Module 4 Neurology

Question 1

What does the central nervous system consist of?

Answer 1

The brain and spinal cord

Question 2

This very lipid-soluble substance can rapidly cross the blood brain barrier

Answer 2

Alcohol is a very lipid-soluble substance that can cross the blood brain barrier. This allows it to disrupt normal functions. This will result in the death of brain cells. Binge drinking in young adults can produce particularly devastating effects because the brain is still developing.

Question 3

The area of the brain responsible for the basic functions of life such as regulation of heart rate, breathing, and heart rhythms.

Answer 3

Brain stem

Question 4

List the cranial nerves, cranial nerve functions, and how to test each:

Answer 4

• CN I - Olfactory - smell
• CN II - Optic - Vision, test snellen chart.
• CN III - Oculomotor - Eye movements upward, medial, downward, and up and in.
• CN IV - Trochlear - eye movement down and in.
• CN V - Trigeminal - Facial touch sensation/ clench teeth.
• CN VI - Abducens - Eye movement side to side.
• CN VII - Facial - Taste on anterior 2/3 of tongue. Responsible for smile, crease forehead, and puff cheeks.
• CN VIII - Vestibulocochlear / Acoustic - hearing, whisper test, weber, rinne tests.
• CN IX - Glossopharyngeal - Controls muscles in oral cavity for speech and swallowing, taste on posterior 1/3 of tongue. Test gag reflex, ask patient to say “ah” watch for soft palate rise. Test taste.
• CN X - Vagus - responsible for digestion, heart rate, and respiratory rate. Ask patient to say “ah” and watch for soft palate rise.
• CN XI -Spinal Accessory - Shoulder shrug
• CN XII - Hypoglossal - Tongue movements

Question 5

What type of pain has a sudden onset such as pain immediately following injury in a motor vehicle crash?

Answer 5

Acute pain

Question 6

What type of pain is typically related to the internal organs in the body?

Answer 6

Visceral pain

Question 7

What types of pain scales are available for patient assessments?

Answer 7

• Numerical pain rating scale
• Verbal descriptor pain scale
• Wong-Baker facial grimace pain scale
• Activity tolerance pain scale

Question 8

Which pain scale would be most appropriate to utilize in the assessment of a 6 year old child’s pain?

Answer 8

Wong-Baker Facial Grimace Scale

Question 9

Which pain scale would be most appropriate to utilize in a 40 year-old male client’s pain assessment who is alert and oriented x 4 with no cognitive impairments?

Answer 9

Numerical Pain Rating Scale

Question 10

Which pain scale would be utilized in the pain assessment of a 25 year-old female patient with a third grade literacy level and history of down syndrome?

Answer 10

Wong-Baker Facial Grimace Scale or potentially the Activity Tolerance Pain Scale after further assessment of the patient’s understanding.

Question 11

Phantom limb pain is a possible complication of?

Answer 11

Amputations can result in phantom limb pain which is thought to be the result of the regenerating nerve becoming trapped in the scare tissue of the amputation site or from spontaneous firing of the spinal cord neurons with abnormal sensory input.

Question 12

Describe the difference between a migraine with aura and without an aura.

Answer 12

A migraine headache without aura includes symptoms of pulsating, throbbing, unilateral headache lasting 1 to 2 days which is intensified by activity. Other symptoms include nausea, vomiting, sensitivity to light/sound, and visual disturbances such as hallucinations of stars, sparks, or flashes of lights. Migraine with aura will include these symptoms along with reversible visual disturbances of flickering lights, spots, lines, loss of vision, feeling of pins/needles, numbness, and reversible speech disturbances. This aura will occur before the headache onset and last from 5 minutes to one hour.

Question 13

Describe a cluster headache.

Answer 13

A cluster headache is more common in female patients. It will typically occur in clusters. This is a severe, unrelenting unilateral headache located behind the eye. The pain is rapid in onset and lasts up to 180 minutes. Other symptoms of conjunctival redness, nasal congestion, rhinorrhea, facial sweating, eyelid edema, and eyelid drooping may occur.

Question 14

Describe a tension headache.

Answer 14

A tension headache is typically described as a dull, diffused pain in a hat band like pattern. The pain is typically the the result of sustained tension in muscles of the back and neck from excessive stress or anxiety. The headache may be also be triggered by depression or the overuse of caffeine products.

Question 15

A patient presents to the emergency department with a report of slowly ascending bilateral paralysis after having influenza. The nurse is concerned about the potential for impaired respiratory function which is a known complication of this diagnosis?

Answer 15

Guillain-Barre Syndrome which is an acute immune mediated polyneuropathy (the immune system is attachking the nerves in the body) which begins as symptoms of weakness and tingling sensations in the feet and legs that will slowly ascend to the upper body. Paralysis occur in an ascending pattern from the feet upward. Potential causes include influenza like illnesses, Zika virus, and Epstein Barr virus.

Question 16

A patient has presented to the clinic today who’s family reports he has developed increasing difficulty with walking resulting in several falls at home. Upon assessment the nurse notes a pill roll tremor, difficulty starting ambulation, and difficulty with suddenly stopping or changing directions with ambulation. What diagnosis does the nurse anticipate the patient will have further referral to a neurologist to accurately diagnose?

Answer 16

The nurse anticipates the patient may have Parkinson’s Disease based on his current symptoms. Other symptoms include stooped posture, mask like face, back rigidity, forward tilt of trunk, reduced arm swing, short shuffling gait, and dementia. A neurologist will determine if the patient meets the absolute inclusion criteria for diagnosis of Parkinson’s Disease since there is no definitive test for Parkinson’s Disease.

Question 17

A 50 year-old male with symptoms of muscle weakness, muscle spasticity, loss of fine motor control, dysphagia, dysphonia, muscle atrophy, and hypo-reflexes reports the beginnings of muscle paralysis in his lower extremities. He reports he was diagnosed with ALS approximately 3 years ago. He would like to know if a cure has been developed for his diagnosis since the time he was told he had ALS 3 years ago. What would be the best response by the nurse?

Answer 17

ALS also known as Lou Gehrig Disease has no cure at this time. Treatment focuses on the management of symptoms. The physician can order medication that can help with the symptoms you are experiencing. Unfortunately it is important to understand that this is a fatal disease and research is still being conducted to try to find a cure or effective treatment that will prolong life. We will assist you in the management of your symptoms and the physician can see if you qualify for research studies being conducted.

Question 18

A 40 year-old female with symptoms of chronic fatigue, diplopia, dysphagia, muscle weakness, chronic pain, and incontinence of urine was recently diagnosed with MS (Multiple Sclerosis). The patient would like to better understand her condition by knowing what is happening in her body to result in her current symptoms. What would be the best response by the nurse?

Answer 18

Multiple Sclerosis (MS) is a demyelinating disease of the central nervous system. Some nerve axons in the body are covered in a fatty substance called a myelin sheath that acts as an insulation that helps impulses travel more rapidly over longer distances. When the myelin is damaged or breaks down the impulses can no longer travel as they should because the impulses are slowed which results in the symptoms experienced in MS.

Question 19

The nurse is preparing to assess the vital signs of a client with a previous diagnosis of quadriplegia in the emergency department. Would the nurse anticipate that the client can raise his arm when asked to position the blood pressure cuff?

Answer 19

No the patient would be unable to raise his arm without assistance based on his diagnosis of quadriplegia which involves paralysis from the body from the neck down.

Question 20

A patient with a diagnosis of paraplegia is being assessed by the nurse. Would the nurse anticipate that the client can lift his legs on command when completing the neurological assessment?

Answer 20

No, the nurse would anticipate that this client has paralysis of the legs and lower body.

Question 21

A client has been diagnosed with hemiplegia. The client asks the nurse what this diagnosis means. How would the nurse respond?

Answer 21

The nurse should respond that hemiplegia is a paralysis that affects one side of the body.

Question 22

Describe safety measures the nurse should discuss in a client newly diagnosed with paralysis?

Answer 22

Teaching points should include the following:

• Check the temperature of bath water to prevent burns.
• Check extremities frequently for injuries.
• Report and treat any injuries to extremities immediately to prevent infection.
• Fall prevention in transferring from wheelchair to bed/chair/tub.
• Assistive services to assist family and prevent caregiver fatigue.
• Aspiration prevention measures.

Question 23

The nurse is caring for a patient diagnosed with an epidural hematoma. What area is affected by an epidural hematoma?

Answer 23

An epidural hematoma develops between the bones of the skull and the dura.

Question 24

The nurse is caring for a patient diagnosed with a subdural hematoma. What area is affected by a subdural hematoma?

Answer 24

A subdural hematoma develops between the dura and the arachnoid (subdural space).

Question 25

The nurse is caring for a patient diagnosed with an intracerebral hematoma. What area is affected by an intracerebral hematoma?

Answer 25

An intracerebral hematoma can occur in any lobe of the brain but is most common in the frontal or temporal lobes.

Question 26

The nurse is caring for a patient diagnosed with a hemorrhagic stroke. The patient’s family asks the nurse what a hemorrhagic stroke means. How would the nurse best respond?

Answer 26

A hemorrhagic stroke means that there is bleeding into the brain tissues which is placing pressure on the tissues of the brain. The pressure builds up because the skull does not allow for expansion. This pressure is reducing the ability of the brain tissues affected to receive the oxygen and nutrients they need. This type of stroke is typically caused by blood vessels rupturing from head injuries, aneurysms, or arteriovenous malformations.

Question 27

The nurse is caring for a client diagnosed with an ischemic stroke. The family asks the nurse to explain what this diagnosis means. How would the nurse best respond?

Answer 27

An ischemic stroke is caused by an interruption of the blood flow in the brain typically from a blood clot. The blockage created by the blood clot means that the area of the brain tissue past the blockage is unable to receive the oxygen and nutrients it needs to survive.

Question 28

A patient has been diagnosed with a transient ischemic attack (TIA, mini stroke). The patient asks the nurse what a “mini-stroke” is and why treatment is important if all the symptoms have resolved. What would be the best response by the nurse?

Answer 28

A “mini-stroke” is also known as a transient ischemic attack. This type of stroke is caused by a temporary clot. The temporary clot caused a lack of oxygen and nutrients to the area past the clot which is why you experienced your symptoms. The clot was temporary and when blood flow resumed the tissues affected by the lack of blood flow were able to receive oxygen and nutrients again so your symptoms resolved. Treatment with anticoagulants is very important because you are at a very high risk for a ischemic stroke due to your history of having a “mini-stroke.”

Question 29

The nurse understands that early recognition of a stroke can save a persons life and reduce long term negative effects associated with a stroke. What symptoms of a cerebral vascular accident (CVA) would the nurse teach a group of clients about to promote early presentation for treatment?

Answer 29

The nurse should teach the clients that the following symptoms can indicate a stroke is occurring:

• Facial droop
• Arm weakness
• Slurred speech
• Sudden confusion
• Sudden difficulty speaking (finding correct words)
• Sudden difficulty understanding speech
• Sudden dizziness, loss of balance, lack of coordination
• Sudden numbness of the face or one side of the body
• Difficulty seeing
• Sudden severe headache

Time is brain tissue so the patient should present as soon as possible!

Question 30

What treatment can a person having an ischemic stroke receive within a three hour window that can significantly improve their symptoms and outcome?

Answer 30

TPA (Tissue plasminogen activator) may be given to someone having an ischemic stroke because it is a clot buster. This medication should never be given to someone having a hemorrhagic stroke.

Question 31

What is the purpose of cerebrospinal fluid?

Answer 31

Cerebrospinal fluids purpose is primarily to cushion the brain and provide a near-water medium for diffusion of nutrients.

Question 32

A 16 year-old patient has been diagnosed with a coup contrecoup injury following a car crash in which they were the unrestrained driver. The family has asked the nurse what a coup contrecoup injury means. What would be the best response by the nurse?

Answer 32

The brain sits in the skull surrounded by cerebral spinal fluid. The brain is not stationary so if a patient suffers an impact to the skull the brain will accelerate toward the injury site. A coup injury is the initial injury site of the impact force on the brain. Then the brain decelerates abruptly hitting the inner skull surfaces typically on the opposite side of the impact injury. This result in another injury to the brain called a contrecoup injury.

Question 33

A group of nursing students are discussing the difference between meningitis and encephalitis. The nursing instructor knows that the students understand the difference when they state:

Answer 33

Meningitis is an infection of the meninges which are the membranes that surround the brain and spinal cord whereas encephalitis is inflammation of the brain itself.

Question 34

State symptoms associated with meningitis:

Answer 34

• Fever and chills
• Headache
• Stiff neck (nuchal rigidity)
• Positive Kernig’s sign and Brudzinski’s sign
• Back, abdominal, and extremity pains
• Nausea and vomiting
• Rash
• Fatigue
• Seizures

Question 35

State symptoms associated with encephalitis:

Answer 35

• Fever
• Headache
• Nuchal rigidity
• Lethargy
• Disorientation
• Seizures
• Paralysis
• Delirium
• Coma

Question 36

Compare and contrast causes of meningitis and encephalitis.

Answer 36

Causes of meningitis include meningococcal bacteria, pneumococcal bacteria, Haemophilus influenzae type b, enterovirus, mumps, and herpes simplex virus. Causes of encephalitis include herpes simplex virus, varicella zoster virus, measles, mumps, West Nile virus, lead toxicity, mosquito bites, rabid animal bites, or ingestion (poliovirus).

Question 37

A patient asks the nurse to describe the difference between a tonic clonic seizure and an absence seizure. How would the nurse best explain the difference in these seizure types?

Answer 37

An absence seizure is a brief sudden loss of consciousness. The person experiencing an absence seizure will often look like they are staring off into space and will then have a rapid return to normal levels of activity. A tonic clonic seizure is what most people view as the typical seizure. This seizure type causes loss of consciousness, rhythmic contractions of muscles, loss of urinary control, and lack of breathing during the seizure activity.