Ch. 22 Flashcards
The part of the nervous system that extends throughout the body is called the ________ nervous system.
A) afferent
B) somatic
C) peripheral
D) ventral
C) peripheral
Page Ref: 566
Objective: Supplemental
The division of the autonomic nervous system that is responsible for controlling vegetative functions is the ________ nervous system.
A) somatic
B) parasympathetic
C) sympathetic
D) afferent
B) parasympathetic
Page Ref: 567
Objective: Supplemental
Your patient opens his eyes only when you pinch his shoulder. He has no verbal response and withdraws from pain. His Glasgow Coma score total is:
A) two.
B) four.
C) three.
D) seven.
D) seven.
Page Ref: 573
Objective: 22.6 Given a scenario with a patient who has indications of a neurologic emergency, perform a focused physical examination.
A problem with the eighth cranial nerve can lead to which of the following disorders involving a sensation of movement when there is none?
A) Photophobia
B) Meningismus
C) Vertigo
D) Macrotia
C) Vertigo
Page Ref: 583
Objective: 22.1 Define key terms introduced in this chapter; 22.7 Apply knowledge of the nervous system to patient findings to identify more likely causes of the patient’s condition.
Bell’s palsy is a temporary weakness or paralysis of which cranial nerve?
A) Third
B) Fifth
C) Seventh
D) Ninth
C) Seventh
Page Ref: 584
Objective: 22.25 Describe basic information about various neurologic disorders, such as Bell’s palsy, vertigo, Parkinson’s disease, Wernicke-Korsakoff syndrome, multiple sclerosis, normal pressure hydrocephalus, and others that may affect the assessment and management of patients.
Which of the following mnemonics is used to help determine the cause of a patient’s altered mental status?
A) SAMPLE
B) AEIOU-TIPS
C) AVPU
D) OPQRST
B) AEIOU-TIPS
Page Ref: 573
Objective: 22.3 List possible underlying causes of neurologic emergencies.
The prehospital stroke scoring system that assesses blood glucose levels, facial droop, grip strength, and arm drift is the:
A) Los Angeles Prehospital Stroke Screen.
B) New York Prehospital Stroke Screen.
C) Cincinnati Prehospital Stroke Scale.
D) North American Prehospital Stroke Scale.
A) Los Angeles Prehospital Stroke Screen.
Page Ref: 572
Objective: 22.13 Assess the patient with possible stroke for neurologic deficits, including use of a stroke assessment scale.
Symptoms from a transient ischemic attack (TIA) generally resolve within:
A) 6 hours.
B) 12 hours.
C) 24 hours.
D) 48 hours.
C) 24 hours.
Page Ref: 576-577
Objective: 22.1 Define key terms introduced in this chapter; 22.9 Identify the signs and symptoms of stroke.
When caring for a patient suffering from a nervous system condition or disease, the FIRST priority in patient care is to:
A) administer thrombolytic therapy.
B) assess for any neurological deficits.
C) establish and maintain a patent airway.
D) apply high-concentration oxygen.
C) establish and maintain a patent airway.
Page Ref: 569
Objective: 22.4 Explain the importance of airway assessment and management in patients with altered mental status and neurologic deficit; 22.8 Determine the need for emergency interventions in the primary assessment of patients with a neurologic emergency.
A generalized motor seizure that begins with a hypertonic state of the muscles is known as a(n):
A) absence seizure.
B) hysterical seizure.
C) complex partial seizure.
D) tonic-clonic seizure.
D) tonic-clonic seizure.
Page Ref: 578
Objective: 22.19 Describe the various ways that seizures can present.
The term “status epilepticus” refers to:
A) a chronic seizure patient taking anticonvulsant medication regularly.
B) a generalized seizure lasting more than one minute.
C) two or more seizures with no intervening periods of consciousness.
D) a patient experiencing a seizure for the first time.
C) two or more seizures with no intervening periods of consciousness.
Page Ref: 580
Objective: 22.1 Define key terms introduced in this chapter; 22.19 Describe the various ways that seizures can present.
What is the name for a series of one-sided headaches that are sudden and intense but of short duration?
A) Syncope
B) Organic
C) Migraine
D) Cluster
D) Cluster
Page Ref: 581
Objective: 22.7 Apply knowledge of the nervous system to patient findings to identify more likely causes of the patient’s condition.
You are caring for a patient whom you suspect has had a stroke. She is having difficulty forming words, resulting in slurred speech and making it difficult for you to understand her. Which of the following would describe the condition of her speech?
A) Dysarthria
B) Ataxia
C) Dysphagia
D) Hypophasia
A) Dysarthria
Page Ref: 576
Objective: 22.2 Recognize complaints that may indicate a neurologic problem; 22.9 Identify the signs and symptoms of stroke.
Consider a hemorrhagic stroke if the patient describes it as:
A) lasting for more than 18-24 hours.
B) sudden in onset and “the worst headache of my life.”
C) being accompanied by nausea and photosensitivity.
D) dull or achy pain with a feeling of forceful pressure.
B) sudden in onset and “the worst headache of my life.”
Page Ref: 576
Objective: 22.9 Identify the signs and symptoms of stroke.
When assessing a patient with a possible stroke, what is the priority of care?
A) Identifying the risk factors for stroke
B) Determining if there is a family history of stroke
C) Recognizing the signs and symptoms of stroke
D) Determining what type of stroke has occurred
C) Recognizing the signs and symptoms of stroke
Page Ref: 577
Objective: 22.2 Recognize complaints that may indicate a neurologic problem; 22.8 Determine the need for emergency interventions in the primary assessment of patients with a neurologic emergency.
Which of the following statements regarding the pathophysiology of stroke is TRUE?
A) Ischemic stroke is often a result of an aneurysm.
B) Neurological damage and death can begin within four minutes.
C) Ventricular fibrillation leads to the formation of blood clots in the atria.
D) Ischemic stroke usually presents with a severe headache.
B) Neurological damage and death can begin within four minutes.
Page Ref: 575
Objective: 22.10 Describe the pathophysiology of stroke.
Which of the following statements regarding a transient ischemic attack is TRUE?
A) Signs and symptoms are very different from a stroke.
B) If it doesn’t resolve within two hours, it is a full-blown stroke.
C) If not promptly treated, a TIA will progress to a stroke.
D) A patient who has had a TIA is at high risk for subsequent stroke.
D) A patient who has had a TIA is at high risk for subsequent stroke.
Page Ref: 577
Objective: 22.12 Describe the relationship between stroke and transient ischemic attack.
Of the following, which is the MOST important in caring for a possible stroke patient?
A) Establish the time of onset of signs and symptoms.
B) Administer oxygen to patients with a SpO2 <94 percent.
C) Recognize signs and symptoms that may indicate stroke.
D) Check the patient’s blood glucose level.
C) Recognize signs and symptoms that may indicate stroke.
Page Ref: 577
Objective: 22.2 Recognize complaints that may indicate a neurologic problem; 22.8 Determine the need for emergency interventions in the primary assessment of patients with a neurologic emergency.
You have arrived on the scene of a call for a possible stroke. On your arrival, the patient denies signs and symptoms, is alert and oriented, and moves all extremities well. Her husband states that before you arrived the patient could not move her right arm and the left side of her face seemed to be “slack.” Which of the following has MOST likely occurred?
A) The patient suffered a cerebral vascular accident.
B) The patient is suffering from aphasia.
C) The patient has had a subarachnoid hemorrhage.
D) The patient suffered a transient ischemic attack.
D) The patient suffered a transient ischemic attack.
Page Ref: 576-577
Objective: 22.7 Apply knowledge of the nervous system to patient findings to identify more likely causes of the patient’s condition.
Which of the following is NOT a common sign or symptom of stroke?
A) Acute chest pain
B) Facial numbness
C) Visual disturbances
D) Loss of coordination
A) Acute chest pain
Page Ref: 576
Objective: 22.9 Identify the signs and symptoms of stroke.
Your patient is a 68-year-old man who has apparently suffered a stroke. He is unable to hold himself in an upright position on the stretcher and has begun to vomit. Which of the following actions would be MOST appropriate?
A) Tighten the chest straps and begin suctioning.
B) Insert an oral airway and lower the head of the stretcher.
C) Place him in the left lateral recumbent position.
D) Begin ventilations with a bag-valve-mask.
C) Place him in the left lateral recumbent position.
Page Ref: 577
Objective: 22.4 Explain the importance of airway assessment and management in patients with altered mental status and neurologic deficit.
Which of the following is a risk factor for hemorrhagic stroke?
A) Atrial fibrillation
B) Hypoglycemia
C) Spinal injury
D) Hypertension
D) Hypertension
Page Ref: 575
Objective: 22.10 Describe the pathophysiology of stroke.
Your patient tells you that he is suffering with a bad migraine. Which of the following would provide the patient with the MOST comfort?
A) Provide three adult aspirins per protocol.
B) Place a cool compress on his forehead.
C) Transport in left lateral recumbent position.
D) Apply gentle pressure to the temples.
B) Place a cool compress on his forehead.
Page Ref: 581
Objective: 22.17 Describe measures that you can take to improve the comfort level of the patient suffering from a headache.
Which of the following is the BEST way to differentiate between non-life-threatening and life-threatening causes of headache?
A) Gather a good history using OPQRST.
B) Find out if trauma was involved.
C) Ask if the patient has allergies.
D) Evaluate the blood glucose level.
A) Gather a good history using OPQRST.
Page Ref: 581
Objective: 22.16 Recognize indications that a headache may have a potentially life-threatening underlying cause.
Which of the following is a cause of secondary headache syndrome?
A) Migraines
B) Hypertension
C) Cluster headaches
D) Photosensitivity
B) Hypertension
Page Ref: 581
Objective: 22.16 Recognize indications that a headache may have a potentially life-threatening underlying cause.
Which of the following statements regarding blood glucose levels and stroke is TRUE?
A) Glucose requires insulin to enter brain cells.
B) Excessive glucose in cells causes cellular dehydration.
C) Hyperglycemia is protective of brain cells.
D) Hypoglycemia worsens neurological outcome.
D) Hypoglycemia worsens neurological outcome.
Page Ref: 578
Objective: 22.14 Discuss the role of blood glucose determination in the assessment of patients with altered mental status, neurologic deficits, and seizures.
You suspect your patient is suffering from a stroke. What information is crucial to obtain from family and bystanders that will aid in proper treatment?
A) When was the last meal consumed?
B) Is the patient oriented to the current time?
C) Does the patient seem more agitated than usual?
D) What was the time of onset of the symptoms?
D) What was the time of onset of the symptoms?
Page Ref: 577
Objective: 22.11 Explain the importance of early recognition of stroke signs and symptoms by patients, family or bystanders, and EMS personnel.
Which of the following patients would be the BEST candidate for fibrinolytic treatment?
A) A 37-year-old woman diagnosed in the ED with a hemorrhagic stroke two hours after onset of symptoms
B) A 48-year-old man whose symptoms started while watching the 6 P.M. news and 911 was called at 6:10 P.M.
C) An 84-year-old man who awoke in the morning with symptoms after sleeping eight hours
D) A 64-year-old woman whose symptoms began at 8 A.M. and resolved 20 minutes later
B) A 48-year-old man whose symptoms started while watching the 6 P.M. news and 911 was called at 6:10 P.M.
Page Ref: 577
Objective: 22.11 Explain the importance of early recognition of stroke signs and symptoms by patients, family or bystanders, and EMS personnel.
Assessment reveals a drooling 57-year-old man with slurred speech and right arm paralysis. Which of the following should be your FIRST priority?
A) Suction the airway.
B) Protect the right arm.
C) Determine his risk factors for stroke.
D) Closely monitor his blood pressure.
A) Suction the airway.
Page Ref: 577
Objective: 22.4 Explain the importance of airway assessment and management in patients with altered mental status and neurologic deficit; 22.8 Determine the need for emergency interventions in the primary assessment of patients with a neurologic emergency.
You are caring for a 68-year-old woman displaying signs of stroke. She has right-sided weakness and slurred speech. Her vitals are pulse 118, respirations 22 with a SpO2 of 92 percent, and blood pressure 188/98. Which of the following would be the LEAST appropriate care?
A) Apply high-flow oxygen and titrate to effect.
B) Place her in the position of comfort.
C) Administer nitroglycerin for hypertension.
D) Check her blood glucose level.
C) Administer nitroglycerin for hypertension.
Page Ref: 577
Objective: 22.6 Given a scenario with a patient who has indications of a neurologic emergency, perform a focused physical examination; 22.8 Determine the need for emergency interventions in the primary assessment of patients with a neurologic emergency.
You are having difficulty verbally communicating with your 55-year-old female patient. Which of the following would be the BEST way to next attempt to communicate with her?
A) Try to use sign language.
B) Attempt written communication.
C) Speak more loudly to her.
D) Have her nod her head.
B) Attempt written communication.
Page Ref: Supplemental
Objective: 22.15 Describe ways of communicating with patients who have difficulty speaking.
You are caring for a patient with significant stroke symptoms. You are completing your assessment when you notice that the patient’s SpO2 reading is dropping. Which of the following should you do next?
A) Check the batteries in your pulse oximeter.
B) Check the patient’s skin color and temperature.
C) Check the patient’s airway and breathing.
D) Check the oxygen cylinder pressure.
C) Check the patient’s airway and breathing.
Page Ref: 577
Objective: 22.4 Explain the importance of airway assessment and management in patients with altered mental status and neurologic deficit; 22.18 Explain the importance of reassessing the patient who is experiencing a neurologic emergency.
You are called for a four-year-old girl who apparently has suffered a seizure. Her mother states that she has been sick for a day or two. Which kind of seizure has she MOST likely had?
A) Focal motor seizure
B) Petit mal seizure
C) Epileptic seizure
D) Febrile seizure
D) Febrile seizure
Page Ref: 578
Objective: 22.20 Discuss possible underlying causes of seizures.
Seizures characterized by rapid, rhythmic contractions of the muscles that may last for several minutes are called:
A) tonic-clonic.
B) febrile.
C) focal motor.
D) complex partial.
A) tonic-clonic.
Page Ref: 578
Objective: 22.19 Describe the various ways that seizures can present.
You arrive on the scene of a seizure patient. In what state will you MOST often encounter the seizure patient?
A) Aura phase
B) Tonic phase
C) Clonic phase
D) Postictal phase
D) Postictal phase
Page Ref: 579
Objective: 22.22 Describe the assessment and emergency medical care of patients who are having a seizure or are in a postictal state.
The MOST common cause of status epilepticus in a patient with a history of seizures is:
A) a sudden drop in blood sugar levels.
B) brain swelling from traumatic head injury.
C) low levels of antiseizure medications.
D) overdose of a hypnotic medication.
C) low levels of antiseizure medications.
Page Ref: 580
Objective: 22.20 Discuss possible underlying causes of seizures.
You are called for a person having a seizure. When you arrive, you note that the patient is postictal and a bystander is providing care for the patient. Which of the following would be considered appropriate care by the bystander?
A) Placing a bite block between the patient’s teeth
B) Placing the patient in the recovery position
C) Giving the patient small sips of water
D) Sweeping the patient’s mouth to remove vomit
B) Placing the patient in the recovery position
Page Ref: 579
Objective: 22.23 Anticipate bystander reactions to patients having seizures and measures needed to stop any unnecessary or inappropriate interventions.
Late one night, you are called for a patient with an acute onset of altered mental status. You find that the elderly patient is confused and combative. His medical history includes hypertension, diabetes, and kidney failure. Which of the following is the MOST likely cause of his altered mental status?
A) Alzheimer’s
B) Dementia
C) Delirium
D) Neuropathy
C) Delirium
Page Ref: 583
Objective: 22.24 Compare and contrast features of dementia and delirium.
The postictal patient with no suspected spinal injury should be placed in which position?
A) Semi-Fowler’s
B) Lateral recumbent
C) Supine
D) Fowler’s
B) Lateral recumbent
Page Ref: 579
Objective: 22.22 Describe the assessment and emergency medical care of patients who are having a seizure or are in a postictal state.
You are called for a patient who passed out with no apparent cause. Bystanders report that she was only out for a few seconds. The patient has a cardiac history and diabetes. The patient reports she was reading at the library and simply fell forward. Which of the following would be the MOST likely cause of her syncope?
A) Transient cardiac dysrhythmia
B) Fright from something she read
C) A focal motor seizure of short duration
D) An acute neurological disorder
A) Transient cardiac dysrhythmia
Page Ref: 574
Objective: 22.3 List possible underlying causes of neurologic emergencies; 22.7 Apply knowledge of the nervous system to patient findings to identify more likely causes of the patient’s condition.
In the mnemonic AEIOU-TIPS, what does the letter “A” stand for?
A) Arm drift
B) Anaphylaxis
C) Alcohol
D) Abnormal speech
C) Alcohol
Page Ref: 573
Objective: 22.3 List possible underlying causes of neurologic emergencies; 22.5 Obtain a focused patient history for patients with a neurologic emergency.
Administer glucose only in what circumstance after consulting with medical direction?
A) Narcotic overdose
B) Syncope
C) Stroke
D) Hypoglycemia
D) Hypoglycemia
Page Ref: 578
Objective: 22.9 Identify the signs and symptoms of stroke; 22.14 Discuss the role of blood glucose determination in the assessment of patients with altered mental status, neurologic deficits, and seizures.
Cerebral edema, neurogenic pulmonary edema, and dysfunction of the cardiac conduction system may be associated with:
A) sudden unexpected death in epilepsy (SUDEP).
B) dementia.
C) transient ischemic attacks (TIA).
D) chronic migraine headache.
A) sudden unexpected death in epilepsy (SUDEP).
Page Ref: 581
Objective: 22.21 Explain the concerns associated with prolonged or successive seizures.
Stroke patients who may be candidates for fibrinolytic therapy MUST receive definitive treatment within ________ hours of onset of symptoms.
A) 1-2
B) 3-4.5
C) 5-6.6
D) 6-8
B) 3-4.5
Page Ref: 577
Objective: 22.11 Explain the importance of early recognition of stroke signs and symptoms by patients, family or bystanders, and EMS personnel.
Which of the following cardiac dysrhythmias can lead to the formation of blood clots, which increases the risk for stroke?
A) Asystole
B) Sinus arrhythmia
C) Ventricular tachycardia
D) Atrial fibrillation
D) Atrial fibrillation
Page Ref: 575
Objective: 22.10 Describe the pathophysiology of stroke.
The Cincinnati Prehospital Stroke Scale evaluates possible stroke patients on what three parameters?
A) Age, duration of symptoms, abnormal speech
B) Arm drift, blood glucose levels, history of seizures
C) Headache, arm drift, onset of symptoms
D) Facial droop, arm drift, abnormal speech
D) Facial droop, arm drift, abnormal speech
Page Ref: 572
Objective: 22.13 Assess the patient with possible stroke for neurologic deficits, including use of a stroke assessment scale.
What sign or symptom of a stroke is defined as a loss of coordination?
A) Aphasia
B) Dysarthria
C) Hemiparesis
D) Ataxia
D) Ataxia
Page Ref: 576
Objective: 22.1 Define key terms introduced in this chapter.
Which of the following is associated with cocaine and methamphetamine use, as well as the use of other drugs?
A) Dementia
B) Meningismus
C) Excited delirium
D) Photophobia
C) Excited delirium
Page Ref: 583
Objective: 22.24 Compare and contrast features of dementia and delirium.
Of the following, which is the MOST common cause of a transient ischemic attack?
A) Illegal drug use
B) Atherosclerosis
C) Prinzmetal’s angina
D) Aneurism
B) Atherosclerosis
Page Ref: 576-577
Objective: 22.3 List possible underlying causes of neurologic emergencies.
You are assessing a patient who reports frequent use of meclizine (Antivert). What condition is this medication used to treat?
A) Vertigo
B) Seizures
C) Migraine headaches
D) Parkinson’s disease
A) Vertigo
Page Ref: 572, Table 22-4
Objective: 22.25 Describe basic information about various neurologic disorders, such as Bell’s palsy, vertigo, Parkinson’s disease, Wernicke-Korsakoff syndrome, multiple sclerosis, normal pressure hydrocephalus, and others that may affect the assessment and management of patients.
Which of the following criteria would indicate that a patient is a candidate for fibrinolytic therapy?
A) The patient has had an ischemic stroke with measurable neurologic deficit.
B) The patient has a low platelet count.
C) The patient has uncontrolled hypertension with medication.
D) The patient has an active hemorrhage.
A) The patient has had an ischemic stroke with measurable neurologic deficit.
Page Ref: 578, Table 22-11
Objective: 22.25 Describe basic information about various neurologic disorders, such as Bell’s palsy, vertigo, Parkinson’s disease, Wernicke-Korsakoff syndrome, multiple sclerosis, normal pressure hydrocephalus, and others that may affect the assessment and management of patients.
Which of the following neurological conditions is caused by Vitamin B1 deficiency?
A) Myasthenia gravis
B) Multiple sclerosis
C) Wernicke-Korsakoff syndrome
D) Bell’s palsy
C) Wernicke-Korsakoff syndrome
Page Ref: 585
Objective: 22.25 Describe basic information about various neurologic disorders, such as Bell’s palsy, vertigo, Parkinson’s disease, Wernicke-Korsakoff syndrome, multiple sclerosis, normal pressure hydrocephalus, and others that may affect the assessment and management of patients.
