LA #10 (Neurological) Chapters 58, 59, 60, 61 Flashcards Preview

Nursing Practice 3 > LA #10 (Neurological) Chapters 58, 59, 60, 61 > Flashcards

Flashcards in LA #10 (Neurological) Chapters 58, 59, 60, 61 Deck (222)
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1

A patient with a deep, large laceration of the left forearm, which has damaged nerve fibres as well as other tissue, asks the nurse to explain what the effect of the nerve damage will be. What is the best response to the patient?

a.

Nerve cells cannot regenerate, and the sensory and motor loss will be permanent.

b.

He will probably have return of normal motor and sensory function because peripheral nerve cells can regenerate.

c.

Only nerve fibres within the central nervous system are capable of regeneration, and the nerve loss he has distal to his injury will be permanent.

d.

There is a chance that some nervous function will return because peripheral nerve fibres can slowly regenerate if cell bodies have not been damaged.

D

In the peripheral nervous system, regeneration of injured nerve fibres is possible if the cell body is intact. The final result depends on the connections the axon sprouts make with end-organs and other nerves.

2

When interviewing an acutely confused patient who has a head injury, which question will provide the most useful information?

a.

“Have you ever been hospitalized for a neurological problem?”

b.

“Do you have any pain at the present time?”

c.

“What have you had to eat in the last 24 hours?”

d.

“Can you describe your usual pattern for coping with injury?”

 

B

The acutely confused patient will be able to state whether he currently has pain. The patient may not be able to provide accurate information about his history of hospitalization, 24-hour dietary recall, or usual coping patterns.

3

When the nurse administers a drug that increases the synaptic release of γ-aminobutyric acid (GABA), what is the effect the nurse would expect?

a.

Widespread increases in nervous system activity

b.

Suppression of nervous system activity

c.

Increased patient alertness and arousal

d.

Excitation of the affected postsynaptic neurons

    B

GABA is a neurotransmitter that has inhibitory activity on action-potential generation and decreases nervous system activity.

4

    For a patient who has a corticospinal tract lesion, the nurse should assess for which of the following?

a.

Extremity movement and strength

b.

Cranial nerve function

c.

Peripheral sensitivity to pain

d.

Level of consciousness

 

A

The corticospinal tract carries impulses from the cortex to the peripheral nerves that control voluntary muscle movement.

5

    A patient has a lesion that affects lower motor neurons. During assessment of the patient’s lower extremities, what does the nurse expect to find?

a.

Spasticity

b.

Flaccidity

c.

Hyperreflexia

d.

Loss of sensation

 

B

Because the cell bodies of lower motor neurons are located in the spinal cord, damage to the neuron will decrease motor activity of the affected muscles, and the nurse would assess flaccidity.

6

Which of the following assessment findings would the nurse expect when examining a patient with a lesion of the left posterior temporal lobe?

a.

Inability to reason or problem solve

b.

Loss of sensation on the left side of the body

c.

Inability to comprehend written or oral language

d.

Inability to voluntarily move the right side of the body

C

The posterior temporal lobe integrates the visual and auditory input for language comprehension.

7

    What is the path of intervention with cranial nerve VI (abducens nerve) that is connected to the brain via the pons?

a.

Motor path

b.

Sensory path

c.

Sympathetic path

d.

Parasympathetic path

 

A

Cranial nerve VI (abducens nerve) that is connected to the brain via the pons has a motor path of intervention.

8

When obtaining a health history from a patient with a neurological problem, the nurse is likely to elicit the most valid response from the patient by asking the patient which of the following questions?

a.

“Do you ever have any nausea or dizziness?”

b.

“Does the pain radiate from your back into your legs?”

c.

“Do you have any sensations of pins and needles in your feet?”

d.

“Can you describe the sensations you are having in your chest?”

 

D

The most useful and valid information is obtained through the use of open-ended questions that allow the patient to describe symptoms.

9

When admitting a patient with acute confusion to the hospital, the nurse will interview the patient about health problems and health history primarily for which of the following reasons?

a.

To determine the patient’s motivation for self-care

b.

To include the patient in health care decisions

c.

To use the information given by the patient to guide care

d.

To assess the patient’s baseline cognitive abilities

D

The appropriateness of the patient’s response and the patient’s use of language will help the nurse assess the baseline cognitive abilities of the patient.

10

A 71-year-old patient reports a change in sleep patterns occurring over the past 2 to 3 years. Based on knowledge of the effects of aging on the reticular activating system, what would the nurse expect the patient to exhibit?

a.

Increased rapid-eye-movement sleep

b.

Longer cycles of sleep

c.

Increased sleep apnea

d.

Increased spontaneous awakening

D

Normal changes in the reticular activating system and autonomic nervous system lead to more spontaneous awakening and less sleep time in older adults.

11

To assess the functioning of the optic nerve (cranial nerve II), what should the nurse do?

a.

Apply a cotton wisp strand to the cornea.

b.

Perform a confrontational test for visual fields.

c.

Evaluate pupil response to light and accommodation.

d.

Ask the patient to follow a finger with the eyes as it is moved vertically, horizontally, and diagonally.

    B

The optic nerve is responsible for visual fields and visual acuity.

12

Neurological testing of the patient by the nurse indicates impaired functioning of the left glossopharyngeal nerve (cranial nerve IX) and the vagus nerve (cranial nerve X). Based on these findings, what should the nurse plan to do?

a.

Insert an oral airway.

b.

Withhold oral fluid or foods.

c.

Provide highly seasoned foods.

d.

Apply artificial tears to protect the cornea.

B

The glossopharyngeal and vagus nerves innervate the pharynx and control the gag reflex. A patient with impaired function of these nerves is at risk for aspiration.

13

The following orders are received for a patient who is unconscious after a head injury caused by an automobile accident. Which one should the nurse question?

a.

Perform neurological checks every 15 minutes.

b.

Prepare the patient for lumbar puncture.

c.

Obtain X-ray films of the skull and spine.

d.

Do computed tomography scanning with and without contrast.

 

B

After a head injury, the patient may be experiencing intracranial bleeding and increased intracranial pressure, which could lead to herniation of the brain with lumbar puncture.

14

The charge nurse is observing a new staff nurse who is assessing a patient with a possible spinal cord lesion for sensation. Which action by the new nurse indicates a need for further teaching about neurological assessment?

a.

Tests for light touch before testing for pain

b.

Has the patient close the eyes during testing

c.

Tells the patient, “You may feel a pinprick now.”

d.

Uses an irregular pattern to test for intact touch

 

C

When performing a sensory assessment, the nurse should not provide verbal or visual clues.

15

To prepare a patient who is to have a lumbar puncture performed for analysis of cerebrospinal fluid, what should the nurse inform him about?

a.

He will be given a mild sedative to help control muscle spasms.

b.

He should cough as soon as he feels the needle enter the spinal canal.

c.

He may be required to lie flat on his back for 24 hours following the test.

d.

He will be positioned on his side with his knees drawn to the chest and his head flexed to the chest.

 

D

For a lumbar puncture, the patient lies in the lateral recumbent position, with the knees drawn to the chest and the head flexed to the chest to separate the vertebrae.

16

When reviewing the results of a patient’s cerebrospinal fluid analysis obtained from a lumbar puncture, which of the following does the nurse identify as abnormal?

a.

pH 7.35

b.

White blood cell count 4 cells/microlitre (0.004 cells/L)

c.

Protein 0.30 g/L (30 mg/dL)

d.

Glucose 1.7 mmol/L (30 mg/dL)

D

The glucose level is low.

17

Which of the following is an age-related change in the nervous system?

a.

Increased efficiency of temperature-regulating mechanism

b.

Decreased size of ventricles in the brain

c.

Decrease in electrical activity

d.

Increase in deep-tendon reflexes

C

A normal age-related change is a decrease in electrical activity. The temperature-regulating mechanism is decreased in efficiency in aging. The size of the ventricles increases with age. The deep-tendon reflexes either remain the same or decrease in aging.

18

During the neurological assessment, the patient cooperates with the nurse’s directions to grip with the hands and to move the feet, but does not respond to the nurse’s questions. The nurse will suspect which of the following?

a.

A temporal lobe lesion

b.

Injury to the cerebellum

c.

A brainstem lesion

d.

Damage to the frontal lobe

 

D

Expressive speech is controlled by Broca’s area in the frontal lobe.

19

Which neurotransmitter is involved in emotions, moods, and regulating motor control?

a.

Serotonin

b.

Epinephrine

c.

Dopamine

d.

Substance P

    C

Dopamine is involved in emotions, moods, and regulating motor activity. Serotonin is also involved with moods and emotions but has no relevance to regulating motor control.

20

Which internal structure arises from the basilar and two internal carotid arteries?

a.

Reticular formation

b.

Blood–brain barrier

c.

Circle of Willis

d.

Anterior communicating centre

 

C

The circle of Willis arises from the basilar and two internal carotid arteries.

21

Which area of the cerebrum would the nurses suspect is injured when the patient is unable to understand spoken words?

a.

Broca’s area

b.

Precentral gyrus

c.

Wernicke’s area

d.

Postcentral gyrus

C

The function of Wernicke’s area is to integrate auditory language, that is, understanding of spoken words.

22

The nurse expects that management of the patient who experiences a brief episode of tinnitus, diplopia, and dysarthria with no residual effects will include

a.

prophylactic clipping of cerebral aneurysms.

b.

heparin via continuous intravenous infusion.

c.

oral administration of low dose aspirin therapy.

d.

therapy with tissue plasminogen activator (tPA).

 

    C

The patient’s symptoms are consistent with transient ischemic attack (TIA), and drugs that inhibit platelet aggregation are prescribed after a TIA to prevent stroke. Continuous heparin infusion is not routinely used after TIA or with acute ischemic stroke. The patient’s symptoms are not consistent with a cerebral aneurysm. tPA is used only for acute ischemic stroke, not for TIA.

23

Aspirin is ordered for a patient who is admitted with a possible stroke. Which information obtained during the admission assessment indicates that the nurse should consult with the health care provider before giving the aspirin?

a.

The patient has dysphasia.

b.

The patient has atrial fibrillation.

c.

The patient states, “My symptoms started with a terrible headache.”

d.

The patient has a history of brief episodes of right-sided hemiplegia.

 

C

A sudden onset headache is typical of a subarachnoid hemorrhage, and aspirin is contraindicated. Atrial fibrillation, dysphasia, and transient ischemic attack (TIA) are not contraindications to aspirin use, so the nurse can administer the aspirin.

24

A patient with a stroke experiences right-sided arm and leg paralysis and facial drooping on the right side. When admitting the patient, which clinical manifestation will the nurse expect to find?

a.

Impulsive behavior

b.

Right-sided neglect

c.

Hyperactive left-sided reflexes

d.

Difficulty in understanding commands

 

D

Right-sided paralysis indicates a left-brain stroke, which will lead to difficulty with comprehension and use of language. The left-side reflexes are likely to be intact. Impulsive behavior and neglect are more likely with a right-side stroke.

25

The nurse receives a verbal report that a patient has an occlusion of the left posterior cerebral artery. The nurse will anticipate that the patient may have

a.

dysphasia.

b.

confusion.

c.

visual deficits.

d.

poor judgment.

C

Visual disturbances are expected with posterior cerebral artery occlusion. Aphasia occurs with middle cerebral artery involvement. Cognitive deficits and changes in judgment are more typical of anterior cerebral artery occlusion.

26

The health care provider prescribes clopidogrel (Plavix) for a patient with cerebral atherosclerosis. When teaching about the new medication, the nurse will tell the patient

a.

to monitor and record the blood pressure daily.

b.

to call the health care provider if stools are tarry.

c.

that Plavix will dissolve clots in the cerebral arteries.

d.

that Plavix will reduce cerebral artery plaque formation.

 

B

Plavix inhibits platelet function and increases the risk for gastrointestinal bleeding, so patients should be advised to notify the health care provider about any signs of bleeding. The medication does not lower blood pressure, decrease plaque formation, or dissolve clots.

27

The health care provider recommends a carotid endarterectomy for a patient with carotid atherosclerosis and a history of transient ischemic attacks (TIAs). The patient asks the nurse to describe the procedure. Which response by the nurse is appropriate?

a.

“The carotid endarterectomy involves surgical removal of plaque from an artery in the neck.”

b.

“The diseased portion of the artery in the brain is removed and replaced with a synthetic graft.”

c.

“A wire is threaded through an artery in the leg to the clots in the carotid artery and the clots are removed.”

d.

“A catheter with a deflated balloon is positioned at the narrow area, and the balloon is inflated to flatten the plaque.”

 

A

In a carotid endarterectomy, the carotid artery is incised and the plaque is removed. The response beginning, “The diseased portion of the artery in the brain is removed” describes an arterial graft procedure. The answer beginning, “A catheter with a deflated balloon is positioned at the narrow area” describes an angioplasty. The final response beginning, “A wire is threaded through the artery” describes the MERCI procedure.

28

When assessing a patient with a possible stroke, the nurse finds that the patient’s aphasia started 3.5 hours previously and the blood pressure is 170/92 mm Hg. Which of these orders by the health care provider should the nurse question?

a.

Infuse normal saline at 75 mL/hr.

b.

Keep head of bed elevated at least 30 degrees.

c.

Administer tissue plasminogen activator (tPA) per protocol.

d.

Titrate labetalol (Normodyne) drip to keep BP less than 140/90 mm Hg.

D

Because elevated BP may be a protective response to maintain cerebral perfusion, antihypertensive therapy is recommended only if mean arterial pressure (MAP) is >130 mm Hg or systolic pressure is >220 mm Hg. Fluid intake should be 1500 to 2000 mL daily to maintain cerebral blood flow. The head of the bed should be elevated to at least 30 degrees, unless the patient has symptoms of poor tissue perfusion. tPA may be administered if the patient meets the other criteria for tPA use.

29

A patient with a history of several transient ischemic attacks (TIAs) arrives in the emergency department with hemiparesis and dysarthria that started 2 hours previously. The nurse anticipates the need to prepare the patient for

a.

surgical endarterectomy.

b.

transluminal angioplasty.

c.

intravenous heparin administration.

d.

tissue plasminogen activator (tPA) infusion.

D

The patient’s history and clinical manifestations suggest an acute ischemic stroke and a patient who is seen within 4.5 hours of stroke onset is likely to receive tPA (after screening with a CT scan). Heparin administration in the emergency phase is not indicated. Emergent carotid transluminal angioplasty or endarterectomy is not indicated for the patient who is having an acute ischemic stroke.

30

The nurse identifies the nursing diagnosis of impaired verbal communication for a patient with expressive aphasia. An appropriate nursing intervention to help the patient communicate is to

a.

have the patient practice facial and tongue exercises.

b.

ask simple questions that the patient can answer with “yes” or “no.”

c.

develop a list of words that the patient can read and practice reciting.

d.

prevent embarrassing the patient by changing the subject if the patient does not respond.

 

B

Communication will be facilitated and less frustrating to the patient when questions that require a “yes” or “no” response are used. When the language areas of the brain are injured, the patient might not be able to read or recite words, which will frustrate the patient without improving communication. Expressive aphasia is caused by damage to the language areas of the brain, not by the areas that control the motor aspects of speech. The nurse should allow time for the patient to respond.