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NSG 316 > EXAM 2 > Flashcards

EXAM 2 Flashcards

1
Q

Cranial Nerve I: Olfactory Test

A

test sense of smell with familiar odor

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2
Q

Cranial Nerve II: Optic Test

A

test visual acuity and visual field with confrontation

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3
Q

Confrontation Test

A

gross measure of peripheral vision
-stand 2 fett from person
-have patient cover one eye, then cover your own eye opposite to the persons covered one
-hold finger as target midline between you and patient, slowly advance to periphery
-as person to say “now” as target is first seen

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4
Q

Confrontation Test: normal

A

50 degrees upward
90 degrees temporal
70 degrees down
60 degrees nasal

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5
Q

Cranial Nerve III, IV, VI: Oculomotor, Trochlear, Abducens Test

A

PERRLA
6 cardinal positions of gaze

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6
Q

PERRLA

A

pupils equal, round, reactive to light (direct and consensual) and accommodation

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7
Q

6 cardinal positions of gaze

A

right & up
right
right & down
left & up
left
left & down

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8
Q

nystagmus

A

back-and-forth oscillation of the eyes

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9
Q

nystagmus: amplitude

A

fine, medium or coarse movement

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10
Q

nystagmus: frequency

A

constant or fades after few beats

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11
Q

nystagmus: plane of movement

A

horizontal, vertical, rotary or combo

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12
Q

Cranial Nerve V: Trigeminal Test

A

Motor: asking the client to clench her teeth while you palpate the masseter (muscle of mastication)
Sensory- test light touch by having a client closer their eyes while you toucher her face gently with a wisp of cotton, patient identifies location

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13
Q

What does the corneal reflex test?

A

CN V sensory, CN VII motor

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14
Q

Corneal reflex test

A

-remove contacts, bring cotton wisp from side, lightly touch cornea
NORMALLY: patient blinks bilaterally

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15
Q

Cranial Nerve VII: Facial Test

A

Motor: have client smile, frown, puff out her cheeks, raise her eyebrows, close her eyes tightly
Sensory: anterior 2/3 taste (sugar, salt, lemon juice)

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16
Q

Cranial Nerve VIII: Vestibulocochlear Test

A

Whispered voice test

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17
Q

Cranial Nerve IX & X: Glossopharyngeal and Vagus Test

A

Motor: open mouth say “ahh” & gag reflex
NORMALLY: uvula and soft palate rise in midline
Sensory: CN IX does posterior 1/3 taste

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18
Q

Cranial Nerve XI: Accessory Test

A

shrug shoulders

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19
Q

Cranial Nerve XII: Hypoglossal Test

A

say “light, tight, dynamite”

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20
Q

screening neuro exam

A

perform on well persons who have no significant subjective findings

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21
Q

complete neuro exam

A

perform on person with neuro concerns

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22
Q

screening neuro exam

A

perform on well persons who have no significant subjective findings

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23
Q

neuro recheck exam

A

perform on person with demonstrated neuro defect, who requires period ic assessment

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24
Q

ansomia

A

Decrease or loss of smell occurs bilaterally

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25
Q

hemianopsia; hemianopia

A

Defective vision or blindness in one half of the visual field

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26
Q

ptosis

A

drooping eyelid

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27
Q

paresthesias

A

tingling, prickling, “pins & needles” (sensory loss)

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28
Q

diplopia

A

double vision

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29
Q

dysphagia

A

difficulty swallowing

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30
Q

What are the test to evaluate cerebellar function?

A

Balance Test (Gait)
Romberg Test
Rapid Alternating Movements (RAM)

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31
Q

Balance Test (Gait)

A

-observe as the person walks 10 to 20 feet, turns and returns to the starting point
NORMALLY: gait is smooth, rhythmic and effortless opposing arm swing is coordinating

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32
Q

Romberg test

A

-ask client to stand with feet at comfortable distance apart, arms at sides, and eyes closed for ~20 seconds
NORMALLY: patient can maintain posture and balance

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33
Q

Rapid Alternating Movements (RAM)

A

pat the knees with both hands, turn hands over, then faster
NORMALLY: done with equal turning and quick rhythmic pace

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34
Q

flaccidity

A

decreased muscle tone (hypotonia), muscle feels limp, soft, flabby

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35
Q

spasticity

A

increased muscle tone (hypertonia)

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36
Q

rigidity

A

constant state of resistance; resists passive movement in any direction (dystonia)

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37
Q

cogwheel rigidity

A

Increased tone is released by degrees during passive range of motion so it feels like small, regular jerks.

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38
Q

paralysis

A

decreased or loss of motor power

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39
Q

hemiplegia

A

Spastic or flaccid paralysis of one side of the body

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40
Q

paraplegia

A

symmetric paralysis of both lower extremities

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41
Q

quadriplegia

A

paralysis of all four extremities

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42
Q

paresis

A

weakness of muscles rather than paralysis

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43
Q

tic

A

involuntary, compulsive, repetitive twitching of a muscle group

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44
Q

myoclonus

A

Rapid, sudden jerk or a short series of jerks at fairly regular intervals. (ex: hiccup)

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45
Q

fasciculation

A

rapid continuous twitching of resting muscle without movement of limb

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46
Q

chorea

A

sudden, rapid, jerky, purposeless movement involving limbs, trunk, or face
irregular intervals, not rhythmic or repetitive

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47
Q

athetosis

A

slow, writhing involuntary movements

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48
Q

tremor

A

involuntary contraction of opposing muscle groups resulting in rhythmic movement of one or more joints

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49
Q

rest tremor

A

occurs when muscles are quiet and supported against gravity (hand in lap), coarse and slow, partly or completely disappears with voluntary movement

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50
Q

intention tremor

A

worse with voluntary movement (like reaching to a target)

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51
Q

spastic hemiparesis

A

Arm is immobile against the body, with flexion of the shoulder, elbow, wrist, and fingers and adduction of shoulder; does not swing freely. Leg is stiff and extended and circumducts with each step (drags toe in a semicircle).

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52
Q

cerebellar ataxia

A

staggering, wide-based gait; difficulty with turns; uncoordinated movement with positive Romberg sign

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53
Q

parkinsonian (festinating)

A

Posture is stooped; trunk is pitched forward; elbows, hips, and knees are flexed. Shuffling gait. Difficulty with any change in direction.

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54
Q

scissors

A

knees cross or are in contact, like holding an orange between the thighs.

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55
Q

steppage or foot drop

A

slapping quality, looks like walking up stairs with no stairs there

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56
Q

waddling

A

weak hip muscles- when the person takes a step, the opposite hip drops, which allows compensatory lateral movement of pelvis

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57
Q

short leg

A

Leg length discrepancy >2.5 cm (1 inch).

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58
Q

cerebral palsy

A

damage to cerebral cortex from a developmental defect (infancy and childhood), intrauterine meningitis or encephalitis, birth trauma, anoxia

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59
Q

muscular dystrophy

A

a chronic, progressive wasting of skeletal musculature producing weakness contracture and respiratory dysfunction or death

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60
Q

Parkinsonism

A

loss of dopamine-producing neurons causing motor tract disorder
symptoms: resting tremor, bradykinesia, cogwheel rigidity

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61
Q

cerebellar

A

A lesion in one hemisphere produces motor abnormalities on the ipsilateral side.

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62
Q

Multiple Sclerosis (MS)

A

chronic, progressive, immune mediated disease which axons experience inflammation, demyelination, degeneration and finally sclerosis

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63
Q

decorticate rigidity

A

upper: flexion of arm, wrist fingers, adduction of arms
lower: extension, internal rotation, plantar flexion
*tippy toes, puppy cry

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64
Q

decerebrate rigidity

A

Upper: stiffly extended, adducted, internal rotation, palms pronated.
Lower extremities: stiffly extended, plantar flexion; teeth clenched; hyperextended back
*tippy toes, sheet gripper, arched back, head back

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65
Q

flaccid quadriplegia

A

complete loss of muscle tone and paralysis of all four extremities (completely nonfunctional brainstem)

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66
Q

Opisthotonos

A

prolonged arching of back, with head and heels bent backward (meningeal irritation)
*doing the superman on stomach

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67
Q

stereognosis

A

Test the persons ability to recognize objects by feeling their forms, sizes and weights

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68
Q

position (kinesthesia)

A

test person’s ability to perceive passive movements of extremities

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69
Q

Tactile discrimination (fine touch)

A

measure the discrimination ability of the sensory cortex

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70
Q

Graphesthesia

A

ability to “read” a number by having it traced on the skin

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71
Q

two point discrimination

A

test ability to distinguish separation of two simultaneous pin points on skin

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72
Q

extinction

A

simultaneously touch both sides of body at the same time, both sensations should be felt

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73
Q

point location

A

touch skin and withdraw stimulus promptly; ask person to put finger where you touched

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74
Q

peripheral neuropathy

A

Loss of sensation involves all modalities; loss most severe distally at feet and hands
*complete loss at fingers and toes, diminished loss up to half forearm/half calf

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75
Q

individual nerves or roots

A

Decrease or loss of all sensory modalities; corresponds to distribution of involved nerve
*such as one entire arm

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76
Q

Spinal Cord Hemisection (Brown-Sequard Syndrome)

A

injury to one-half of the cord, causing contralateral loss of pain and temp
the ipsilateral side side of the lesion has paralysis and loss of vibration and touch sensation
*one leg has complete loss and the other has semi loss

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77
Q

Complete transection of spinal cord

A

Complete loss of all sensory modalities below level of lesion; associated with motor paralysis and loss of sphincter control

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78
Q

thalamus

A

loss of all sensory modality son the face, arm and leg on the side contrateral to lesion

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79
Q

cortex lesion

A

loss of discrimination on contralateral side; loss of graphesthesia, stereognosis, recognition of shapes and weights, finger findings

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80
Q

deep tendon reflexes (DTR)

A

measurement of stretch reflex reveals intactness of reflex arc at specific spinal levels and normal override on reflex of higher cortical levels

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81
Q

DTR scale

A

0 - no response
1+ - diminished low normal or occurs w reinforcement
2+ - normal
3+ - brisker than average may indicate disease
4+ - hyperactive w/ clonus, very brisk, indicative of disease

82
Q

Clonus

A

test when reflex are hyperactive

83
Q

how do you test clonus?

A

support lower leg in one hand and with other hand move foot up and down to relax muscle; then stretch muscle by briskly dorsiflexing fort, hold stretch

84
Q

what do you normally and abnormally see in a clonus test?

A

NORMALLY: you feel no further movement
ABNORMALLY: note rapid rhythmic contractions of calf and foot

85
Q

Tempomandibular Joint (TMJ) assessment

A

note smooth movement without limitations or tenderness, clicking or popping when jaw opens and closes

86
Q

how do you assess the thyroid gland?

A

ask client to take a sip of water, hold in mouth, the swallow while palpating thyroid gland
-one hand palpates and the other displaces

87
Q

what is abnormal in palpating the thyroid gland?

A

an enlarged thyroid

88
Q

What does the nurse do next if the thyroid gland is enlarged?

A

LISTEN FOR BRUIT (turbulent blood flow)
check the area they drain from for source of the problem

89
Q

how do you examine lymph nodes?

A

gentle circular motion of finger, palpate lymph nodes

90
Q

visual acuity test: snellen chart

A

person 20 feet from chart, ask to read smallest line possible

91
Q

what does 10/20 vision mean

A

patient reads 10 feet way what a normal person reads 20 feet away

92
Q

visual acuity: jaeger card

A

normal: 14/14 without hesitancy or moving card

93
Q

Corneal Light Reflex (Hirschberg Test)

A

Assess the parallel alignment of the eye axes by shining a light toward the person’s eyes.

94
Q

what is normal for the corneal light reflex test?

A

light reflection on cornea should be in same spot on each eye

95
Q

pupillary light reflex

A

normal constriction of pupils when bright light shines on retina

96
Q

consensual light reflex

A

simultaneous constriction of the other pupil

97
Q

red reflex

A

red glow that appears to fill the person’s pupil caused by reflection of light of inner retina

98
Q

what is a normal finding for the whispered voice test

A

person can repeat back a the combo of letters and numbers

99
Q

tuning fork test

A

Measure bone and air conduction of sound

100
Q

what is vestibular apparatus and what test is used?

A

a sensory organ for detecting sensations of equilibrium.
-romberg test

101
Q

palpation of the sinus area

A

Using thumbs, press frontal sinuses by pressing up and under the eyebrows and over maxillary sinuses below cheekbones

102
Q

tonsil scale

A

1+ visible
2+ halfway between tonsillar pillars and uvula
3+ touching uvula
4+ touching each other
NORMAL IS 1-2

103
Q

presbyopia

A

lens loses elasticity, becoming hard and glasslike. decrease ability to change shape and accommodate near vision

104
Q

cataracts

A

transparent fibers of lens begin to thicken and yellow, resulting from a clumping of protein in lens

105
Q

glaucoma

A

increased intraocular pressure

106
Q

macular degeneration

A

breakdown of cells in macula of the retina
- loss of central vision is the most common cause of blindness (person may be unable to read fine print, sew, etc)

107
Q

pingueculae

A

common non-cancerous growth that forms on conjunctiva

108
Q

otosclerosis

A

gradual hardening that causes foot plate of stapes to become fixed in oval window, impeding of sound transmission causing progressive deafness

109
Q

impacted cerumen

A

common but reversible cause of hearing loss in older people

110
Q

presbycusis

A

type of hearing loss occurring w aging

111
Q

gradual sensorineural loss

A

caused by nerve degeneration in inner ear to auditory nerve

112
Q

what tone loss is noticed first in older adults

A

high-frequency

113
Q

senile tremors

A

benign and include head nodding (as if saying yes or no) and tongue protrusion (older adult)

114
Q

kyphosis

A

humpback

115
Q

when performing ROM on older adult…

A

PERFORM ROM SLOWLY to prevent lightheaded/diziness

116
Q

tension headache

A

occurs on both sides across frontal, temporal and occipital region, BAND LIKE TIGHTNESS, non throbbing, non pulsatile

117
Q

migraine headache

A

commonly one sided but can occur on both sides, pain behind eyes, temples and forehead, throbbing, pulsating

118
Q

cluster headache

A

rare HA, intermittent, excruciating , unilateral, always one sided, often behind or around eye, temple, forehead, cheek, continuous, burning or piercing

119
Q

Parkinsons syndrome facial appearances

A

immobility of features produces face that is flat, expressionless, “MASK LIKE” with elevated eyebrows, staring gaze, oily skin, drooling

120
Q

Cushing syndrome facial appearances

A

rounded “MOONLIKE” face, prominent jewels, red cheeks and chin, acneiform rash on chest

121
Q

Graves disease facial appearance

A

(hyperthyroidism) goiter, eyelid retraction and exophthalmos (bulging eyeballs)

122
Q

Hypothyroidism (myxedema)

A

puffy, edematous face, periorbital edema, puffy hands feet, coarse face feature, cool dry skin, coarse hair and eyebrow

123
Q

bells palsy facial appearance

A

complete paralysis of one side of face, person cannot wrinkle forehead, raise eyebrows, close eyelids, whistle or show teeth on left side. usually presents w smooth forehead, wide palepral fissure

124
Q

stroke (brain attack/cerebrovasular accident) facial appearance

A

note paralysis of lower facial muscle but also note the upper half of the face is NOT affected, person is able to wrinkle forehead and close eyes
*paralyzed quadrant of face

125
Q

cachexia appearance

A

sunken eyes, hollow cheeks and exhausted defeated expression

126
Q

scleroderma

A

“hard skin”. a chronic connective tissue disorder associated with decreased mobility

127
Q

strabismus

A

crossed eyes

128
Q

diplopia

A

double vision

129
Q

what do normal conjunctiva look like

A

clear and show normal color, pink lower ids and white sclera

130
Q

normal eye appearance in African Americans

A

have gray/blue or darker color to sclera, normally my see small brown macule (like freckles) on sclera
-may have yellowish fatty deposits beneath lids away from cornea

131
Q

esotropia

A

inward turning of the eye

132
Q

exotropia

A

outward turning of the eye

133
Q

periorbital edema

A

edema around the eyes

134
Q

exophthalmos

A

protruding eyeballs

135
Q

Enophthalmos

A

sunken eyes

136
Q

ptosis

A

drooping upper lid

137
Q

upward palpebral slant

A

seen in Asians, also it indicates Down syndrome.

138
Q

ectropion

A

the rolling out (eversion) of the edge of an eyelid

139
Q

entropion

A

inward turning of the rim of the eyelid

140
Q

blepharitis

A

inflammation of the eyelid

141
Q

chalazion

A

beady nodule protruding on the lid (an obstruction and inflammation of meibomian gland)

142
Q

hordeolum

A

stye, acute localized staph infection of hair follicles at lid margin, painful red swollen

143
Q

dacryocystitis

A

inflammation of the lacrimal (tear) sac

144
Q

basal cell carcinoma

A

small painless nodule with central ulceration and sharp, rolled out pearly edges, removal, usually cures it

145
Q

anisocoria

A

unequal pupil size

146
Q

monocular blindness

A

When light is directed into blind eye, no response in either eye. When it is directed to normal eye, both pupils constrict.

147
Q

miosis

A

constricted & fixed pupils

148
Q

mydriasis

A

dilation & fixed pupil

149
Q

mydriasis

A

dilation & fixed pupil

150
Q

Argyll Robertson pupil

A

Constricts w/ accomodation but is not reactive to light.

151
Q

Tonic (Adie’s) Pupil

A

reaction to light and accommodation is sluggish

152
Q

CN III damage

A

Unilateral dilated pupil has no reaction to light or accommodation. Ptosis with eye deviating down and laterally may be present.
*ptosis, mydriasis, down and out

153
Q

Horner’s syndrome

A

Unilateral, small, regular pupil does react to light and accommodation. also note Ptosis and absence of sweat (anhidrosis) on same side.
*ptosis, miosis, and anhidrosis

154
Q

Conductive hearing loss causes

A

partial loss caused by impacted cerumen, pus, perforated TM, decrease mobility of ossicles

155
Q

sensorinerual hearing loss

A

path of inner ear and CN VIII or auditory area of cerebral cortex

156
Q

mixed hearing loss

A

combination of sensorineural and conductive hearing loss

*sens: dmg to nerve = muffled sound
*cond: blockage/dmg to outer ear; earwax impaction, perf TM

157
Q

dry cerumen

A

gray, flaky, and frequently forms thin mass in ear canal

158
Q

wet cerumen

A

honey brown to dark brown and moist

159
Q

otitis externa

A

swimmers ear

160
Q

sebaceous cyst

A

a nodule with central black punctum indicates blocked sebaceous glands

161
Q

tophi

A

Small, whitish yellow, hard, nontender nodules in or near helix or antihelix; contain greasy, chalky material of uric acid crystals and are a sign of gout.

162
Q

Chondrodermatitis Nodularis Helicus

A

Painful nodules develop on the rim of the helix as a result of repetitive mechanical pressure or environmental trauma

163
Q

keloid

A

overgrowth of scar tissue

164
Q

bifid uvula

A

uvula split completely or partially

165
Q

cleft lip and palate

A

congenital split of the lip and roof of the mouth

166
Q

torus palatinus

A

bony ridge running in middle of hard palate

167
Q

leukoedema

A

a benign lesion occurring on buccal mucosa, is seen more often in African Americans

168
Q

epistaxis

A

nosebleed

169
Q

xerostomia

A

dry mouth

170
Q

what is a normal appearance in mouth of African Americans

A

bluish lips and dark line on gingival margin

171
Q

Edentulous

A

lacking teeth

172
Q

furuncle

A

A small boil located in the skin or mucous membrane; appears red and swollen and is quite painful.

173
Q

foreign body

A

putting an object up the nose

174
Q

perforated septum

A

hole in septum

175
Q

acute rhinitis

A

(nonallergic) first sign is watery discharge which can become purulent with sneezing

176
Q

rhinorrhea

A

discharge from the nose

177
Q

allergic rhinitis

A

abnormal immune response, rhinorrhea , itching of nose eyes, lacrimation, congestion sneezing

178
Q

Sinusitus

A

acute inflames sinus area may have mucopurulent drainage with face pain/pressure

179
Q

nasal polyps

A

smooth, pale gray nodules (overgrowth of mucosa) from chronic allergic rhinitis

180
Q

Angular Cheilitis (Stomatitis, Perleche)

A

Erythema, scaling, and shallow and painful fissures at the corners of the mouth

181
Q

what is the acronym for a stroke?

A

FAST
F: facial drooping
A: arm weakness
S: speech impairment
T: time to call 911

182
Q

use abbreviation of neurologic examination in the following sequence:

A

Level of Consciousness (LOC)
Glasgow Coma Scale (GSG)
Motor function
Pupillary respinse
Vital signs

183
Q

Level of Consciousness (LOC)

A

state of awareness of self and environment
-change in LOC is the single most important factor in this examination

184
Q

Glasgow Coma Scale (GCS)

A

rate patient on :
-Eye-opening response (4-1):
spontaneous, to speech, to
pain, no response
-Motor response (6-1): obeys
verbal command, localizes pain, flexion (withdrawal), flexion (abnormal), extension (abnormal), no response
-Verbal response (5-1): oriented x3 (appropriate), conversation confused, speech inappropriate, speech incomprehensible, no response

185
Q

what is normal on the GCS?

A

15 - AOx3

186
Q

what is the sequence of a Neuro exam

A

mental status
cranial nerves
motor system
sensory system
reflexes

187
Q

Spinothalmic Tract

A

pain
temperature
light touch

188
Q

posterior column tract

A

vibration, position, tactile discrimination

189
Q

normal response: biceps reflex

A

contraction of biceps muscle and flexion of forearm

190
Q

normal response: triceps reflex

A

extension of forearm

191
Q

normal response: brachioradialis reflex

A

flexion and supination of forearm

192
Q

normal response: quadriceps reflex

A

extension of lower leg

193
Q

normal response: achilles reflex

A

foot is plantar flexes against your hand

194
Q

Superficial (cutaneous) reflexes

A

sensory receptors in skin rather than in muscles;
motor response is localized muscle contraction

195
Q

Babinski reflex

A

Reflex in which a newborn fans out the toes when the sole of the foot is touched
-for those 1 year old or younger otherwise its abnormal

196
Q

normal response: abdominal reflexes

A

ipsilateral contraction of abdominal muscle with observed deviation of umbilicus toward stroke

197
Q

normal response: planter reflex

A

plantar flexion of toes and inversion and flexion of forefoot

198
Q

dyskinesia

A

difficult movement
older adults: repetitive stereotyped movements in jaw, lips, or tongue may accompany senile tremors; no associated rigidity present

199
Q

lymph node palpation technique order

A

-Preauricular: in front of ear
-Posterior auricular (mastoid): superficial to mastoid
process
-Occipital: at base of skull
-Submental: midline, behind tip of mandible
-Submandibular: halfway between angle and tip of
mandible
-Jugulodigastric (tonsillar): under angle of mandible
-Superficial cervical: overlying sternomastoid
muscle
-Deep cervical: deep under sternomastoid muscle
-Posterior cervical: in posterior triangle along edge
of trapezius muscle
-Supraclavicular: just above and behind clavicle, at
sternomastoid muscle

200
Q

hydrocephalus

A

obstruction of drainage of cerebrospinal fluid results in
excessive accumulation, increasing intracranial pressure, and enlargement of the head

201
Q

objective vertigo

A

room is spinning

202
Q

subjective vertigo

A

Person feels like he or she spins

NSG 316 (9 decks)

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