NEURO

Question 1

What is the most important assessment finding in determining patient’s mental status?

Answer 1

orientation level

Question 2

Your patient has a severe closed head injury. VS are listed. Which value is it crucial in evaluating him for brain death?

Answer 2

Pt is not normothermic

Question 3

Your patient has a closed head injury and is ventilated. His ABGs are: pH 7.48, pCO2 35, FiO2 40%, pO2 60. What is the recommended action?

Answer 3

Leave the setting as it is (CO2 in head trauma = 35 goal. Permissive hypocapnea)

Question 4

Your patient has suffered a spinal cord injury. What sign indicates recovery has begun?

Answer 4

Increase in DTRs

Question 5

Your patient presents to ED with ischemic stroke-like symptoms. Her BP is 160/90 and she is on Norvasc. Symptom onset was 4 hours ago. Which of the following is a contraindication to fibrinolytic therapy?

Answer 5

Time

Question 6

Your patient is s/p craniotomy and is about to d/c home. You notice ataxic gait and holding the wall while walking. What is your action?

Answer 6

Consult PT

Question 7

Patient has a hip fracture, carotid bruit, weakness, and confusion. What do you order?

Answer 7

Carotid US

Question 8

A patient was diagnosed with cauda equina syndrome and neurosurgery has been consulted. What is the NP responsibility in anticipation of surgery?

Answer 8

discuss the MRI results and how the nerves are affected

Question 9

Your patient has had a CVA and is now having trouble feeding himself. Who do you consult?

Answer 9

OT

Question 10

A patient has hyperactive reflexes of the lower extremities. The adult-gerontology acute care nurse practitioner assesses for
ankle clonus by:

Answer 10

sharply dorsiflexing and maintaining the foot in this position, while supporting the knee

Question 11

Which muscle moves the eye from center, to side, and back?

Answer 11

Rectus

Question 12

Change in LOC diagnostics

Answer 12

CT wo contrast

Question 13

MS patho and flare up treatment

Answer 13

Tx for a flare-up: steroids Patho: autoimmune dz, immune system attacking myelin. flare up

Question 14

Myasthenia gravis patho, s/s, Tx,

Answer 14

Patho: reduction of the number of acetylcholine receptor sites at neuromuscular junction. S/s: ptosis, diplopia, extremity weakness worse w/exercise, respiratory difficulty. Meds/tx: anticholinesterase drugs like prostigmin, plasmapheresis, and immunosuppressives. Vent may be needed in crisis.

Question 15

Dementia vs delirium

Answer 15

Delirium: sudden transient clouded sensorium, Dementia: gradual, permanent memory/intellectual

Question 16

What is the number one cause of death in dementia patients?

Answer 16

Pneumonia (think aspiration)

Question 17

Pt with a 50% R-sided carotid artery occlusion r-sided weakness that went away (TIA)

Answer 17

ASA or Plavix. My version had Plavix.

Question 18

CVA tPA contraindication:

Answer 18

CVA 2 months ago

Question 19

Chronic subdural hematoma symptoms

Answer 19

may present with the insidious onset of HA, light-headedness, cognitive impairment, apathy, somnolence, and occasionally Sz.

Question 20

Chronic subdural hematoma management

Answer 20

surgical evacuation of in pts w/potential for recovery if there is evidence of mod-sev cognitive impairment, if progressive neurologic deterioration, or if clot thickness ≥10 mm or midline shift ≥5 mm

Question 21

Latest sign that you missed a herniation?

Answer 21

Pupil change and positive babinski (toes fan UP/out)

Question 22

Left middle cerebral artery infarct symptom

Answer 22

aphasia

Question 23

CN sensory only:

Answer 23

CN I, II, VIII

Question 24

CN both motor and sensory?

Answer 24

V Trigeminal, VII Facial, IX Glossopharyngeal, X Vagus

Question 25

CN nerve: hands on the side of pt face and ask them to chew:

Answer 25

CN V, trigeminal nerve

Question 26

Status epilepticus-meds not working, low SaO2/desating, family can’t decide:

Answer 26

intubate

Question 27

Cauda Equina Syndrome

Answer 27

Medical emergency. 18 nerve roots of the cauda equine at base of spine. S/S : Pain, numbness, tingling & LBP radiating into leg(s), S1-S2: weak plantar flexion w/loss of ankle jerks, foot drop. S3-S5: Loss of bowel/bladder. Muscle weakness, sensory loss in the dermatomal distribution of the affected nerve roots. Cause: tumor, spinal stenosis, herniated disc, CA, infxn, inflammation.

Question 28

What is the pathology of Parkinson’s disease?

Answer 28

imbalance between ACH and dopamine in the corpus striatum

Question 29

You are examining a pt with PMH of seizures. Pt sustains a seizure lasting around 1 minutes. What is the most appropriate intervention?

Answer 29

Valium 5-10 mg IV

Question 30

Initial action in a patient with new onset seizures?

Answer 30

CT scan

Question 31

60 yo M presents to ER and his child reports he passed out in the care while driving, regained consciousness and was drooling and out of it. Pts HR and BP are decreased. You give Nimodipine. What is the rationale for administering Nimodipine to this patient?

Answer 31

Calcium channel blocker, counters vasospasm s/p CVA

Question 32

What CSF values are characteristic of bacterial meningitis?

Answer 32

↑ opening pressure, ↑ protein, WBC, ↓ glucose