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Nursing III > Chapter 48 - CNS Exam > Flashcards

Chapter 48 - CNS Exam Flashcards

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1
Q

Contralateral hemiparesis

A

Weak on opposite site

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2
Q

Ipsilateral hemiplegia

A

Paralyzed on same side

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3
Q

Quadriplegia

A

All four extremities paralyzed

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4
Q

Paraplegia

A

Paralyzed lower extremities

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5
Q

Photophobia

A

Sensitive to light

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6
Q

Bradykinesia

A

Slow movement

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7
Q

Craniotomy

A

Surgical opening in the skull

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8
Q

Encephalitis

A

Inflammation of the brain

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9
Q

Nuchal rigidity

A

Neck pain and stiffness

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10
Q

Prodromal

A

Warning sign

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11
Q

Mannitol

A

Osmotic diuretic

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12
Q

Tacrine (Cognex)

A

Cholinesterase inhibitor

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13
Q

Carbamazepine (Tegretol)

A

Anticonvulsant

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14
Q

Dexamethasone (Decadron)

A

Corticosteroid

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15
Q

Levodopa/carbidopa (Sinemet)

A

Converts to dopamine in the brain

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16
Q

Primary symptom of Stage 1 Alzheimer’s

A

Forgetfulness

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17
Q

Primary symptom of Stage 2 Alzheimer’s

A

Confused

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18
Q

Primary symptom of Stage 3 Alzheimer’s

A

Ambulatory dementia

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19
Q

Primary symptom of Stage 4 Alzheimer’s

A

Terminal

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20
Q

Unconscious at accident scene

A

Epidural bleed

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21
Q

Polyuria and polydipsia following head injury

A

Diabetes insipidus

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22
Q

Hypotension, loss of sympathetic function

A

Spinal shock

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23
Q

Nuchal rigidity

A

Meningitis

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24
Q

High blood pressure, bradycardia, diaphoresis

A

Autonomic dysreflexia

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25
Q

Brief period of starving

A

Absence seizure

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26
Q

Automatic repetitive movement such as picking or lip smacking

A

Complex partial seizure

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27
Q

Status epilepticus

A

Continuous seizure

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28
Q

Cushing’s triad

A

Increased intracranial pressure

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29
Q

Cerebral vasoconstriction followed by vasodilation

A

Migraine

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30
Q

Which of the following settings is the most therapeutic for an agitated patient with a head injury?

a) A day room with family visitors and a variety of caregivers
b) A semiprivate room with one or two consistent caregivers
c) A ward with other patients who have head injuries and volunteers to assist with needs
d) A hallway near the nurse’s station with adequate sensory stimulation

A

b) A semiprivate room with one or two consistent caregivers

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31
Q

Decreasing level of consciousness is a symptom of which of the following physiological phenomena?

a) Increased intracranial pressure (ICP)
b) Sympathetic response
c) Parasympathetic response
d) Increased cerebral blood flow

A

a) Increased intracranial pressure (ICP)

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32
Q

Which of the following blood pressure changes alerts the nurse to increasing ICP, and should be reported immediately?

a) Gradual increase
b) Rapid drop followed by gradual increase
c) Widening pulse pressure
d) Rapid fluctuations

A

c) Widening pulse pressure

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33
Q

Which of the following nursing interventions will help prevent a further increase in ICP?

a) Encourage fluids
b) Elevate the head of the bead
c) Provide physical therapy
d) Reposition the patient frequently

A

b) Elevate the head of the bed

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34
Q

A 90-year-old nursing home resident with stage 2 Alzheimer’s disease is found alone and crying in the dining room. She says she lost her mother and doesn’t know what to do. Which response by the nurse will help calm the resident?

a) “Remember your mother has been dead for 30 years. You forgot again didn’t you?”
b) “I’m sorry you lost your mother; let’s go try and find her.”
c) “Are you feeling frightened? I’m here and I will help you.”
d) “You are 90 years old. It is impossible for your mother to still be living. I know if you try, you can figure out what to do.”

A

c) “Are you feeling frightened? I’m here and I will help you.”

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35
Q

A patient asks the nurse what side effects to expect from a muscle relaxant medication that has been prescribed. Which of the following side effects should the nurse relate?

a) Hypoglycemia
b) Hypotension
c) Drowsiness
d) Dyspnea

A

c) Drowsiness

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36
Q

A nurse caring for a patient with a herniated lumbar disk develops a plan of care for impaired mobility related to nerve compression. Which patient outcome indicates that the plan has been successful

a) The patient rates the pain at 3 to 4 on a 0-to-10 scale
b) The patient has full range of motion of the upper extremities
c) The patient demonstrates correct self-administration of analgesics
d) The patient is able to ambulate 25 feet without pain

A

d) The patient is able to ambulate 25 feet without pain

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37
Q

Which of the following problems during the immediate postoperative course following lumbar microdiskectomy should be reported to the physician immediately?

a) Incisional pain
b) Two-inch area of bleeding on dressing
c) Inability to move affected leg
d) Muscle spasm of affected leg

A

c) Inability to move affected leg

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38
Q

A patient with a brain tumor is admitted to the medical unit to begin radiation treatments. Which nursing action should take priority?

a) Pad the patient’s side rails
b) Assess the patient’s pain level
c) Teach the patient what to expect during radiation treatments
d) Place the patient in isolation

A

a) Pad the patient’s side rails

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39
Q

Which nursing interventions can help prevent falls in a patient with Parkinson’s disease? (Select all that apply)

a) Keep the patient’s call light within reach
b) Apply a soft vest restraint when the patient is in bed
c) Avoid use of throw rugs
d) Maintain the patient’s bed in a low position
e) Encourage the patient to be independent for as long as possible
f) Provide a cane or walker for ambulation

A

a, c, d, f

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40
Q

The nurse is counseling a young woman with a spinal cord injury at C7. Which of the following birth control options would the nurse recommend for this client?

a) Condom
b) Oral contraceptives
c) Diaphragms
d) Norplant
e) Intrauterine device
f) No birth control is needed since she will be infertile

A

a, d

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41
Q

An inflammation of the brain and spinal cord that may be caused by either bacterial or viral infections

A

Meningitis

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42
Q

Type of meningitis that is a serious infection. Spread by direct contact with discharge from the respiratory tract of an infected person

A

Bacterial meningitis

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43
Q

Type of meningitis that is more common and rarely serious

A

Viral meningitis

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44
Q

Prevention of meningitis?

A

Hib vaccine and pneumonia vaccine

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45
Q

What is the etiology of meningitis

A

Generally begins in another area such as the upper respiratory tract, enters the blood, and invades the CNS

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46
Q

Signs and symptoms of meningitis?

A

Severe headache, fever, photophobia, petechial rash, nuchal rigidity, nausea, vomiting, encephalopathy

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47
Q

What is a positive Kernig’s sign?

A

After flexing the knee 90 degrees, trying to extend it all the way will cause hamstring pain

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48
Q

What is a positive Brudzinski’s sign?

A

When flexing the neck downward, the knees will flex and there will be pain in the neck

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49
Q

What are some complications of meningitis?

A

Hydrocephalus
Seizures
Respiratory impairment
Neurological deficits

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50
Q

How do you diagnose meningitis?

A

Lumbar puncture, look at the CSF

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51
Q

What will the CSF look like with bacterial meningitis?

A

Fluid is cloudy from the increase in WBC

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52
Q

What will the CSF look like with viral meningitis?

A

Fluid is clear, but the WBC count is elevated

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53
Q

Therapeutic interventions for meningitis?

A 
Antibiotics(bacterial)
Antipyretics (for fever)
Cooling blanket (for fever)
Dark quiet environment
Analgesics
Antiemetics
Isolation
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54
Q

Inflammation of brain tissue in a local area

A

Encephalitis

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55
Q

Signs and symptoms of encephalitis?

A

Headache, fever, nausea, vomiting, nuchal rigidity, confusion, decreased LOC, seizures, photophobia, tremors
(Very similar to meningitis)

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56
Q

what is ataxia?

A

lack of muscle coordination

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57
Q

What tests are used to diagnose encephalitis?

A

CT scan, MRI, lumbar puncture, and EEG

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58
Q

Breakdown of blood after cerebral hemorrhage results in ___-colored CSF

A

yellow

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59
Q

Therapeutic interventions for encephalitis?

A 
Analgesics
Antipyretics
Anti-virals
Neuro assessment
Symptomatic care
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60
Q

Is there a treatment for insect borne encephalitis?

A

No

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61
Q

What med is given for herpes simplex encephalitis?

A

Acyclovir (zovirax)

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62
Q

Pressure exerted within the cranial cavity by its components (blood, brain and cerebrospinal fluid)

A

ICP - intracranial pressure

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63
Q

The theory stating that there are 3 components in the skull. If one increases and something doesn’t, the result will be increased ICP

A

Monro-Kellie doctrine

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64
Q

What are possible etiologies for increased ICP?

A

Brain trauma, brain tumor, intracranial hemorrhage

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65
Q

Signs and symptoms of ICP

A

Restlessness, irritability, decrease in LOC, pupil changes (due to pressure)

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66
Q

Normal ICP is __ to __ mm HG

A

0 to 15

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67
Q

Any patient with a pathological intracranial condition may be at risk for ?

A

Increased ICP

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68
Q

If compression continues and the brain tissue exerts pressure on the opposite side of the brain from an injury, both pupils become ___ and _____

A

fixed and dilated

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69
Q

What is the most common method of monitoring ICP in adults?

A

Placing a catheter in the ventricle of the brain, in the cerebral parenchyma or in the subdural or subarachnoid space

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70
Q

How can you diagnose increased ICP?

A

CAT scan, MRI, PET, ICP monitoring, EEG

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71
Q

What is the highest score you can get on the Glasgow coma scale?

A

15

72
Q

What is the lowest score you can get on the Glasgow coma scale?

A

3

73
Q

What are the 3 sections of the Glasgow coma scale?

A

Eye opening, verbal response, motor response

74
Q

How is the ‘eye opening’ section of the Glasgow coma scale broken down?

A

spontaneously - 4 points
to speech - 3 points
to pain - 2 points
none - 1 point

75
Q

How is the ‘verbal response’ section of the Glasgow coma scale broken down?

A 
orientated - 5 points
confused - 4 points
inappropriate - 3 points
incomprehensible - 2 points
none - 1 point
76
Q

How is the ‘motor response’ section of the Glasgow coma scale broken down?

A 
obeys commands - 6 points
localizes to pain - 5 points
withdraws from pain - 4 points
flexion to pain - 3 points
extension to pain - 2 points
none - 1 point
77
Q

Headache pain is usually behind the forehead and/or cheekbones

A

sinus headache

78
Q

Headache pain is in and around one eye

A

cluster headache

79
Q

Headache pain is like a band squeezing the head

A

tension headache

80
Q

Headache pain, nausea and visual changes are typical of classic form

A

migraine headache

81
Q

____ is the most common symptom of neurologic disorders

A

Headaches

82
Q

What B/P meds can be given for migraines?

A

Nifedipine, propranolol

83
Q

Vascular disturbances, stress, anxiety and emotional distress are all proposed causes of ____ headaches

A

cluster

84
Q

These headaches can be due to premenstrual syndrome, stress or anxiety

A

tension headaches

85
Q

Nursing care for headaches

A 
Assessment
Patient education (keep diary, record triggers, timing and symptoms, and medication teaching)
86
Q

Abnormal electrical discharge within the brain due to instability of the neuron cell membrane

A

seizures

87
Q

____ may be a symptom of epilepsy or other neurological disorders such as a tumor or brain attack

A

seizures

88
Q

This type of seizure begins on one side of cerebral cortex

A

partial seizure

89
Q

This type of seizure has both hemispheres of the brain involved

A

generalized seizure

90
Q

A chronic neurologic disorder characterized by recurrent seizure activity

A

epilepsy

91
Q

Epilepsy may be ____ or _____

A

acquired or idiopathic

92
Q

What is acquired epilepsy?

A

Underlying neurological disorder such as a traumatic brain injury and anoxic events (events where the brain is left without oxygen)

93
Q

What is idiopathic epilepsy?

A

No cause identified, and they usually begin before age 20

94
Q

A sensation that warns the patient that a seizure is about to occur
-These sensations can be visual distortion, odor and sound

A

Aura

95
Q

How many types of generalized seizures are there?

A

2

96
Q

Seizures that are classic in children and they stare for several seconds.

A

Absence (petit mal)

97
Q

Seizures characterized by rigidity followed by muscle contraction and relaxation with twitching movements

A

Tonic clonic (grand mal)

98
Q

____ period follows the seizure which is a recovery period

A

Postictal

99
Q

An ___ is the most useful test for evaluating seizures

A

EEG

100
Q

Many anticonvulsants require periodic ___ tests to monitor serum levels as well as kidney and liver functions

A

blood

101
Q

What are the emergency care steps during a seizure used to prevent injury?

A 
Pad side rails
Monitor airway
Turn on side to prevent aspiration
Suction PRN
Observe and document
102
Q

Stopping an anticonvulsant can result in ?

A

status epilepticus

103
Q

30 minutes of seizure activity without a return to consciousness

A

Status epilepticus

104
Q

What is the treatment for status epilepticus?

A

Ensure airway and oxygenation

Administer IV diazepam

105
Q

____ ____ ____ is a major cause of death and disability in adults

A

traumatic brain injury

106
Q

What accounts for the largest percentage of traumatic brain injuries?

A

motor vehicle accidents

107
Q

When there has been rapid back and forth movement of the brain that causes bruises and tearing of brain tissues and vessels, but the skull is intact

A

Closed head injury (or nonpenetrating injury)

108
Q

Refers to a break in the skull

A

Open head injury (or penetrating injury)

109
Q

A term used to describe a moving object hitting a stationary head. An example of this type of injury is a patient who is hit in the head with a baseball bat.

A

Acceleration injury

110
Q

Occurs when the head is in motion and strikes a stationary surface. This type of injury is seen in patients who trip and fall, hitting their head on furniture or the floor

A

Deceleration injury

111
Q

_____ injuries may be caused by a direct blow to the head or may occur during a motor vehicle accident in which the vehicle is struck from the side

A

Rotational

112
Q

Twisting of the brainstem can damage the _____ _____ _______, causing loss of consciousness

A

reticular activating system

113
Q

A mild brain injury with loss of consciousness for under 5 minutes. Characterized by headache, dizziness, nausea and vomiting

A

Concussion

114
Q

Bruising of the brain possibly accompanied by hemorrhage. Respirations, pupil reaction and motor response are affected

A

Contusion

115
Q

Usually a venous bleed

A

subdural hematoma

116
Q

Occur 24 hours after injury
As it increases, the patient may exhibit extremity weakness or dilation of the pupil
LOC may further deteriorate as ICP increases

A

Acute hematoma

117
Q

Due to the chronic stretches of veins between the brain and the dura
A minor fall can cause the veins to rupture and bleed

A

Chronic hematoma

118
Q

Usually an arterial bleed between the dura mater and the skull. Because it’s arterial, it can become large quickly
Loss of consciousness occurs and dilated pupil. Seizures or hemiparesis may occur, especially if there is no interventions
This is a fatal condition if not treated
The goal is to keep an oral airway and decrease the ICP

A

Epidural hematoma

119
Q

If ICP remains elevated despite drainage of CSF, the next step is use of an ?

A

osmotic diuretic (such as mannitol (Osmitrol)

120
Q

Edema or direct injury that affects the posterior portion of the pituitary gland or hypothalamus can result in adequate release of antidiuretic hormone, causing ?

A

diabetes insipidus

121
Q

____ is displacement of brain tissue out of its normal anatomical location

A

Herniation

122
Q

Herniation usually results in ?

A

brain death

123
Q

Neoplastic growths of the brain or meninges

A

Brain tumors

124
Q

Primary brain tumors rarely metastasize; however, if they do, it is to the ____

A

spine

125
Q

____ tumors are those arising from the cells of the central nervous system

A

Primary

126
Q

Most brain tumors are _____; that is, they have metastasized from a primary malignancy elsewhere in the body

A

secondary

127
Q

Metastatic tumors arise from the primary cancer of:

A

prostate, thyroid, breast, liver and kidney

128
Q

Signs and symptoms of brain tumors

A 
Seizures
Motor and sensory deficits
Headaches
Visual disturbances
Hormone disturbances
129
Q

Compression of nerve root(s) occurs

Cause can be from a known injury or unknown event

A

herniated disk

130
Q

Signs and symptoms of herniated disk

A 
Pain that follows the nerve path
Muscle spasms
Numbness or tingling of extremity
Weakness of the extremity
Muscle atrophy
131
Q

A ____ is when dye is injected into the fluid by the spinal cord. This then outlines the spinal cord

A

myelogram

132
Q

How do you diagnose a herniated disk?

A

MRI, myelogram

133
Q

Treatment for herniated disk

A 
Bed rest for 1-2 days
Physical therapy, TENS unit, heat/cold, deep massage
Traction - for cervical herniation
Muscle relaxants
NSAIDs and analgesics
Epidural anesthetic injections
Steroids and surgeyr
134
Q

A _____ is generally done for a herniated cervical disk. This can be accomplished via an anterior or posterior approach.

A

Diskectomy

135
Q

When the laminae is removed to relieve pressure or to assist with the removal of a herniated disk

A

Laminectomy

136
Q

What are complications of surgery for herniated disks?

A

Hemorrhage
Nerve root damage
Reherniation
Herniation of another disk

137
Q

How many cervical spine nerves are there?

A

8

138
Q

What do the cervical spinal nerves do

A

controls the diaphragm, chest wall muscles, arms and shoulders

139
Q

How many thoracic spine nerves are there?

A

12

140
Q

What do the thoracic spinal nerves do?

A

controls upper body, gastrointestinal function

141
Q

How many lumbar and sacral nerves are there?

A

5 for each

142
Q

What do the lumbar and sacral nerves do?

A

controls lower body, bowel and bladder

143
Q

What is the pathophysiology of spinal cord injuries?

A

Damage to nerve fibers, therefore there is interference with communication between brain and body

144
Q

What are common causes of spinal cord injuries?

A

MVAs, sports injuries and falls

145
Q

Loss of function of all extremities

A

quadriplegia

146
Q

Weakness in function of all extremities

A

quadriparesis

147
Q

Cervical injury of C3 or above is ____

A

fatal

148
Q

Paralysis of the legs

A

paraplegia

149
Q

C4 spinal cord injury

A

quadriplegic, paralyzed from the neck down

150
Q

C5 and C6 spinal cord injury

A

quadriplegic with some arm and shoulder movement

151
Q

C7 and C8 spinal cord injury

A

quadriplegic with some arm and hand movement

152
Q

This is a term that can be applied to any nervous system disorder that causes degeneration, or wasting of the neurons in the nervous system

A

Neurodegenerative

153
Q

____ is not a disease, but rather is a symptom of a number of different disorders

A

dementia

154
Q

Characteristics of dementia

A

Patients have impaired intellectual functioning
They lose the ability to solve problems and maintain emotional control
They may experience personality changes and behavioral problems

155
Q

Possible causes of dementia

A 
Huntington's
Parkinson's
Alzheimer's
multiple "mini-strokes/TIAs"
Chronic alcoholism
Neurological infections
156
Q

What medications can cause disturbed thought processes?

A 
Atropin
Meperidine
Morphine
Tagamet
Sleeping pills
Cortisone or prednisone
157
Q

What are the common meds utilized for treatment of dementia?

A 
Aricept
Cognex
Exelon
Reminyl
Namenda
158
Q

Destruction of substantia nigra in the brain responsible for dopamine production

A

Parkinson’s disease

159
Q

Progressive, hereditary, degenerative, incurable neurological disorder
A disorder in which nerve cells in certain parts of the brain waste away

A

Huntington’s disease

160
Q

What are the characteristics of Huntington’s?

A

involuntary, irregular, jerky movements

161
Q

Huntington’s disease affects the ____ ____

A

basal ganglia

162
Q

Is there a cure for Huntington’s?

A

No

163
Q

Meds are given for Huntingtons to treat what?

A

Involuntary movement and behavioral outbursts

164
Q

An overall term that describes a wide range of symptoms associated with a decline in memory or other thinking skills severe enough to reduce a person’s ability to perform everyday activities
It is a progressive disease

A

Alzheimer’s

165
Q

____ is a mental disturbance that is temporary, and can have either a rapid or gradual onset

A

delirium

166
Q

Which of the following problems predisposes someone to develop meningitis?

a) A sore throat for 3 days
b) A migraine headache
c) A muscle injury in the neck
d) Vision changes

A

a) A sore throat for 3 days

167
Q

A patient with meningitis has photophobia and a severe headache. Which nursing interventions will be most helpful to relieve symptoms?

a) Administer antibiotics as ordered, and prepare the patient for lumbar puncture
b) Darken the room and administer analgesics
c) Administer acetaminophen as ordered and maintain isolation
d) Check level of consciousness with the Glasgow Coma Scale and monitor vital signs

A

b) Darken the room and administer analgesics

168
Q

Which type of headache is most commonly associated with an aura?

a) Migraine
b) Cluster
c) Tension
d) Muscle contraction

A

a) Migraine

169
Q

A patient makes an appointment to see a primary care practitioner for recurrent severe headaches. Which instruction by the nurse will help gather the best additional data prior to the appointment?

a) “Try relaxation and warm moist compresses for your headaches.”
b) “Call and come in the next time you have a headache so you can be examined”
c) “Keep track of how many headaches you have before you come in”
d) “Keep a diary of your headaches, recording symptoms, timing and headache triggers”

A

d) “Keep a diary of your headaches, recording symptoms, timing, and headache triggers

170
Q

A patient who has had a generalized tonic-clonic seizure is sound asleep 30 minutes after the seizure. Meals are about to be delivered. Which nursing action is most appropriate?

a) Wake the patient because nourishment is essential following a seizure
b) Wake the patient to do a complete neurologic assessment before the meal
c) Let the patient sleep during the postictal state, and keep the meal warm
d) Do not attempt to wake the patient because of the risk of a repeat seizure

A

c) Let the patient sleep during the postictal state, and keep the meal warm

171
Q

A patient with a history of seizures reports experiencing an aura and is concerned about an impending seizure. Place the nurse’s interventions in the correct order

a) Protect the patient from injury during the seizure
b) Document the events of the seizure
c) Help the patient lie down in a safe place
d) Turn the patient on his or her side to sleep

A

C, A, D, B

172
Q

Which patients should be closely monitored by the nurse for symptoms of increased intracranial pressure?

a) The patient who has a history of epilepsy
b) The patient admitted with a high fever and severe headache
c) the patient in the post-anesthesia care unit following craniectomy
d) The patient with a brain tumor who is admitted for radiation therapy
e) The patient with a history of migraine headaches, admitted for orthopedic surgery
f) The patient with Alzheimer’s disease admitted with a urinary tract infection

A

b, c, d

173
Q

Which of the following actions should the nurse take to help prevent increased intracranial pressure in a patient following a traumatic brain injury?

a) Cluster care so the patient can have long periods of rest
b) Keep the head of the bed elevated at 30 degrees
c) Suction frequently to keep the airway clear
d) Do not give anything by mouth

A

b) Keep the head of the bed elevated at 30 degrees

174
Q

How much function can be expected in a patient with a spinal cord injury at the L2 down?

a) Quadriplegic from the neck down
b) Quadriplegic with some arm movement
c) Paraplegic with some trunk movement
d) Paraplegic, may learn to walk with a brace

A

d) Paraplegic, may learn to walk with a brace

175
Q

A patient admitted following a T4 spinal injury. When taking morning vitals, the nurse notes that the patient appears restless and the blood pressure is elevated. Which of the following actions by the nurse is appropriate?

a) Recheck the patient’s blood pressure in 30 minutes
b) No action is necessary. This is an expected finding
c) Check for a full bladder
d) Encourage the patient to express any anxiety

A

c) Check for a full bladder

176
Q

The symptoms of Parkinson’s disease are caused by depletion of which neurotransmitter?

a) Dopamine
b) Acetylcholine
c) Serotonin
d) Norepinephrine

A

a) Dopamine

177
Q

Which nursing interventions are appropriate for the patient with a neurodegenerative disorder who has difficulty swallowing?

a) Show the patient how to tuck his or her chin down to the chest during swallowing
b) Provide clear to full liquids; avoid solid foods
c) Place the patient in semi-Fowler’s position for earing
d) Provide adaptive eating utensils

A

a) Show the patient how to tuck his or her chin down to the chest during swallowing

Nursing III (6 decks)

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