polymorphonuclear neutrophils
The emergency room doctor suspects a client may have bacterial meningitis. The most important diagnostic test to perform would be:
Lumbar puncture
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:
assess the client for additional signs/symptoms of increased intracranial pressure.
