Neurological

Question 1

How do you calculate MAP?

Answer 1

MAP = (2 (diastolic) + systolic) / 3

Question 2

What is a normal ICP range?

Answer 2

5-15 mmHg

Question 3

What is a normal range for CPP?

Answer 3

60-100 mmHg

Question 4

A patient’s BP is 108/72, their ICP is 13. What is their CPP? Is it normal?

Answer 4

CPP = 71 mmHg. Yes this is normal

Question 5

What would a patient with decorticate posturing look like?

Answer 5

Person is stiff, bent arms, clenched fists and legs held out straight

Question 6

How can a nurse help the family of a patient with a TBI?

Answer 6

Engage them in patient care, allow them to stay with their loved one, explain to them what is happening and what procedures are happening

Question 7

How should the bed be positioned for an unconscious patient with an altered CPP from cerebral edema? And why?

Answer 7

Head of the bed elevated to 30 degrees to promote cerebral drainage

Question 8

What discharge instructions are required for a patient with a concussion who is being discharged?

Answer 8

Educate the patient and family how to monitor neurological status

Question 9

What is a contraindication for inserting an NG tube related to a head injury?

Answer 9

A skull fracture and patient has clear drainage coming from nose

Question 10

What pupil finding is extremely concerning in a patient with a head injury? What are the normal sizes of pupils and what is concerning?

Answer 10

A dilated unresponsive pupil. Constricted pupil size is 2-4mm range, dilated pupil is 4-8mm range.

Question 11

Your patient with a head injury has a change in LOC and is difficult to arouse. Is this concerning and does it require rapid action?

Answer 11

Yes

Question 12

Signs of increased intracranial pressure? (4)

Answer 12

Behavioural change, irregular respirations, widening pulse pressure (increasing systolic pressure), decreased pulse rate. Also called Cushing’s triad (pulse pressure, bradycardia, resps)

Question 13

How would you suction a patient with increased ICP to prevent it from worsening?

Answer 13

Suction less than 10 seconds, limit to 2 passes, give 100% oxygen before and after suctioning.

Question 14

How would you plan your care for a patient who received tPA within the past 24 hrs? (4)

Answer 14

Cluster patient care activities, keep their head in a neutral position, monitor BP closely, keep lights down low

Question 15

Health teaching for dysphasia patient after a stroke?

Answer 15

Watch for fatigue during meals, no distractions during meals, place food on the unaffected side of the mouth, sit upright when eating

Question 16

A patient has low sodium levels, decreased LOC, and a headache. What are they at risk for?

Answer 16

Cerebral edema. Fluid will shift intro brain cells because of low sodium (will try to balance out concentration)

Question 17

What deficits do you expect with a right hemisphere stroke?

Answer 17

Spatial deficits (spatial neglect)- lose awareness of things on one side of your body
Perceptual deficits- hearing, smell, somatosensation, taste, touch, and vision. Impaired ability to interpret sensory information, impacting their ability to interact.

Question 18

How can you help prevent secondary brain injury after a severe TBI?

Answer 18

Ensure normal ventilation (prevent hypoxia), maintain BP (prevent hypotension), maintain normal temperature

Question 19

What risk needs to be assessed after a stroke

Answer 19

Risk for aspiration

Question 20

A patient who experiences TIAs is having repeated symptoms. Should they seek help? Why or why not?

Answer 20

Yes, it could be a stroke and not a TIA

Question 21

What should a patient be assessed for before receiving tPA? What are some contraindications?

Answer 21

Risk for bleeding- hx of bleeding, hx of trauma, hemorrhagic stroke

Question 22

A patient presents with new onset right sided weakness. What is the first test that should be done?

Answer 22

CT

Question 23

How should you communicate with a patient with expressive aphasia?

Answer 23

Ask simple questions, yes or no questions, leave out small connecting words in sentences

Question 24

A patient has left sided homonymous hemianopsia. What side should you approach them from?

Answer 24

Approach from the left, they only have vision of the left visual field

Question 25

What are facial droop and slurred speech signs of?

Answer 25

Stroke

Question 26

What is the battle sign? What does it is suggest the patient has?

Answer 26

Bruising (ecchymosis) over the mastoid process or retroauricular. Indicates a skull fracture

Question 27

Ischemic vs hemorrhagic stroke?

Answer 27

Ischemic- most common, vessel becomes blocks and prevents blood supply to portion of the brain, resulting in tissue death
Hemorrhagic- artery ruptures and blood leaks from artery into the brain

Question 28

What does FAST stand for?

Answer 28

Face, Arms, Speech, Time