Neurological Dysfunction

Question 1

Homonymous hemianopia

Answer 1

Visual field blindness -Either the two right or the two left halves of the visual fields of both eyes. Results from damage to the optic nerves.

Question 2

Astereognosis

Answer 2

Inability to identify common objects through touch alone

Question 3

Oculogyric crisis

Answer 3

Eyeballs are in a fixed position, can last for a minutes or hours. Response to antipsychotic medications.

Question 4

Can a person talk while the gag reflex is absent?

Answer 4

Speech maybe normal without a gag reflex.

Question 5

What kind of strokes could cause aphasia?

Answer 5

Lobar strokes in the cerebral hemispheres

Question 6

Cataract surgery postop

Answer 6

Pain should not be present. Pain might mean hyphema (clouding in the anterior chamber) and infection.

Blurred vision glare and itching may be present.

No need to limit sodium intake.

Question 7

Causes of cataracts

Answer 7

Besides advancing age, cataract risk factors include:
Ultraviolet radiation
Diabetes, Hypertension, Obesity, Smoking, Prolonged use of corticosteroids, Statins, HRT,
Significant alcohol consumption,High myopia,
Family history
Previous eye injury, inflammation or surgery

(NOT caused by rubella during pregnancy, increased intraocular pressure or strep throat)

Question 8

What kind of med is used frequently for increased intracranial pressure?
What are other uses for the med?

Answer 8

Osmotic diuretic (mannitol) increases the pressure gradient, drawing fluid from intracellular to intravascular spaces.

Reduces intraocular pressure, prevents acute tubular necrosis and draws water into the vascular system to increase blood pressure.
It increases the pressure gradient in renal tubules thus increasing urine output.

Question 9

What kind of metabolic problem can be caused by increased ICP?

Answer 9

Diabetes insipidus can be caused by increased intracranial pressure and head trauma.
Urine output of 300 mL per hour, low specific gravity, increased serum osmolarity and dehydration.

Question 10

hypophysectomy:

Answer 10

surgical removal of the pituitary gland. The procedure may be done for cancerous or noncancerous tumors.
Post op: observe for hemorrhage.

Question 11

Guillain-Barre syndrome

Answer 11

Ascending paralysis

Post viral illness

Question 12

Cause of Multiple Sclerosis.

How is it diagnosed?

Answer 12

Loss of myelin sheath

Lumbar puncture showing increased gamma globulin level.

Question 13

Cause of Myasthenia gravis

Answer 13

Autoimmune
Caused by destruction of acetylcholine receptors

Can be triggered by stress or pregnancy

Question 14

Cause of Parkinson’s

Answer 14

Basal ganglia can’t produce sufficient dopamine

Question 15

Early and late signs of myasthenia gravis

Answer 15

Early: ptosis (drooping eyelid) and diplopia

Late: dysphasia and respiratory distress

Question 16

Glaucoma symptoms

Answer 16

Blurred vision
Central vision loss
maybe no symptoms

Treatment for glaucoma won’t restore vision but will stop progression.

Question 17

Spinal cord injury at thoracic level causes what?
Injury at C6 would be probable what?

C4?

Answer 17

Thoracic- paraplegia

C6- most likely quadriplegia
C5- might need ventilation, but may resolve it time
C4- ventilation necessary

Question 18

Neurogenic shock symptoms:

Answer 18

Hypotension
Bradycardia 
Warm,dry skin
flaccid paralysis 
Symptoms are caused due to loss of adrenergic stimulation below level of lesion.

Question 19

What is Autonomic dysreflexia?

Answer 19

syndrome in which there is a sudden onset of excessively high blood pressure. It is more common in people with spinal cord injuries that involve the thoracic nerves of the spine or above (T6 or above).

Question 20

Symptoms of autonomic dysreflexia:

Answer 20

Anxiety, flushing above the level of the lesion,

piloerection (goosebumps), hypertension, bradycardia, sweating.

Question 21

Nursing considerations with autonomic dysreflexia

Answer 21

Usually caused by stimuli such as full bladder, fecal impaction, or pressure ulcer.

Lying flat will cause BP to increase more. High Fowler’s is best.

Indwelling Catheter should be assessed immediately after the head of the bed is raised in the patient with autonomic dysreflexia.

Question 22

Symptoms of intracranial pressure

Answer 22

headache
nausea
vomiting
increased blood pressure
decreased mental abilities
confusion about time, and then location and people as the pressure worsens
double vision
pupils that don’t respond to changes in light
shallow breathing
seizures
loss of consciousness
coma
Bradycardia, widening pulse pressure, bradypnea

Question 23

Dysarthria

Answer 23

Garbled speech

Question 24

Uses for Gardner-Wells tongs

Answer 24

Used to reduce dislocations, supplications, pain, spasm in cervical spinal cord injuries.

NOT used to reduce ICP, prevent DVT or improve neurologic outcome.

Question 25

How do you test Cardinal fields of vision?

Answer 25

Having the client follow an object up, down, obliquely, and horizontally

Question 26

What is legal blindness

Answer 26

Visual acuity of 20/150

Question 27

What is global aphasia and what causes it?

Answer 27

Results from damage to Broca’s and Wernicke’s area.

Combination of receptive and expressive aphasia. Brain’s communication is damaged.

Question 28

Cause of expressive aphasia.

What is it?

Answer 28

Damage to Broca’s area, located in frontal lobe.

Difficulty expressing themselves in speech is slow and labored. Still able to comprehend written and verbal communication.

Question 29

What is cause of receptive aphasia?

What is it?

Answer 29

Results from damage to Warnicke’s area.(Located in Temporel lobe)

can’t comprehend written or verbal communication.
Speech is normal but they convey information poorly.

Question 30

Sign of basilar skull fracture.

Answer 30

CSF seepage from ears and nose.

Question 31

After TBI, how often do you do neuro Glasgoma assessment?

What is HOB for TBI?

Answer 31

Neuro assess q 15 min.

HOB 30 degrees

Question 32

Bell’s palsy:
Which cranial nerve is affected?
What is treatment?

Answer 32

Cranial nerve 7

Prednisone is treatment

Question 33

What is charcots neuro triad?

Answer 33

1. Nystagmus
2. Intention tremor
3. Staccato

although these three signs are indicative of multiple sclerosis, they are not definitive of the diagnosis.

Question 34

2 types of neurogenic bladder: spastic bladder
and flaccid bladder

What is the difference?

Answer 34

Spastic Bladder:: with injury “above” the T12 level. When the bladder fills with urine, a reflex will automatically trigger the bladder to empty. The problem with spastic bladder is that individuals do not know when their bladder will automatically empty. Therefore, frequent leakage is a great concern.

Flaccid Bladder (non-reflexive) injury “below” the T12 level. reflex is slow or absent. Because individuals do not feel when their bladder is full, the bladder is at risk of being overfilled. As a result, urine can back up through the ureters to the kidneys; a condition called “reflux”. This can cause kidney damage and urine leakage.

Question 35

What is a Positive Babinski test?

Answer 35

Plantar flexion of foot when sole is stroke with hard object, toes fan.

Positive with TBI and MS.

Question 36

Myasthenia gravis symptoms

Answer 36

Weak, fatigue,

Dysphagia, difficult chewing, aphasia, ptosis, diplopia, decreased breath sounds, resp paralysis and failure

Question 37

How is myasthenia gravis diagnosed?

Answer 37

Tensilon test.

Upon administration, improved muscle tone is positive for diagnosis

Question 38

Huntington’s disease symptoms

And how is it diagnosed?

Answer 38

Big sporadic random movements.
Abnormal facial expressions.
difficult chewing, swallowing and speaking.
Sleep disturbances and malnutrition.

Diagnosed by genetic testing, CT/ MRI, PET scan

Question 39

Cause of ALS

Answer 39

Excess glutamate

Glutamate relays messages between motor neurons.

Question 40

GCS score range

Answer 40

3-15 in eye, verbal and motor

Below 7 is comatose

Question 41

Complications of head injuries

Answer 41

ARDS
DIC
Neurogenic pulmonary edema

Question 42

Thoracic level spinal injuries can cause:

Answer 42

Loss of bowel and bladder control

Question 43

Which med is used for reducing cerebral edema

Answer 43

Mannitol, an osmotic diuretic.

Dehydrates the brain.

Question 44

Cranial nerve 1

Answer 44

Olfactory

Question 45

Testing the Cranial nerve II (optic): Sensory, vision

Answer 45

Assess visual acuity with a Snellen chart or newspaper, or ask the client to count how many fingers the examiner is holding up.
Check visual fields by confrontation.
Have the client sit directly in front of the examiner and stare at the examiner’s nose.
Examiner slowly moves his or her finger from the periphery toward the center until the client says it can be seen.
Check color vision by asking the client to name the colors of several nearby objects.

Question 46

Testing for Cranial nerve III (oculomotor);
cranial nerve IV (trochlear);
cranial nerve VI (abducens)

Answer 46

The motor functions of these nerves overlap; therefore, they need to be tested together.
First, inspect the eyelids for ptosis (drooping); then assess ocular movements and note any eye deviation.
Test the eyes for size, regularity, equality, light reflexes, accommodation; May be documented as PERRLA (pupils equally round, reactive to light and accommodation).
Test extraocular movements (EOMs) by the cardinal positions of gaze
Test for nystagmus by assessing downward and inward eye movements.

Question 47

Testing for Cranial nerve V (trigeminal): Sensory, motor

Answer 47

To test motor function, ask the client to close the jaws tightly and then try to separate the clenched jaws.
If decreased level of consciousness is present, test the corneal reflex by lightly touching the client’s cornea with a cotton wisp.
Check sensory function by asking the client to close the eyes; then lightly touch the forehead, cheeks, and chin, noting whether the client can feel the touch equally on both sides.

Question 48

Cranial nerve VII (facial): Sensory, motor

Answer 48

Test taste perception on the anterior two thirds of the tongue.
Have the client show the teeth.
Attempt to close the client’s eyes against resistance, and ask the client to puff out the cheeks.
Place sugar, salt, or vinegar on the front of the tongue, with an applicator, have the client identify these substances by their tastes.

Question 49

Cranial nerve VIII (acoustic): Sensory

Answer 49

The ability to hear tests the cochlear portion.
The sense of equilibrium tests the vestibular portion
Check the client’s ability to hear a watch ticking or a whisper.
Observe the client’s balance, and observe for swaying when walking or standing.

Question 50

Cranial nerve IX (glossopharyngeal): Sensory, motor

Answer 50

Test assesses swallowing ability.
Test assesses sensation to the pharyngeal soft palate ,tonsillar mucosa, taste perception on the posterior third of the tongue, and salivation.

Question 51

Cranial nerve X (vagus): Sensory, motor

Answer 51

Test assesses swallowing and phonation, sensation to the exterior ear’s posterior wall, sensation behind the ear.
Test assesses sensation to the thoracic and abdominal viscera.

Question 52

Testing the Cranial nerve IX (glossopharyngeal); cranial nerve X (vagus)

Answer 52

Have the client identify a taste at the back of the tongue.
Inspect the soft palate and observe for symmetrical elevation when the client says “aah.”
Touch the posterior pharyngeal wall with a tongue depressor to elicit a gag reflex.

Question 53

Testing Cranial nerve XI (spinal accessory): Motor

Answer 53

Test assesses uvula and soft palate movement and sternocleidomastoid and trapezius muscles.
Test assesses upper portion of the trapezius muscle, which governs shoulder movement and neck rotation.
Palpate and inspect the sternocleidomastoid muscle as the client pushes the chin against the examiner’s hand.
Palpate and inspect the trapezius muscle as the client shrugs the shoulders against the examiner’s resistance.

Question 54

Testing Cranial nerve XII (hypoglossal): Motor

Answer 54

Test assesses tongue movements involved in swallowing and speech.
Observe the tongue for asymmetry, atrophy, deviation to one side, and fasciculations.
Ask the client to push the tongue against a tongue depressor. then have the client move the tongue rapidly in and out and from side to side.
Ask the client to say “light,” “tight,” “dynamite” and observe whether the sounds of the letters l, t, d, and n are clear and distinct.

Question 55

Assessment for posturing
Posturing indicates a deterioration of the condition

List and describe 3 types

Answer 55

1-Flexor (decorticate posturing):flexes one or both arms on the chest, may extend the legs stiffly. Flexor posturing indicates a nonfunctioning cortex.

2-Extensor (decerebrate posturing): stiffly extends one or both arms and possibly the legs. Extensor posturing indicates a brainstem lesion.

3-Flaccid posturing: Client displays no motor response in any extremity.

Question 56

Vocab for some brain dysfunction

Answer 56

AGNOSIA - Inability to use an object correctly
APRAXIA - Inability to carry out a purposeful activity
HEMIANOPSIA - Blindness in half the visual field
HOMONYMOUS HEMIANOPSIA Blindness in the same visual field of both eyes
NEGLECT SYNDROME (UNILATERAL NEGLECT) - Client unaware of the existence of his or her paralyzed side
PROPRIOCEPTION ALTERATIONS Altered position sense that places the client at increased risk of injury

• With visual problems, the client must turn the head to scan the complete range of vision.

Question 57

BELL’S PALSY (FACIAL PARALYSIS)
Description
Symptoms and interventions

Answer 57

caused by a lower motor neuron lesion of the seventh cranial nerve that may result from infection, trauma, hemorrhage, meningitis, or tumor.
results in paralysis of one side of the face.
Recovery usually occurs in a few weeks, without residual effects.

Assessment

1. Flaccid facial muscles
2. Inability to raise the eyebrows, frown, smile, close the eyelids, or puff out the cheeks
3. Upward movement of the eye when attempting to close the eyelid
4. Loss of taste

Interventions

1. Encourage facial exercises to prevent the loss of muscle tone (a face sling may be prescribed to prevent stretching of weak muscles).
2. Protect the eyes from dryness and prevent injury.
3. Promote frequent oral care.
4. Instruct the client to chew on the unaffected side.

Question 58

GUILLAIN-BARRÉ SYNDROME

Description, symptoms and interventions

Answer 58

acute infectious neuronitis of the cranial and peripheral nerves.
The immune system overreacts to the infection and destroys the myelin sheath. Usually is preceded by a mild upper respiratory infection or gastroenteritis.
The recovery is a slow process and can take years.
The major concern is difficulty breathing.

Assessment

1. Paresthesias
2. Weakness of lower extremities
3. Gradual progressive weakness of the upper extremities & facial muscles
4. Possible progression to respiratory failure
5. Cardiac dysrhythmias
6. CSF that reveals an elevated protein level
7. Abnormal electroencephalogram

Interventions

1. treatment of symptoms.
2. Monitor respiratory status.
3. Provide respiratory treatments.
4. Prepare to initiate respiratory support.
5. Monitor cardiac status.
6. Assess for complications of immobility.
7. Provide the client and family with support

Question 59

What can happen to BP and pulse with ICP?

Answer 59

blood pressure with a wide pulse pressure

bradycardia

Question 60

Positioning MS patient for eating if they are have trouble swallowing

Answer 60

Sitting upright with the head flexed toward the sternum will prevent choking or aspiration.

Question 61

Common presentation of tia

Answer 61

Manifestations of transient ischemic attack include:
focal neurological deficits, like inability to sense one side of the body, unilateral loss of vision, loss of speech, or facial droop.

Global deficits, like restlessness, confusion, or lethargy, are not characteristic with TIAs.

Question 62

Difference in sx of hemorrhagic stroke vs thrombotic stroke.

Answer 62

Hemorrhagic strokes occur rapidly and without significant warning signs, although some patients experience severe headache at the onset of symptoms. The nurse should anticipate that the patient with suspected hemorrhagic stroke, as identified by ambulance personnel, has symptoms that are significant enough to warrant the potential diagnosis from the field. Therefore, the nurse should anticipate that the patient will have loss of consciousness and severe neurologic impairment upon arrival to the emergency department.

Thrombotic strokes commonly occur in older patients with atherosclerosis. Symptoms vary according to the vessel affected. Thrombotic occlusion of the middle cerebral artery may result in drowsiness, stupor, coma, contralateral hemiplegia, sensory deficits of the arm and face, aphasia, and homonymous hemianopsia.

Question 63

A common side effect of phenytoin (Dilantin) therapy

Answer 63

gingival hyperplasia.

This can be prevented with good oral hygiene—brushing daily with a soft toothbrush, massaging the gums, and using dental floss daily.

Question 64

What does cortical function do

Answer 64

Consciousness is a state of awareness. Level of consciousness provides insight into the patient’s level of cortical functioning.

Question 65

Cerebellar impairment affects:

Answer 65

coordination and ability to ambulate. It is evident that the patient has adapted to this impairment when the patient demonstrates proper use of a walker.

Question 66

How to assess trigeminal nerve function

Answer 66

The trigeminal nerve has both sensory and motor capabilities. To assess its sensory function, the nurse would use a safety pin to assess for recognition of pain; cold and hot items to identify cold and hot sensations; and a cotton wisp to evaluate recognition of touch sensations.
To test motor abilities of CN V, the nurse would ask the patient to clench the jaw and close the mouth and then assess for symmetry bilaterally.

Question 67

How to assess the glossopharyngeal and vagus cranial nerves.

Answer 67

Both the glossopharyngeal and vagus nerves have both sensory and motor functions.
To test the motor function, the nurse should have the patient open the mouth and say, “aaah.” The palate and the uvula should move upward in response.
Other testing that should be done includes checking for gag response and assessing voice quality for hoarseness.

Question 68

Clinical manifestations of meningitis include:

Answer 68

restlessness, agitation, irritability, nausea and vomiting, severe headaches, nuchal rigidity, positive Brudzinski’s sign, positive Kernig’s sign, chills, high fever, confusion, altered level of consciousness, and signs and symptoms of increased cranial pressure.

Question 69

frontal lobe of the brain controls:

Answer 69

judgment, personality, and affect.

Question 70

Lumbar puncture set up and post procedure

Answer 70

aspiration needle into the subarachnoid space of the spinal cord, usually in the lumbar area at the level of the fourth intervertebral space. Positioned on side, with neck and knees flexed to increase the space between vertebrae.

To prevent complications and allow time for more CSF to form, clients are kept flat in bed for several hours after undergoing lumbar puncture. Increasing fluids helps re-form CSF at a faster rate.
To apply pressure on the puncture site, a supine position rather than a side-lying position is preferred.
Assisting the client into a sitting position is unsafe; it can lead to a severe headache or neurologic complications.

Question 71

Autonomic dysreflexia

Answer 71

acute emergency that occurs as a result of exaggerated autonomic responses to stimuli.
Symptoms: severe hypertension, slow heart rate, pounding headache, nausea, blurry vision, flushed skin, sweating, nasal stiffness, goose bumps.
Clinical manifestations occur after spinal shock has been resolved and are often triggered by a full bladder or fecal impaction. Therefore, checking the client’s catheter for patency is an appropriate action to take. Autonomic dysreflexia can have life-threatening consequences if unrelieved.

Question 72

widened pulse pressure is a sign of what?

Answer 72

ominous sign that accompanies increased intracranial pressure.
Pulse pressure between 30 and 50 mm Hg is considered normal.
A widened pulse pressure is one that exceeds 50 mm Hg.
If a trend is developing, however, it should be reported early rather than waiting until the pulse pressure equals or exceeds 50 mm Hg.

Question 73

First post op dressing is moist, what do you do?

Answer 73

Usually, the surgeon performs the first dressing change unless otherwise specified in the medical orders. To reduce the potential for a wound infection, it is best to reinforce a moist dressing. Removing or changing the dressing would be inappropriate.

Dressing must be reinforced to prevent wicking pathogens in the direction of the incision.

Question 74

Tegretol(carbamazepine) can affect liver function. What are some signs to look for with liver impairment?

Answer 74

Because the liver produces prothrombin, a substance important to clot formation, signs of unusual bleeding in a client taking carbamazepine (Tegretol) indicate adverse effects to the liver.
This drug also causes hematologic changes that may be evidenced as abnormal bleeding. Clay-colored stools and dark brown urine, not black stools or cloudy urine, are associated with liver disturbances. Mottled skin is not a sign of liver impairment.
A physiologic functions of the liver include the production of prothrombin, a substance that promotes clotting.

Question 75

Signs of spinal shock:

And what to do first with spinal injuries

Answer 75

Spinal shock, which is the immediate response to spinal cord transection: Hypotension occurs and body loses core temperature.
Immediately manage hypotension and hypothermia. The nurse should also ensure that there is an adequate airway. may be respiratory compromise due to intercostal muscle involvement. Once the client is stable, the nurse should conduct a complete neurologic check. The nurse should take all precautions to keep the client’s head, neck, and spine position in straight alignment. If the client is conscious, the nurse should briefly assess major reflexes, such as the Achilles, patellar, biceps, and triceps tendons, sensation of the perineum for bladder function.

Question 76

Patient teaching for warfarin

Answer 76

The maximum dosage is not achieved until 3 to 4 days after starting the medication,
Effects of the drug continue for 4 to 5 days after discontinuing the medication. blood levels tested periodically
Peak action of 9 hours.
Vitamin K is the antidote for warfarin; (protamine sulfate is the antidote for heparin.)

Question 77

What are symptoms of overdose of cholinergic?

Answer 77

Excess of cholinergic agents produce urinary and fecal incontinence, increased salivation, diarrhea, and diaphoresis.
In a severe overdose, CNS depression, seizures and muscle fasciculations, bradycardia or tachycardia, weakness, and respiratory arrest due to respiratory muscle paralysis occur.
Anticholinergics produce dry mucous membranes.
Skin rash is not a sign of overdose with a cholinergic agent.

Question 78

Which reflexes are intact or not intact after brain death?

Answer 78

A client who is brain dead typically demonstrates
nonreactive dilated pupils
nonreactive or absent corneal and gag reflexes.
May still have spinal reflexes, such as deep tendon and Babinski reflexes, in brain death.
Decerebrate or decorticate posturing would not be seen.
Do not have a blink reflex.

Question 79

Patient teaching for migraines

Answer 79

Avoid foods that contain tyramine, such as alcohol and aged cheese.

Avoid drugs such as Tagamet, nitroglycerin, Nifedipine, estrogen.

Abortive therapy is aimed at eliminating the pain during the aura.

A potential side effect of medications is rebound headache.

Complementary therapies such as relaxation may be helpful.

Question 80

with a spinal cord injury c/o severe throbbing headache that suddenly started a short time ago. Increased blood pressure and decreased heart rate, diaphoresis, and flushing of the face and neck. What action should you take first?

Answer 80

Check the Foley tubing for kinks or obstruction.

symptoms are characteristic of autonomic dysreflexia, a neurologic emergency that must be promptly treated to prevent a hypertensive stroke. The cause is noxious stimuli, most often a distended bladder or constipation, so checking for poor catheter drainage, bladder distention, or fecal impaction is the first action that should be taken.
Adjusting the room temperature may be helpful, since too cool a temperature in the room may contribute to the problem.
Tylenol will not decrease the autonomic dysreflexia that is causing the patient’s headache. Notification of the physician may be necessary if nursing actions do not resolve symptoms.

Question 81

How to test peripheral response to pain?

Answer 81

Motor testing in the unconscious client can be done only by testing response to painful stimuli.

Nail bed pressure tests a basic peripheral response. Cerebral responses to pain are tested using sternal rub, placing upward pressure on the orbital rim, or squeezing the clavicle or sternocleidomastoid muscle. Strategic words peripheral response. The nail beds are the most distal of all the options and are therefore the most peripheral. Each of the other options may elicit a generalized response, but not a localized one.

Question 82

How to distinguish CSF from other body fluids

Answer 82

Leakage of cerebrospinal fluid (CSF) from the ears or nose may accompany basilar skull fracture. CSF can be distinguished from other body fluids because the drainage will separate into bloody and yellow concentric rings on dressing material, called a halo sign. The fluid also tests positive for glucose. CSF contains glucose, whereas other secretions, such as mucus, do not. Knowing that CSF separates into rings also will help you answer this question.

Question 83

What history is obtained in patient who is suspected to have Guillain-Barré?

Answer 83

Guillain-Barré syndrome is a clinical syndrome of unknown origin that involves cranial and peripheral nerves. Many clients report a history of respiratory or gastrointestinal infection in the 1 to 4 weeks before the onset of neurological deficits. Occasionally, the syndrome can be triggered by vaccination or surgery. Recent history of respiratory or gastrointestinal infection are predisposing factors.

Question 84

Function of
Limbic system:
frontal lobe:
Cerebral hemispheres:
hippocampus:

Answer 84

The limbic system: responsible for feelings (affect) and emotions.

frontal lobe: Calculation ability and knowledge of current events

cerebral hemispheres: control orientation.

hippocampus: Recall of recent events