Pathology Module 11
Which of the following are correct for the thrombolytic (fibrinolytic) alteplase (tPA)? Select all that apply. Minimizing physical manipulation of the patient Safe with patients with intracranial hemorrhage Bleeding is the major complication of treatment Avoiding subQ and IM injections
-Bleeding is the major complication of treatment -Indicated for acute MI, acute ischemic stroke, and acute massive PE -Avoiding subQ and IM injections -Minimizing invasive procedures -Minimizing physical manipulation of the patient
The nurse is preparing to administer a reversible cholinesterase inhibitor neostigmine [Bloxiverz]. The nurse knows which of the following are correct? Select all that apply.
Cholinesterase inhibitor toxicity can cause a life-threatening cholinergic crisis: Mnemonic 1: SLUDGE and the Killer Bs: Salivation, Lacrimation, Urination, Diaphoresis/Diarrhea, Gastrointestinal cramping, Emesis; Bradycardia, Bronchospasm, Bronchorrhea cholinesterase inhibitors used for treatment of urinary retention Cholinesterase inhibitors used for management of myasthenia gravis
What is an early indicator of increased intracranial pressure? Bilateral fixed dilated pupils Rapid heart rate Papilledema Decreasing responsiveness
Decreasing responsiveness
What is the pathophysiological change in Parkinson's disease? Degeneration of the basal nuclei with a deficit of dopamine Degeneration of motor fibers in the pyramidal tracts Deficit of acetylcholine and degeneration of the motor cortex in the frontal lobe Excess secretion of stimulatory neurotransmitters in the CNS.
Degeneration of the basal nuclei with a deficit of dopamine
Which of the following classes of drugs may provide temporary improvement in cases of myasthenia gravis? Dopamine replacement drugs GABA replacement drugs Skeletal muscle relaxants
GABA replacement drugs
The largest category of primary malignant brain tumors that arise from cells in the central nervous system (CNS) are called which of the following? Lymphomas Myelomas Gliomas Sarcomas
Gliomas
Following a head injury, what is the most likely cause of secondary damage to the brain? Laceration by foreign objects Tearing of blood vessels as the brain rotates across the inside of the skull Hypoxia or acidosis Hematoma or infection
Hematoma or infection
The best description of a myelomeningocele is which of the following?
Herniation of meninges, CSF, and spinal cord or nerves through a vertebral defect
Which statement applies to Huntington's disease? It is manifested in individuals by age 20 years. It is inherited as an autosomal recessive trait. It presents with choreiform movements in the upper body and decreased ability to concentrate. It causes decreased levels of all neurotransmitters in the CNS.
It presents with choreiform movements in the upper body and decreased ability to concentrate.
Examination of CSF, obtained by lumbar puncture, confirms the diagnosis of _________.
Meningitis
Which of the following are assessed in the Glasgow Coma Scale? Select all that apply. Motor response Heart rate Skin temperature Eye opening Verbal response
Motor response Eye opening Verbal response
The therapeutic goal of disease treatment is symptomatic relief or control of the patient's symptoms.
Parkinson
A patient has been diagnosed with multiple sclerosis (MS) for 10 years and has a history of 3 periods of neurologic dysfunction lasting several weeks separated by long periods of full recovery. In the past 6 months, the patient has had a prolonged period of neurologic dysfunction without remission. The nurse understands that the patient may have which MS subtype? Primary progressive MS Progressive-relapsing MS Relapsing-remitting MS Secondary progressive MS
Secondary progressive MS
Vertebral fractures are classified as which of the following? Compound, open, closed, shattered Complex, torsion, open, multiple Pressure, complex, simple, variable Simple, compression, edge, dislocation
Simple, compression, edge, dislocation
Which of the following can be treated surgically by clipping or tying it off when diagnosed prior to rupture? CVA aneurysm spinal cord injury brain injury
aneurysm
Failure of the spinous processes to fuse, but without herniation of the meninges is called which of the following?
Spina bifida occulta
A vegetative state is the loss of awareness and intellectual function but continued brain stem function.
T
Acetylcholine, norepinephrine, and epinephrine are neurotransmitters in the body.
T
Anticholinesterase agents may provide temporary improvement in cases of myasthenia gravis.
T
Approximately 90% of Parkinson's disease patients develop sleep disturbances, autonomic disturbances, and dementia.
T
Assessing the patient's ability to swallow is an important initial safety measure for patients diagnosed with myasthenia gravis.
T
Bleeding is a major risk when treating a stroke victim with thrombolytic therapy.
T
CSF is like plasma in appearance, it is a clear, almost colorless liquid.
T
Generalized seizures are uncontrolled discharges of neurons in both hemispheres.
T
Immunomodulators can be used in progressive-relapsing MS, relapsing-remitting MS, and secondary progressive MS.
T
In bacterial meningitis, the swelling and purulent exudate form in the pia mater, arachnoid, and surface of the entire brain.
T
Interferon beta may promote or exacerbate depression and some patients may experience suicidal ideation or may attempt suicide.
T
Levodopa combined with carbidopa is the initial drug of choice to treat motor symptoms.
T
Methotrexate is an immunosuppressant and is used experimentally to treat primary progressive MS.
T
Muscle strength assessments before and after medication administration for myasthenia gravis are important for the nurse to evaluate the medication's effectiveness.
T
Outcomes are best when thrombolytic therapy is started within 2-4 hours of symptom onset and even earlier, if possible.
T
Patients with primary progressive MS may experience occasional plateaus or temporary improvement, but they do not have clear remissions.
T
Physostigmine is the drug of choice for treating poisoning from atropine and other drugs that cause muscarinic blockade.
T
Secondary progressive MS occurs when a patient with relapsing-remitting MS develops steadily worsening dysfunction with or without plateaus or acute exacerbations, or minor remissions.
T
The ataxic form of cerebral palsy results from damage to the cerebellum.
T
The definition of aphasia is the inability to comprehend or express language appropriately.
T
The heart rate decreases as intracranial pressure increases.
T
The left hemisphere is the usual location of language centers.
T
The maximum score on the Glasgow Coma Scale is 15, which is a good/normal score.
T
The parasympathetic nervous system dominates the digestive system and aids in the recovery of the body after sympathetic activity.
T
Thrombolytic agents promote clot degradation.
T
While giving alteplase, if the nurse notes a change in level of consciousness, she will suspect cerebral bleeding and would stop the infusion immediately and call the provider.
T
In which type of neuron is progressive degeneration occurring with amyotrophic lateral sclerosis (ALS)? Motor, sensory, and autonomic system neurons Upper motor neurons Upper and lower motor neurons Motor and sensory neurons
Upper and lower motor neurons
Which of the following correctly describe the sympathetic nervous system? Select all that apply. craniosacral nervous system necessary for the fight-or-flight, or stress, response cholinergic blocking agents reduce activity in this system. thoracolumbar nervous system dominates the digestive system
necessary for the fight-or-flight, or stress, response thoracolumbar nervous system increases the general level of activity in the body
Which of the following would a seizure consisting of bizarre or inappropriate activity be classified?
psychomotor seizure
An absolute contraindication of use is active internal bleeding.
thrombolytic
A nurse provides teaching for a patient who is newly diagnosed with Parkinson's disease. Which statement by the patient indicates understanding of the drug therapy for this disease? "When 'off' times occur, I may need to increase my dose of levodopa." "There are several drugs available to treat dyskinesias." "With adequate drug therapy, the disease progression may be slowed." "A levodopa/carbidopa combination is used to improve motor function."
"A levodopa/carbidopa combination is used to improve motor function."
Two nurses are discussing the major differences between physostigmine (Antilirium) and neostigmine (Prostigmin). One nurse correctly makes which statement about physostigmine (Antilirium)? "It is not effective for treating poisoning by muscarinic blocking drugs." "It can be given by all routes." "It does not cause any side effects." "It can readily cross the blood-brain barrier."
"It can readily cross the blood-brain barrier."
A patient who has myasthenia gravis will be taking neostigmine. What will the nurse emphasize when teaching this patient about the medication? "Take a supplementary dose before exercise." "Stop taking the drug if you have diarrhea." "Use atropine if you have excessive salivation." "Withhold the dose if ptosis occurs."
"Withhold the dose if ptosis occurs."
How does a depressed skull fracture cause brain damage? A bone fragment penetrates and tears brain tissue. A section of skull bone is displaced below the level of the skull, causing pressure on the brain. The contrecoup injury is the cause of brain damage. A section of the skull is missing, leaving the brain unprotected.
A section of skull bone is displaced below the level of the skull, causing pressure on the brain.
A/An ________that is diagnosed before rupture can be treated surgically as soon as possible by clipping or tying it off.
ANEURYSM
A patient is being treated with interferon beta-1a [Avonex] for relapsing-remitting MS. The patient calls the clinic to report headache, fever, chills, and muscle aches after administering a dose. What will the nurse recommend? Acetaminophen or ibuprofen Discontinuing the drug immediately Asking the provider to order a complete blood count Coming to the clinic for evaluation for leukoencephalopathy
Acetaminophen or ibuprofen
Which of the following are correct nursing implications for the thrombolytic (fibrinolytic) alteplase (tPA)? Select all that apply. Minimizing invasive procedures Alteplase administered as a single IV bolus Indicated for acute MI, acute ischemic stroke, and acute massive PE Bleeding is the major complication of treatment
Administer as an initial IV bolus followed by a 90-minute IV infusion.
Match the following. -Symptoms include weakness and muscle atrophy, initially in the upper extremities, with loss of fine motor coordination. -At this time no specific treatment is available to reverse the course of this degenerative process. -Autoimmune disorder that impairs receptors for acetylcholine. -Symptoms include diplopia, loss of spontaneous facial expressions, monotone speech, and upper respiratory infections. -Progressive degenerative disorder that affects motor function through loss of extrapyramidal activity.
Answer 1: Amyotrophic lateral sclerosis Answer 2: Amyotrophic lateral sclerosis Answer 3: Myasthenia gravis Answer 4: Myasthenia gravis Answer 5: Parkinson's Disease
Match the following. -Tough, fibrous, double-layered membrane making up the outer layer of meninges. -Loose, web-like middle layer of the meninges. -The motor or expressive speech area of the brain. -The integration center in the brain that comprehends received spoken and written language.
Answer 1: Dura mater Answer 2: Arachnoid mater Answer 3: Broca's area Answer 4: Wernicke's area
-Inflammatory condition of the peripheral nervous system. -In some cases, there may be considerable delay before signs of this infection appear. -Usually results from the spread of organisms from ear, throat, lung, or sinus infections -Sudden onset is common, with severe headache, back pain, photophobia, and nuchal rigidity -Infection of the parenchymal or connective tissue in the brain and cord -Also known as postinfectious polyneuritis, acute idiopathic polyneuropathy, and acute infectious polyradiculoneuritis. -Usually results from the spread of organisms from ear, throat, lung, or sinus infections -Early diagnosis and treatment is essential to prevent deficits or death.
Answer 1: Guillain-Barre Syndrome Answer 2: encephalitis Answer 3: abscess Answer 4: meningitis Answer 5: encephalitis Answer 6: Guillain-Barre Syndrome Answer 7: abscess Answer 8: meningitis
Match the following. -Such protrusions into the extradural space, usually laterally, exert pressure on the spinal nerve root or spinal cord at the site, interfering with nerve conduction. -A person may be predisposed to this because of degenerative changes in the intervertebral disc, resulting from age or metabolic changes -inherited disorder that does not manifest until midlife. -Involves progressive demyelination of the neurons of the brain, spinal cord, and cranial nerves. -Diagnosis is possible with the presence of a defective gene detected with DNA analysis.
Answer 1: Herniated intervertebral disc Answer 2: Herniated intervertebral disc Answer 3: Huntington's Disease Answer 4: Multiple sclerosis Answer 5: Huntington's Disease
-Localized dilation in an artery -Develop where there is a weakness in the arterial wall -Five minutes (or less) of ischemia causes irreversible nerve cell damage -Do not usually have well-defined margins but are invasive and have irregular projections into adjacent tissue making them difficult to remove. -Infarction of brain tissue that results from lack of blood
Answer 1: cerebral aneurysms Answer 2: cerebral aneurysms Answer 3: CVA Answer 4: brain tumor Answer 5: CVA
Match the following. -May result from hyperextension or hyperflexion of the neck, with possible fracture. -Paralysis of the lower part of the trunk and legs -A form of neurogenic shock
Answer 1: cervical spine injuries Answer 2: paraplegia Answer 3: spinal shock
-Reversible interference with brain function, usually resulting from a mild blow to the head -Memory loss -Bruising of brain tissue with rupture of small blood vessels and edema -Brain tissue is injured, and blood vessels may be ruptured by force exerted against the skull -Involves fractures or penetration of the brain by missiles or sharp objects.
Answer 1: concussion Answer 2: amnesia Answer 3: contusion Answer 4: closed head injury Answer 5: open head injury
-Bleeding between the dura and the skull -Develops between the dura and the arachnoid -Occurs in the space between the arachnoid and pia
Answer 1: epidural hematoma Answer 2: subdural hematoma Answer 3: subarachnoid hemorrhage
Match the following. -Signs related to the specific area of the brain or spinal cord in which the lesion or trauma is located -Occur in the cerebral hemispheres above the tentorium cerebelli -Absence of tone -Rigid flexion in the upper limbs with adducted arms and internal rotation of the hands; the lower limbs are extended. -Both the upper and lower limbs are extended, as is the head, and the body is arched.
Answer 1: local effects Answer 2: supratentorial lesions Answer 3: flaccid Answer 4: decorticate Answer 5: decerebrate
Match the following. -An infection, usually of bacterial origin, in the meninges of the CNS. -Major cause of meningitis. -Rapidly progressive and severe -Localized infection, frequently occurring in the frontal or temporal lobes -Infection of the parenchymal or connective tissue in the brain and cord
Answer 1: meningitis Answer 2: Streptococcus pneumoniae Answer 3: fulminant Answer 4: brain abscess Answer 5: encephalitis
Match the following. -Diagnosis is often delayed due to lack of a definitive test -Also known as Lou Gehrig disease; involves muscle wasting and degenerative changes in both upper and lower motor neurons. -Usually caused by trauma or poor body mechanics. -Dysfunction of the extrapyramidal motor system occurs because of progressive degenerative changes in the basal nuclei.
Answer 1: multiple sclerosis Answer 2: amyotrophic lateral sclerosis Answer 3: herniated intervertebral disc Answer 4: Parkinson's Disease
Match the following. -Serves as a sorting and relay station for incoming sensory impulses. -Controls the autonomic nervous system and much of the endocrine system through the hypophysis, or pituitary gland. -Acts as the connection between the limbic system and other areas of the brain. -Coordinates movement and maintains posture and equilibrium.
Answer 1: thalamus Answer 2: hypothalamus Answer 3: epithalamus Answer 4: cerebellum
-Results from a temporary localized reduction of blood flow in the brain. Recovery usually occurs within 24 hours. -Stiff, extended neckaneurysmtransient ischemic attack -Increased sensitivity of the eyes to light aneurysmtransient ischemic attack -Localized dilation in an artery. -Infarction of brain tissue that results from lack of blood
Answer 1: transient ischemic attack Answer 2: nuchal rigidity Answer 3: photophobia Answer 4: aneurysm Answer 5: CVA
A nursing student wants to know how carbidopa can be effective for treating Parkinson's disease if it prevents the conversion of levodopa to dopamine. The nurse explains that carbidopa does which of the following? It has dopamine-like effects of its own. It reduces abrupt loss of effect. Does not cross the blood-brain barrier. It can be taken with high-protein meals.
Does not cross the blood-brain barrier.
A subdural hematoma is located between the dura mater and the skull.
F
Alteplase, Tenecteplase, and Retevase all promote the conversion of plasmin to plasminogen, an enzyme that degrades the fibrin matrix of thrombi.
F
Cerebrospinal fluid circulates around the brain and spinal cord in the subdural space.
F
Examination of CSF, obtained by bone marrow biopsy, confirms the diagnosis of meningitis.
F
If a patient reports they have had no improvement of their Parkinson's symptoms after taking levodopa for two weeks, a nurse would anticipate that the provider would double the dose.
F
In Parkinson's disease, there is an even balance between dopamine and acetylcholine in the striatum.
F
In cases of noncommunicating hydrocephalus, cerebrospinal fluid (CSF) accumulates because flow around the spinal cord is blocked.
F
Myelomas are the largest category of primary malignant brain tumors that arise from cells in the central nervous system (CNS).
F
Parkinson's disease rarely develops in women.
F
Speech, occupational, and physical therapy are not typically needed in the aid of Parkinson's Disease.
F
Tenecteplase has a compound identical to human tPA.
F
Tenecteplase has a half-life of 5 minutes.
F
The initial concern after exposure to organophosphate insecticides from a spill is to administer diphenhydramine to control secretions.
F
The pathophysiological change in Parkinson's disease is degeneration of motor fibers in the pyramidal tracts
F
The signs and symptoms of stroke depend upon the size of the obstruction, condition of the heart, and duration of the blockage
F
The signs of autonomic dysreflexia are urinary and bowel incontinence.
F
Through what area does the cerebrospinal fluid circulate around the brain and spinal cord? Between the double layers of the dura mater In the subdural space In the subarachnoid space Through the arachnoid villi
In the subarachnoid space
The nurse is preparing to administer the Antiparkinson drugs to a patient. The nurse knows which of the following are correct nursing implications? Select all that apply. Inform patients that levodopa may be taken with food to reduce nausea and vomiting. However, high-protein meals should be avoided. Drug effectiveness is demonstrated within 24 hours of first drug dose Assess motor symptoms—bradykinesia, akinesia, postural instability, tremor, rigidity—and the extent to which they interfere with activities of daily living (e.g., ability to work, dress, bathe, walk). Inform patients about possible levodopa-induced psychosis (visual hallucinations, vivid dreams, paranoia), and instruct them to notify the prescriber if these develop.
Inform patients that levodopa may be taken with food to reduce nausea and vomiting. However, high-protein meals should be avoided: Amino acids compete with levodopa for absorption from the intestine and for transport across the blood-brain barrier. Drug effectiveness is demonstrated within 24 hours of first drug dose: So that expectations may be realistic, inform patients that benefits of levodopa may be delayed for weeks to months. This knowledge will facilitate adherence. Dopamine drugs should be taken on an empty stomach one hour before or two hours after meals: Inform patients that oral dopamine agonists may be taken with food to reduce nausea and vomiting. Inform patients that nausea and vomiting can be reduced by taking oral dopamine agonists with food. Instruct patients to notify the prescriber if nausea and vomiting persist or become severe. Instruct patients taking apomorphine to pretreat with trimethobenzamide [Tigan], an antiemetic.
The nurse is preparing to administer an Antiparkinson drug. What are the advantages of taking a combination of carbiodopa and levodopa? Select all that apply.
Monitor renal function: Laboratory monitoring of liver enzymes is required Take Parkinson drugs with high protein meals: High-protein meals can reduce therapeutic responses to levodopa Accordingly, patients should be advised to spread their protein consumption evenly throughout the day.
Match the drug to the appropriate route of administration. Oral Intravenous Intramuscular Subcutaneous
Oral: Fingolimod Intravenous: Natalizumab Intramuscular: Interferon Beta Subcutaneous: Glatiramer Acetate
Following a spinal injury at C5, what is the expected effect during the period of spinal shock? Normal blood pressure Possible periods of apnea Urinary incontinence Spastic paralysis below the level of the injury
Possible periods of apnea
A patient taking cholinesterase inhibitors who reports excessive salivation, sweating, or increased gastric secretions will receive atropine to suppress these responses.
T
A cerebral hemorrhage is a major risk when treating a stroke victim with thrombolytic therapy.
T
A nurse should notice that there is an increasing pulse pressure in a patient who has increased intracranial pressure.
T
A protrusion of the nucleus pulposus through the annulus fibrosis is what causes a herniated intervertebral disc.
T
A patient has been diagnosed with primary progressive multiple sclerosis for 1 year and reports a recent brief period of being symptoms free. The nurse will tell the patient that this indicates which of the following? Hope for long-term remission Development of secondary progressive MS Temporary improvement Development of relapsing-remitting MS
Temporary improvement
Which of the following are correct in reference to drug treatment of multiple sclerosis? Select all that apply. Interferon beta inhibits the migration of proinflammatory leukocytes across the blood-brain barrier, preventing these cells from reaching neurons of the CNS and suppresses T-helper cell activity. Disease-modifying drugs can decrease the frequency and severity of relapses, reduce development of brain lesions, decrease future disability, and help maintain quality of life. In addition, they may prevent permanent damage to axons. Interferon beta can suppress bone marrow function, thereby decreasing production of all blood cell types. To monitor for myelosuppression, complete blood counts (CBCs) should be obtained at baseline, every 3 months for 1 year, and every 6 months thereafter. There are multiple contraindications to MS drugs among older adult patients
There are multiple contraindications to MS drugs among older adult patients: There are no contraindications for use in older adults; however, the health status of the patient, along with comorbidities and their treatment, needs to be considered in planning to ensure optimal outcomes.
Which of the following correctly describe the parasympathatic nervous system? Select all that apply. necessary for the fight or flight response ganglia are in two chains or trunks, one on either side of the spinal cord cholinergic blocking agents reduce activity in this system. controls digestive system aids in the recovery of the body after sympathetic activity
cholinergic blocking agents reduce activity in this system. controls digestive systemaids in the recovery of the body after sympathetic activity
In a case of bacterial meningitis, where does swelling and purulent exudate form?
pita mater, arachnoid, and surface of the entire brain.
Motor symptoms result from damage to the extrapyramidal system, a complex neuronal network that helps regulate movement. When extrapyramidal function is disrupted, dyskinesias (disorders of movement) result. The dyskinesias that characterize PD are tremor at rest, rigidity, postural instability, and bradykinesia ( movement). In severe PD, bradykinesia may progress to akinesia—complete absence of movement.
slowed
