Neuro

Question 1

Parts of the Frontal Lobe

Answer 1

Personality, creativity, problem solving, motor speech (Broca)

Question 2

Parts of the Parietal Lobe

Answer 2

sensory Lobe; (pain, touch, temp, pressue), NO smell

Question 3

Parts of the Temporal lobe

Answer 3

Hearing, smell, understand spoken language (Wernicke’s area), memory

Question 4

Parts of the Occipital Lobe

Answer 4

Vision, visual interpretation

Question 5

Normal ICP

Answer 5

Normal ICP less than 15

Question 6

Nursing intervention for a CPP less than 60

Answer 6

Notify MD

Question 7

Normal CPP

Answer 7

60-100mmhg

Question 8

S/S of IICP

Answer 8

LOC (earliest sign)
H/A (intermittend or constant)
Vomiting 
Papilledema (swelling of the Optic Nerve)
Unequal pupil or abnormal response
Seizures 
Loss of gag reflex
Abnorm BP (increase in pulse pressure)
Brady cardia 
Irregular respiration

Question 9

Late sign of IICP

Answer 9

Cushing’s Triad: increase in SBP (pulse pressure to improve cerebral perfusion)
Bradycardia (d/t increase in BP), and irregular or abnormal respiration (d/t brainstem compression)

Question 10

Definition of Diabetes Insipidus and Tx

Answer 10

Decrease secretion of ADH, which l/d excessive urination.

Tx: increase fluids, and Desmopressin (DDAVP)

Question 11

Definition of Syndrome of Inappropriate ADH (SIADH) and Tx

Answer 11

Increased secretion in ADH, which l/t retention in fluids.

Tx: fluid restriction, Diuretics, Dilantin (decreases release of ADH), and Declomycin (blocks effect of ADH on kidney)

Question 12

What’s is the goal in managing cerebral aneurysm

Answer 12

Prevent development of vasospasm with Ca channel blocker Nimodipine (Nimotop)

Question 13

First line tx of status epilepticus

Answer 13

Immediate control with benzodiazepine: Diazpam (Valium) Lorazepam (Ativan)

Question 14

Tx for refractory Status Epilepticus

Answer 14

Pentobarbital

Question 15

How to calculate Dilantin/Albumin Ratio

Answer 15

0.2 x albumin level + 0.1 = X
Dilantin Level/ X
If level is above 20 it’s above the therapeutic range (10-20mcg/ml)

Question 16

Medication used as paralytic agent for neuromuscular blockage?

Answer 16

Norcuron or Pavulon

Question 17

Why is a Neuromuscular Blockade used?

Answer 17

Do decrease oxygen conduction and decrease CO2

Question 18

What must be done before a patient can have a neuromuscular blockade?

Answer 18

The patient must be intubated and sedated prior and during paralysis.

Question 19

What is the Train of Four and what should be the goal?

Answer 19

Assess the degree of paralysis when a neuromuscular blockade was initiated. (NOT the degree of sedation)
90% of blockage is the goal (1/4 twitches)
Avoid 100% blockage (0/4 twitches)

Question 20

What should be avoided to prevent an IICP?

Answer 20

Increase in intrathorasic pressure.
Use of PEEP (5-10cm is OK)
Hip flexion 
coughing 
vomitting
Straining 
Valsvala

Question 21

Nursing consideration when administering Mannitol

Answer 21

Rapid administration for optimal effect
Use filter
watch for crystallization
Monitor fo dehydration - Do NOT exceed 320***

Question 22

Normal albumin and Prealbumin level

Answer 22

Albumin 3.5-5

Pre albumin >20mg/dl

Question 23

Nursing consideration for Phenytoin

Answer 23

Flush IV line pre and post administration with NS
Verify IV patency
Use of a filter is recommended
Never mix with anything, especially Dextrose
Administer no faster than 50mg/min (in elderly 5-10)
Rapid adm. can result in cardiovascular collapse
Monitor serum level 10-20mcg/ml