Neurological System (Exam One)

Question 1

What is the purpose of the myelin sheath?

Answer 1

Insulation for the neuron cells

Question 2

What is the purpose of glial cells?

Answer 2

• Support neurons
• Protect neurons
• Nourish neurons

Question 3

Damage to the frontal lobe changes an individuals what?

Answer 3

• Personality

- Judgement

Question 4

Broca’s area is located in which lobe of the brain?

Answer 4

Frontal lobe

Question 5

Wernicke’s area is located in which lobe of the brain?

Answer 5

Temporal lobe

Question 6

Broca’s area is responsible for __________ language.

Answer 6

Expressing

Question 7

Wernicke’s area is responsible for __________ language.

Answer 7

Understanding

Question 8

If Broca’s area is damaged, what type of problem might occur?

Answer 8

Expressive aphasia

Question 9

If Wernicke’s area is damaged, what type of problem might occur?

Answer 9

Receptive aphasia

Question 10

On which side of the brain are language centers located, for most individuals?

Answer 10

Left side

Question 11

If an individual has damage to the left side of their brain, such as a stroke or tumor, what is likely to be affected?

Answer 11

Speech

Question 12

If an individual has a tumor located in the occipital lobe of the brain, what is likely to be affected?

Answer 12

Vision

Question 13

What is the primary function of the hypothalamus?

Answer 13

Regulates body function

Question 14

The brainstem regulates:

Answer 14

• Heart rate
• Breathing
• Blood pressure
• Swallowing
• Digestion

Question 15

What would be the priority nursing assessment for a patient who has a experienced trauma to their brainstem?

Answer 15

• Oxygen saturation

- Respiratory assessment

Question 16

What is the primary function of the cerebellum?

Answer 16

Provides smooth, coordinated body movement

Question 17

A patient has experienced trauma to their cerebellum. The nurse should be most concerned about what?

Answer 17

• Falling

- Safety

Question 18

Describe hydrocephalus.

Answer 18

Excessive build-up of fluid

Question 19

What is considered the normal rate of cerebrospinal fluid production?

Answer 19

20 mL/hr

Question 20

In regard to muscle tone, lower motor neuron lesions will cause what?

Answer 20

Flaccidity

Question 21

In regard to muscle tone, upper motor neuron lesions will cause what?

Answer 21

Spasticity

Question 22

What is considered a normal Babinski sign for children over age 2 and adults?

Answer 22

Flexion of toes downward

Question 23

An adult patient has fanning of the toes when the nurse assess’s their Babinski reflex. Is this considered a normal of abnormal finding in an adult? What type of problem might this indicate?

Answer 23

• Abnormal

- Indicate a neural problem

Question 24

Describe a clonus.

Answer 24

• Continual jerking

- Hypereflexia

Question 25

Which cranial nerves are assess concurrently using the 6 cardinal fields test?

Answer 25

• Cranial nerve 3 (Oculomotor)
• Cranial nerve 4 (Trochlear)
• Cranial nerve 6 (Abducens)

Question 26

Which cranial nerves control the gag reflex?

Answer 26

• Cranial nerve 9 (Glossopharyngeal)

- Cranial nerve 10 (Vagus)

Question 27

If cranial nerve 9 (glossopharyngeal) and cranial nerve 10 (vagus) nerve are impaired, what is the primary nursing intervention?

Answer 27

Keep patient NPO

Question 28

When assessing cranial nerve 3, constriction of the pupils does not occur. The nurse knows that this may be indicative of what?

Answer 28

Herniation

Question 29

If the patient is a poor historian or unable to answer questions regarding their condition, who should the nurse get that information from?

Answer 29

• Family members

- Person at bedside

Question 30

The nurse is assessing a patients sensory function. What type of question would the nurse want to ask this patient? What should the nurse avoid when asking this question?

Answer 30

• “Can you feel this?”

- Avoid using descriptors like sharp or dull

Question 31

What diagnostic test is used to assess for electrical activity of the brain or seizures?

Answer 31

Electroencephalogram (EEG)

Question 32

The nurse knows they must assess for what if the patient is receiving any type of diagnostic test that uses contrast medium, such as a myelogram?

Answer 32

Shellfish allergy

Question 33

What is the primary nursing assessment for a patient who has had a cerebral angiography?

Answer 33

• Bleeding
• Blood pressure
• Heart rate

Question 34

What position is the patient positioned in during a lumbar puncture?

Answer 34

Lateral position

Question 35

When should a lumbar puncture not be performed?

Answer 35

If increased intracranial pressure is suspected

Question 36

What is the normal appearance of cerebrospinal fluid?

Answer 36

Clear

Question 37

What is the normal amount of pressure of cerebrospinal fluid?

Answer 37

9 - 18 cm/H2O

Question 38

What is the normal amount of white blood cells in cerebrospinal fluid?

Answer 38

0 - 5 WBC/mm3

Question 39

What is the normal amount of glucose in cerebrospinal fluid?

Answer 39

50 - 75 mg/dL

Question 40

What is the normal amount of total protein in cerebrospinal fluid?

Answer 40

15 - 40 mg/dL

Question 41

The nurse is caring for a patient who is admitted after a head injury. When would the nurse obtain most of the data related to this patient’s mental status?

A. While observing patient behaviors
B. During the nursing health history
C. While asking specific problem-solving questions
D. While reviewing answers on a written mental examination

Answer 41

B. During the nursing health history

Question 42

Intracranial pressure is balanced by:

Answer 42

• Brain tissue
• Blood
• Cerebrospinal fluid

Question 43

What is considered a normal amount of pressure inside of the skull?

Answer 43

5 - 15 mm/Hg

Question 44

Should excess blood be shunted to the brain if the patient has a head injury?

Answer 44

No

Question 45

The nurse knows the brain needs a constant supply of what in order to maintain cerebral blood flow?

Answer 45

• Oxygen

- Glucose

Question 46

What is the priority nursing intervention for a patient with cerebral edema, hyponatremia, and a headache?

Answer 46

Administer 3% or 5% hypertonic saline

Question 47

What is the most sensitive and reliable indicator of a patients neurological status?

Answer 47

Level of consciousness

Question 48

A fixed unilateral, dilated pupil that is unresponsive to light may be indicative of what?

Answer 48

• Herniation of the brain

- Medical emergency!

Question 49

If a patient arrives at the emergency department (ED) orientated upon initial assessment, but become disoriented after 30 minutes, what is the priority nursing intervention?

Answer 49

• Further assessment

- Call the physician

Question 50

List the three components of Cushing’s triad.

Answer 50

• Bradycardia
• Hypertension
• Irregular breathing

Question 51

Cushing’s triad is a sign of what?

Answer 51

• Brainstem compression

- Medical emergency!

Question 52

An increase in temperature is an indication of an increase in what?

Answer 52

Intracranial pressure

Question 53

What diagnostic test is the gold standard for monitoring intracranial pressure?

Answer 53

Ventriculostomy

Question 54

What is a serious complication of a ventriculostomy?

Answer 54

Infection

Question 55

What does the ventriculostomy measure?

Answer 55

Pressure within the ventricles

Question 56

A normal intracranial pressure waveform resembles a what?

Answer 56

Staircase