Neuro

Question 1

General Diagnostic Tests:

2. .

Answer 1

1. ) CT

2. )MRI

Question 2

General Diagnostic Tests:
1. CT:
a. With/without contrast (dye)
Will you need the client to sign a consent form prior to the test when using
dye? \_\_\_
b. Takes pictures in \_\_\_
c. Keep \_\_\_\_\_ still
d. No \_\_\_\_\_\_\_\_

Answer 2

General Diagnostic Tests:
1. CT:
a. With/without contrast (dye)
Will you need the client to sign a consent form prior to the test when using
dye? \_\_\_YES
b. Takes pictures in \_\_\_\_SLICES/LAYERS_
c. Keep \_\_\_HEAD\_\_ still
d. No \_\_\_\_\_\_\_\_TALKING

Question 3

MRI (Magnetic Resonance Imaging):

Which is better CT or MRI? ___________ Is dye used? _____________
• Is radiation used? _____________
• A _____________is used Will be placed in a tube where client will have to lie flat.
Remove ______________________
No credit cards
No ______________
Do fillings in teeth matter? _____________
Do tattoos matter? _____________
Will hear a thumping sound
What type of client can’t tolerate this procedure? _____________________
Can talk and hear others while in the _______________

Answer 3

2. MRI (Magnetic Resonance Imaging):
   a. Which is better CT or MRI? _________MRI because he picks up on pathology earlier then a CT
   b. Is dye used? _ NOT USUALLY BUT IT CAN BE BUT IT DOESN’T HAVE TO BE_
   Is radiation used? ____NO__
   A _____ MAGNET is used
   c. Will be placed in a tube where client will have to lie flat.
   d. Remove __ JEWELRY__
   e. No credit cards
   f. No _ PACEMAKERS IN OTHER WORDS NO MENTAL AT ALL
   g. Do fillings in teeth matter? NO BECAUSE THEY ARE NOT A TRUE METAL
   h. Do tattoos matter? ___YES BECAUSE OLD TATTOOS MAY CONTAIN LEAD
   i. Will hear a thumping sound-tell the client this in head of time to relieve their anxiety
   j. What type of client can’t tolerate this procedure? The claustrophobic
   k. Can talk and hear others while in the TUBE

Question 4

Cerebral Angiography
Will a consent form be needed? ______ Why?___
•X-ray of cerebral circulation
•Go through the ______ artery.

a. Pre:
1) Well hydrated/void/peripheral pulses/groin prepped
•Anytime an iodine based dye is used the client will need to be well
hydrated to promote excretion of the dye.

Watch:
BUN and Creatinine? \_\_\_\_\_\_
Output? \_\_\_\_\_\_
Hold metformin (Glucophage)? \_\_\_\_\_
2) Explain they will have a warmth in face and a metallic taste;
3) Allergies? \_\_\_\_\_\_ OR \_\_\_\_\_\_\_\_
Because An iodine base dye is used.

b. Post:
1) Bed rest for _____HOURS__
2) Watch for ______ at the femoral artery site (BLEEDING/HEMORRHAGE)
3) Embolus
An embolus can go lots of different places:
Arm, Heart, Lung, Kidney
Since we are performing a test on the brain….if the embolus goes to the
brain… the client will have a change in ___ one-sided
____, and _____ _______, motor/sensory deficits.

Answer 4

Cerebral Angiography
Will a consent form be needed? YES Why?___BECAUSE DYE IS BEING USE__
X-ray of cerebral circulation
Go through the ___FEMORAL__ artery.
a. Pre:
1) Well hydrated/void/peripheral pulses/groin prepped
Anytime an iodine based dye is used the client will need to be well
hydrated to promote excretion of the dye.
Watch:
BUN and Creatinine? ____YES__
Output? ___YES___
Hold metformin (Glucophage)? ____YES_
2) Explain they will have a warmth in face and a metallic taste;
3) Allergies? ______ IODINE OR SHELLFISH_____
An iodine base dye is used.

b. Post:
1) Bed rest for 4-6 _____HOURS__
2) Watch for bleeding at the femoral artery site (BLEEDING/HEMORRHAGE)
3) Embolus
An embolus can go lots of different places:
Arm, Heart, Lung, Kidney
Since we are performing a test on the brain….if the embolus goes to the
brain… the client will have a change in ___LOC one-sided
weakness, and _____ PARALYSIS____, motor/sensory deficits.

Question 5

EEG: (Electroencephalography)
a. Records electrical activity of the brain
b. Helps diagnose ______ _ disorders and evaluate the types of seizures
occurring

d. Screening procedure for ________
e. Indicator of ___________death

g. Pre procedure:
•Hold sedatives. Why? ___
•No caffeine-because caffeine will
Not _____________(drops blood sugar)= Low blood sugar effects electrical activity in the brain
f. During procedure
• Will get a baseline first with client lying quietly; may be asked to hyperventilate or cough; if they are completely unconscious, A pain response or
noxious stimuli may be introduced to stimulate a brain wave. clap hands in face, blow whistle in face.

Answer 5

EEG: (Electroencephalography)
a. Records electrical activity of the brain
b. Helps diagnose ___ SEIZURE_ disorders and evaluate the types of seizures
occurring

e. Indicator of __________________BRAIN____death

g. Pre procedure:
Hold sedatives. Why? ___ DECREASE ELECTRICITY IN THE BRAIN__
No caffeine-because caffeine will increase electricity in the brain
Not __________NPO___(drops blood sugar)
h. f. During procedure
• Will get a baseline first with client lying quietly; may be asked to hyperventilate or cough; if they are completely unconscious, A pain response or
noxious stimuli may be introduced to stimulate a brain wave. clap hands in face, blow whistle in face.

Question 6

For cerebral Anguography

1st Do neuro assignment so ____

Answer 6

You can know if any changes occur when they back

Question 7

Lumbar Puncture is contraindications in a pt with

Answer 7

ICP because of herniation

Question 8

What’s the puncture site for lumbar puncture?

Answer 8

subarachnoid space (3rd - 4th)

Question 9

Purpose for lumbar puncture

Purpose:

1) To obtain _____________fluid to analyze for __________, infection, and tumor cells.
2) To measure pressures reading with a manometer
3) To administer drugs intrathecally (brain, spinal cord)

Answer 9

1) To obtain ___SPINAL__fluid to analyze for _____BLOOD, infection, and
tumor cells.
2) To measure pressures reading with a manometer
3) To administer drugs intrathecally (brain, spinal cord)

Question 10

How is it my position in a lumbar puncture?

Answer 10

1. .PROPER UP OVER THE BEDSIDE TABLE WITH THEIR HEAD DOWN(you want a lot of arch to their back)
2. SIDE LYING FETAL POSITION( they’re on their side kneeto chest)

Question 11

Complications: Meningitis

Lumbar puncture

Answer 11

chills, fever, positive Kernig and Brudzinski, vomiting, nuchal rigidity, photophobia.

Question 12

What is the most common complication

Answer 12

What is the most common complication? ______A HEADACHE___
The pain of this headache_ INCREASES___ when the client sits up
and _____ DECREASES__ when they lie down.
How is this headache treated? Bed rest, fluids, pain med, and a
_____________BLOOD___ patch

Question 13

Herniation

Answer 13

When brain tissue is pulled down through foramen magnum as a result of a sudden drop in ICP.

Question 14

Lumbar puncture

d. Inspect the surrounding skin at the puncture site for any infection.
e. CSF should be clear and colorless (looks like water). If it looks like anything else something is wrong.

f. Post-procedure:
Lie flat or prone for 2-3 hrs.
Increase ______to replace lost spinal fluid.

Answer 14

d. Inspect the surrounding skin at the puncture site for any infection.
e. CSF should be clear and colorless (looks like water). If it looks like anything else something is wrong.
f. Post-procedure:
Lie flat or prone for 2-3 hrs.
Increase __FLUID____to replace lost spinal fluid.
I

Question 15

1.  6 Signs and Symptoms of ↑ ICP:
Early Signs:
a. Earliest sign? \_\_
b. Speech? \_\_\_
c. Delay in response to \_\_\_\_\_\_\_ suggestion. Slow to respond to
commands
d. Increasing drowsiness
e. Restless with no apparent reason
f. Confusion

Answer 15

1. Signs and Symptoms of ↑ ICP:
Early Signs:
a. Earliest sign? \_\_CHANGE IN LOC
b. Speech? \_\_\_SLURRED_OR SLOWED
c. Delay in response to \_\_\_\_\_VERBAL\_\_ suggestion. Slow to respond to
commands
d. Increasing drowsiness
e. Restless with no apparent reason
f. Confusion

Question 16

Late Signs: ICP
g. Marked change in LOC progressing to stupor then_____.
h. Vital sign changes:
Called Cushing’s Triad and requires _______ _____intervention to prevent brain ischemia.

i. Posturing: A response to ______ or noxious stimuli. Posturing indicates
that the motor response centers of the brain are compromised.
1) _________posturing: arms flexed inwardly; legs extended with plantar flexion).
2) _______ posturing: arched spine, plantar flexion); worst. extension;
WORST.
3) Client will be rigid and tight and burning _________________more calories____
Normal Lab Value:
ICP: 0-15 mm Hg

Hemiparesis –
Hemiplegia –

Answer 16

Late Signs:
g. Marked change in LOC progressing to stupor then__COMA.
h. Vital sign changes:
Called Cushing’s Triad and requires _______ IMMEDIATE___intervention to
prevent brain ischemia.

i. Posturing: A response to ____PAINFUL__ or noxious stimuli. Posturing indicates
that the motor response centers of the brain are compromised.
1) Decorticate posturing: arms flexed inwardly; legs extended with plantar flexion).
2) Decerebrate posturing: arched spine, plantar flexion); worst. extension;
WORST.
3) Client will be rigid and tight and burning _________________more calories____
Normal Lab Value:
ICP: 0-15 mm Hg

Hemiparesis – weakness
Hemiplegia – paralysis

Question 17

Miscellaneous Signs:

j. Headache
k. Changes in ____ and pupil response. (fixed and dilated)
l. Projectile _________can occur because the vomiting center in the brain is being stimulated.

Answer 17

Miscellaneous Signs:
j. Headache
k. Changes in __PUPILS__ and pupil response. (fixed and dilated)
l. Projectile _________VOMITING_ can occur because the vomiting center in the
brain is being stimulated.

Question 18

Cushing’s Triad:
1) Systolic hypertension with a ____ pulse pressure.
2) _______ Slow, full and bounding pulse
3) ________ respirations. Look for a change in pattern, like
Cheyne Stokes or Ataxic Respirations.

Answer 18

Cushing’s Triad:
1) Systolic hypertension with a ___ WIDENING_ pulse pressure.
2) Bradycardia Slow, full and bounding pulse
3) _______ IRREGULAR_ respirations. Look for a change in pattern, like
Cheyne Stokes or Ataxic Respirations.

Question 19

1. Complications of Increased ICP
   a. Brain Herniation: This herniation ________________.
   b. DI and SIADH: Can be either so you must assess for both.

Answer 19

1. Complications of Increased ICP
   a. Brain Herniation: This herniation obstructs the blood FLOW_to the brain
   leading to anoxia(an absence of oxygen.
   ) and then brain___DEATH_.
   b. DI and SIADH: Can be either so you must assess for both.

Question 20

3. Tx of ↑ ICP:
   a. Osmotic diuretics: Mannitol (Osmitrol®) → pulls _________ from brain cells and is placed into the general circulation→ this ______________ circulating blood volume; since these drugs increase blood volume, what does this do to the workload of the heart? ________________
   b. Due to the increase in circulating blood volume, does this put the client at risk for FVD or FVE? __________
   • Furosemide (Lasix®) is frequently given with these drugs to enhance ______________.
   c. Steroids:Dexamethasone(Decadron®)–decreases cerebral edema.
   d. Hyperventilation→ alkalosis→ brain vasoconstriction→ makes ICP come _down_____
   • PCO2 is kept on the low side (35), if lower PCO2 too much it will cause too much vasoconstriction resulting in decreased cerebral perfusion and brain ischemia.
   e. Keeptemperaturebelow______________________________
   1) An increased temp will increase cerebral metabolism which increases ICP.
   2) The hypothalamus may not be working properly and a cooling blanket may be needed.
   f. Avoid __________________/ bowel/ bladder distention/ hip flexion/ Valsalva/ isometrics/ no sneezing/ no nose ________________
   g. Decrease ____________________ and coughing
   h. Space nursing interventions
   • Anytime you do something to your client, ICP increases.
   i. Watch the________________monitor with turning, etc
   j. Barbiturate induced coma-decreases cerebral metabolism: phenobarbital (Luminal®).
   k. Elevate the _________________________.
   l. Keep ____________in midline so jugular veins can drain.
   m. Monitor the Glasgow coma scale (look at eye opening, motor responses, verbal performance) Max score = 15

Restrict fluids to ________ to _________ mL per day (too much fluid increases ICP).
Ensure cerebral tissue perfusion.
Watch for _____________________________ (not pumping out much volume).
Watch for increased BP (heart pumping against more pressure, so not as much blood can get out of heart).
ICPmonitoringdevices
1) Ventricular catheter monitor or subarachnoid screw
2) Greater risk? _____________________
3) No loose connections
4) Keep dressings dry (bacteria can travel through something that is wet much easier than something that is dry).

Answer 20

3. Tx of ↑ ICP:
   a. Osmotic diuretics: Mannitol (Osmitrol®) → pulls ____fluid_____ from brain cells and is placed into the general circulation→ this ____increases__________ circulating blood volume; since these drugs increase blood volume, what does this do to the workload of the heart? ____increases____________
   b. Due to the increase in circulating blood volume, does this put the client at risk for FVD or FVE? ____FVE______
   • Furosemide (Lasix®) is frequent given with these drugs to enhance __Diuresis____________.
   c. Steroids:Dexamethasone(Decadron®)–decreases cerebral edema.
   d. Hyperventilation→ alkalosis→ brain vasoconstriction→ makes ICP come ______
   • PCO2 is kept on the low side (35), if lower PCO2 too much it will cause too much vasoconstriction resulting in decreased cerebral perfusion and brain ischemia.
   e. Keeptemperaturebelow______________________________
   1) An increased temp will increase cerebral metabolism which increases ICP.
   2) The hypothalamus may not be working properly and a cooling blanket may be needed.
   f. Avoid __________________/ bowel/ bladder distention/ hip flexion/ Valsalva/ isometrics/ no sneezing/ no nose ________________
   g. Decrease ____________________ and coughing
   h. Space nursing interventions
   • Anytime you do something to your client, ICP increases.
   i. Watch the________________monitor with turning, etc
   j. Barbiturate induced coma-decreases cerebral metabolism: phenobarbital (Luminal®).
   k. Elevate the _________________________.
   l. Keep ____________in midline so jugular veins can drain.
   m. Monitor the Glasgow coma scale (look at eye opening, motor responses, verbal performance) Max score = 15

Restrict fluids to __1200______ to __1500_______ mL per day (too much fluid increases ICP).
Ensure cerebral tissue perfusion.
Watch for ______bradycardia_______________________ (not pumping out much volume).
Watch for increased BP (heart pumping against more pressure, so not as much blood can get out of heart).
ICPmonitoringdevices
1) Ventricular catheter monitor or subarachnoid screw
2) Greater risk? _____infection________________
3) No loose connections
4) Keep dressings dry (bacteria can travel through something that is wet much easier than something that is dry).

Question 21

Meningitis:

a. Definition: Meningitis is _______________ ____ of the spinal cord or brain.

Answer 21

Meningitis:

a. Definition: Meningitis is _______________ INFLAMMATION____ of the spinal cord or brain.

Question 22

Causes: Can be either viral or ___________ BACTERIAL INFECTION. Bacterial is transmitted
through the respiratory system.

Answer 22

Causes: Can be either viral or ___________ INFECTION. Bacterial is transmitted through the respiratory system.

Question 23

Signs and Symptoms:

1) Chills and Fever
2) Severe _____ HEADACHE__.
3) Nausea and Vomiting
4) Nuchal rigidity (stiff neck)
5) Photophobia-light hurts Their eye

Answer 23

Signs and Symptoms:

1) Chills and Fever
2) Severe _____ HEADACHE__.
3) Nausea and Vomiting
4) Nuchal rigidity (stiff neck)
5) Photophobia-light hurts Their eye

Question 24

Treatment: for meningitis i

Answer 24

Treatment:
1) Steroids
2) Antibiotics if ___ The infection is bacterial__
3) Analgesics
4) Droplet ___ precautious____ for bacterial meningitis.
Bacterial meningitis is a very contagious, medical emergency. It has a
high mortality and______ meningitis_immunization__ is recommended for
college aged students.

Viral meningitis is transmitted by feces and requires____CONTACT_
precautions.
Commonly seen in infants and children

Question 25

Define:
Should be thought of as a ______of an underlying disorder
rather than a disease.

Answer 25

Define:
Should be thought of as a SYMPTOM__of an underlying disorder
rather than a disease.

Question 26

Seizures are not considered ___________ if they discontinue when
the disease has gone away

Answer 26

Seizures are not considered _________________ EPILEPSY if they discontinue when
the disease has gone away

Question 27

Partial Seizure:
A partial seizure is limited to a specific ________ area of the
brain.
An aura may be the only manifestation
Called ___ seizures.
Symptoms can range from simple to complex.
Simple means ____ loss of consciousness, will see
numbness, tingling, prickling or ____.
Complex means that they have impaired consciousness and may be
confused and unable to respond.

Answer 27

Partial Seizure:
A partial seizure is limited to a specific ________LOCAL area of the
brain.
An aura may be the only manifestation
Called __FOCAL_ seizures.
Symptoms can range from simple to complex.
Simple means __WITHOUT__ loss of consciousness, will see
numbness, tingling, prickling or ____PAIN_.
Complex means that they have impaired consciousness and may be
confused and unable to respond.

Question 28

Generalized Seizure:
Involves the _______ brain.
Called non-focal seizures.
Loss of consciousness is the _______ manifestation.

Answer 28

Generalized Seizure:
Involves the ______ENTIRE_ brain.
Called non-focal seizures.
Loss of consciousness is the _____ INITIAL__ manifestation.

Question 29

Tonic – Clonic – formerly known as grand mal Myoclonic –

Answer 29

sudden, brief contractures of a muscle or group of muscles

Question 30

Absence – formally called petit mal and characterized by a

Answer 30

brief loss of consciousness.

Question 31

Complications of Seizures:

1) Status epilepticus: a continuous seizure without returning to consciousness______ seizures.
2) Trauma: Protect the client

Answer 31

Complications of Seizures:
1) Status epilepticus: a continuous seizure without returning to consciousness
____BETWEEN_ seizures.
2) Trauma: Protect the client

Question 32

Treatment: Status epilepticu
1) Neurological examination including lab and X-ray
2) Anticonvulsants:
Can be __LONG_ or short term therapy.
Rapid acting: lorazepam (Ativan®) and diazepam (Valium®)
Long Acting: phenytoin (Dilantin®) or phenobarbital
Have __TOXIC side effects. Use a smaller suppose you can to control the seizure
Monitor drug levels for toxicity through lab values.
Abrupt _______ WITHDRAWAL____ can cause a seizure.
3) Don’t forget the basics of __AIRWAY__ and safety during a seizure
Rule: The NCLEX® lady only uses the generic name of a drug in an NCLEX® question.
Rule: Do not put anything in the mouth of a seizing client.

Answer 32

Treatment:
1) Neurological examination including lab and X-ray
2) Anticonvulsants:
Can be __LONG_ or short term therapy.
Rapid acting: lorazepam (Ativan®) and diazepam (Valium®)
Long Acting: phenytoin (Dilantin®) or phenobarbital
Have __TOXIC side effects. Use a smaller suppose you can to control the seizure
Monitor drug levels for toxicity through lab values.
Abrupt _______ WITHDRAWAL____ can cause a seizure.
3) Don’t forget the basics of __AIRWAY__ and safety during a seizure
Rule: The NCLEX® lady only uses the generic name of a drug in an NCLEX® question.
Rule: Do not put anything in the mouth of a seizing client.

Question 33

Neurological Injuries:
1. Skull Injury
May/may not damage ___THE BRAIN_.
Open fracture→ dura _____TORN__
Closed fracture→ dura ___NOT_ torn
With basal skull fractures you see bleeding where? ________EENT (Eyes, ears nose and throat__)_
Battle’s sign: bruising over _mastoid__.
Raccoon eyes (peri-orbital bruising)
Cerebrospinal rhinorrhea- leaking spinal fluid from your ________
How do we tell CSF from other drainage? Positive for __________ _____ and the
halo test.
Non-depressed skull fractures usually do not require surgery; depressed do require
surgery.

Answer 33

Neurological Injuries:
1. Skull Injury
May/may not damage ___THE BRAIN_.
Open fracture→ dura _____TORN__
Closed fracture→ dura ___NOT_ torn
With basal skull fractures you see bleeding where? ________EENT (Eyes, ears nose and throat__)_
Battle’s sign: bruising over _mastoid__.
Raccoon eyes (peri-orbital bruising)
Cerebrospinal rhinorrhea- leaking spinal fluid from your ___nose_____
How do we tell CSF from other drainage? Positive for __________ glucose_____ and the
halo test.
Non-depressed skull fractures usually do not require surgery; depressed do require
surgery.

Question 34

Concussion
Temporary loss of neurologic function with ___ recovery
Will have a short (maybe seconds) period of unconsciousness or may just get
dizzy/see spots

Teach caregiver to bring client back to ED if the following occurs:
-•Difficulty awakening/speaking,
confusion, severe headache, vomiting,
pulse changes, unequal pupils, one-sided weakness

Answer 34

Concussion
Temporary loss of neurologic function with ____complete recovery
Will have a short (maybe seconds) period of unconsciousness or may just get
dizzy/see spots
Teach caregiver to bring client back to ED if the following occurs:
Difficulty awakening/speaking,
confusion, severe headache, vomiting,
pulse changes, unequal pupils, one-sided weakness
b. Hematomas

Question 35

Hematomas
A small hematoma that develops rapidly may be fatal, while a massive hematoma
that develops slowly may allow the client to ____________adapt___.
All of these are
signs that the ICP
is going_________up_!
Neuro

Answer 35

Hematomas
A small hematoma that develops rapidly may be fatal, while a massive hematoma
that develops slowly may allow the client to \_\_\_\_\_\_\_\_\_\_\_\_adapt\_\_\_.
All of these are
signs that the ICP
is going
\_\_\_\_\_\_\_\_\_up_!
Neuro

Question 36

Epidural Hematoma: • Pathophysiology:
This is rupture of the middle meningeal artery (fast bleeder).
Injury→ Loss of consciousness→ Recovery period→ Can’t compensate any longer→ Neuro changes.
Emergency!

Answer 36

Epidural Hematoma:
• Pathophysiology:
This is rupture of the middle meningeal artery (fast bleeder).

Injury→ Loss of consciousness→ Recovery period→ Can’t compensate any longer→ Neuro changes.
Emergency!