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109 Cards in this Set

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What are 16 ways to assess the mental status?
appropriate answers?...
behavior and facial expressions appropriate?...
speech pattern of normal tone, rate, rhythm, volume?...
answers complete?...
appearance neat or untidy?...
appearance appropriate for
age?...
appearance appropriate for
current weather?...
cooperative?...
euphoric?...
hostile?...
anxious?...
withdrawn?...
guarded?...
hallucinations?...
delusions?...
posture and hygiene appropriate?...
Glasgow Coma Scale
Eye Opening?
spontaneous 4
to sound 3
to pain 2
never 1
Glasgow Coma Scale
Motor Response?
obeys commands 6
localizes pain 5
normal flexion (withdrawal) 4
abnormal flexion 3
extension 2
none 1
Glasgow Coma Scale
Verbal Response?
oriented 5
confused conversation 4
inappropriate words 3
incomprehensible sounds 2
none 1
Highest possible score of Glasgow Coma Scale is?
15
Go over stick scale figure 44-11
okay
Special considerations are taken for clients who will receive a contrast agent as part of their diagnostic test.
Following institutional guidelines regarding ____ ____?
informed consent
Special considerations are taken for clients who will receive a contrast agent as part of their diagnostic test.
Determine whether the client has any _____ or ____ restriction before the test.
food or fluid
Special considerations are taken for clients who will receive a contrast agent as part of their diagnostic test.
Ask client about allergies to ___ ____, ____, or ____.
contrast agents
shellfish
iodine
Determine the factors for contrast-induced nephropathy (renal damage) which include?
pre-existing renal disease
diabetic nephropathy
heart failure
dehydration
medications that interfere
with renal perfusion, such
as metformin (diabetic
clients on the metformin
require preprocedure and
postprocedure changes in
their medication regimen)
Notify ____ if client has reported a risk factor.
hcp
Checking the client's ____ level (Clients with a level greater than _____ are more at risk for contrast-induced nephropathy.)
creatinine
1.5 mg/dL
CSF pressure of less than 20 cm H20 is considered?
normal range
If color or appearance of CSF is clear and colorless, it's considered?
normal
If color or appearance of CSF is pink-red to orange, it indicates that?
red blood cells present
If color or appearance of CSF is yellow, it indicates that?
bilirubin present owing to hemolysis of rbcs; possible causes include:
subarachnoid hemorrhage jaundice
increased CSF protein hypercarotenemia hemoglobinemia
If color or appearance of CSF is brown, it indicates?
methemoglobin present, indicating meningeal hemorrhage
If color or appearance is unclear or hazy, it indicates?
cell count is elevated
If the CSF contains cells that are 0-5 small lymphocytes/mm3, it indicates?
normal
If the CSF contains cells that are more than 5 lymphocytes/mm3, it indicates?
reaction to infection, tumor, chemical substance, or blood
If proteins in CSF total 15-45 mg/dL, it indicates?
normal
If proteins in CSF total 45-100 mg/dL, it indicates?
paraventricular tumor
If proteins in CSF total 50-200 mg/dL, it indicates?
viral infection
If proteins in CSF total more than 500 mg/dL, it indicates?
bacterial infection, Guillain-Barre syndrome
If proteins in CSF total less than 15 mg/dL, it indicates?
meningismus
pseudotumor cerebri
hyperthyroidism
normal finding after lumbar
puncture
In CSF, if immune gamma globulin (IgG, the most important protein) is 3% to 12% of total protein, then it's considered?
normal
In CSF, if immune gamma globulin (IgG, the most important protein) is more than 3% to 12% of total protein, it's considered?
multiple sclerosis
neurosyphilis
viral infection
In CSF, if albumin/globulin ratio is 8:1, it's considered?
normal
In CSF, if glucose is 50 to 75 mg/dL or 60% to 70% of blood glucose level, it's considered?
normal
In CSF, if glucose is less than 50 mg/dL (usually accompanied by the presence of pathologic organisms), it indicates?
bacterial, fungal, or viral
meningitis
CNS leukemia
cancer
In CSF, normal lactic acid is?
10-25 mg/dL
In CSF, if lactic acid is more than 10-25 mg/dL, then it might indicate (2)?
systemic acidosis
increased CSF glucose
metabolism
In CSF, if glutamine is less than 20 mg/dL, then it's considered?
normal
In CSF, if glutamine is more than 20 mg/dL, it's considered?
hepatic coma or cirrhosis of liver
In CSF, if lactate dehydrogenase is 10% of serum level or 2.0-7.2 units/mL, then it's considered?
normal
In CSF, if lactate dehydrogenase is more than 10% of serum level, then it may indicate?
bacterial meningitis
inflammatory diseases of CNS
If a client is having an electroencephalogram, thoroughly explain the procedure to the patient.
okay
If a client is having an electroencephalogram, if the order is for theh client to be "sleep deprived", tell the client to awaken about ___ to ___ a.m. and to stay awake for the rest of the night.
2 to 3 a.m.
If a client is having an electroencephalogram, instruct the client to avoid ___ ____ or _____; without _____ only if instructed by the physician
CNS depressants
stimulants
anticonvulsants
If a client is having an electroencephalogram, tell the client not to drink _____-____ fluids, such as coffee or tea, on the day of the test
caffeine-containing
If a client is having an electroencephalogram, reassure the client that the test is not ____ or _____.
dangerous
uncomfortable
If a client is having an electroencephalogram, ask the client to wash ____ on the morning of the test and to remove all ____, ____, or ____.
hair

hairpins, sprays, oils
If a client is having an electroencephalogram, inform the client that the hair will need to be washed again after the test to remove the ____ ____.
electrode glue
Name the sites of acetylcholine?
brain
brainstem
basal ganglia
ANS
Name the function of acetylcholine?
nerve and muscle transmission...
parasympathetic and preganglionic sympathetic system...
Name the action of acetylcholine?
excitatory, but some inhibitory
Name the action of serotonin?
medial brainstem
hypothalamus
dorsal horn of spinal cord
Name the function of serotonin?
possible onset of sleep, mood control;
pain pathway inhibitor in spinal cord
Name the action of serotonin?
inhibitory
What are 2 catecholamines?
dopamine
norepinephrine (epinephrine
parallels)
What is the site for dopamine?
substantia nigra to basal ganglia
What is the function for dompamine?
complex movements emotional response regulation, attention
What is the action of dopamine?
usually inhibitory
What is the site for NE?
hypothalamus
brainstem
reticular formation
cerebellum
sympathetic nervous system
What is the function of NE?
maintenance of arousal, reward system, dreaming sleep, mood regulation
What is the action of NE?
mainly excitatory
Name 4 amino acids that are transmitters?
aspartate
gamma-aminobutyric acid
(GABA)
glutamate
glycine
What is the site for transmitter aspartate?
brain
spinal cord interneurons
What is the function for transmitter aspartate?
sensation
What is the action for transmitter aspartate?
excitatory
Where is the site for transmitter gamma-aminobutyric acid (GABA)?
brain
brainstem
basal ganglia
ANS
What is the function of transmitter gamma-aminobutyric acid (GABA)?
nerve and muscle transmission
possibly one third of brain
neurons
What is the action of gamma-aminobutyric acid (GABA)?
inhibitory
What is the site for transmitter glutamate?
sensory pathways
What is the function for transmitter glutamate?
sensation
What is the action for transmitter glutamate?
excitatory
What is the site for glycine?
spinal cord interneurons
What is the function of glycine?
muscle control
What is the action of glycine?
inhibitory
What are 2 transmitter peptides?
substance P
endorphine, enkephalins
What is the site for transmitter peptide substance P?
brain
neurons in spinal cord
What is the function for transmitter peptide substance P?
pain transmission
What is the action for transmitter peptide substance P?
excitatory
What is the site for transmitter peptide endorphins, enkephalins?
thalamus
hypothalamus
spinal cord
pituitary
What is the function for transmitter peptide endorphins, enkephalins?
pleasure sensation
reward system
analgesia
(inhibits release of substance P), released with ACTH (corticotropin) during stress
What is the action for peptide transmitter endorphins, enkephalins?
probably excitatory
What are two transmitter gases and where are their sites?
nitric acid
carbon monoxide

neurons
What is the function for transmitter gas nitric acid?
not stored in specific site; made by enzymes as needed; released by diffusion
What is the action for transmitter gas nitric acid?
excitatory
The function and action of the transmitter carbon monoxide is?
not well understood and questionable
The transmitters that are excitatory are?
acetylcholine
NE
aspartate
glutamate
substance P
nitric acid
endorphins, enkephalins
(probably)
The transmitters that are inhibitory are?
serotonin
dopamine (usually)
gamma-aminobutyric acid
(GABA)
glycine
The 5 cranial lobes are?
frontal
limbic
occipital
parietal
temporal
What are the functions of the frontal lobe?
primary motor area ("strip")
Broca's speech center on
dominant side
voluntary eye movement
sensory data (access to
current)
past information or
experience (access to)
affective response to a
situation
regulates behavior based on
judgment and foresight
judgment
long-term goals (ability to
develop)
reasoning, concentration,
abstraction
What are the functions of the parietal lobe?
understand sensation,
texture, size, shape, and
spatial relationships
3-dimensional (spatial)
perception
important for singing,
playing musical instrument,
and processing nonverbal
visual experiences
perception of body parts and
body position awareness
taste impulses for inter-
pretation
What are the functions of the temporal lobe?
auditory center for sound
interpretation
complicated memory patterns
Wernicke's area for speech
What are the functions of the occipital lobe?
primary visual center
What are the parts of the diencephalon?
thalamus
hypothalamus
epithalamus
subthalamus
The function of the thalamus is?
all sensation except smell
sensation perceived at the
thalamic level is crude
and cannot be localized
or qualified
The function of the hypothalamus is?
regulates water metabolism,
appetite, sleep-wake cycle,
temperature control, and
thirst
hormonal activity
posterior pituitary hormones,
such as vasopressin and
oxytocin
anterior pituitary hormone
excretion
growth, thyrotropin, and
follicle-stimulating
hormones, prolactin, and
corticotropin
regulates emotions and
controls basic drive for
self-preservation
The function of the epithalamus is?
often calcified by young
adulthood and is radiopaque
used as a point of reference
on an x-ray film or a
computed tomography scan
The function of the subthalamus is?
contains sensory tracts
connectors to basal ganglia
What are the 3 brainstem structures?
medulla
pons
midbrain
What are the functions of the medulla?
cardiac-slowing center
respiratory center
cranial nerves IX
(glossopharyngeal), X
(vagus), XI (accessory),
and XII (hypoglossal)
emerge from the medulla, as
do portions of cranial
nerves VII (facial) and
VIII (acoustic)
What are the functions of the pons?
cardiac acceleration and
vasoconstriction centers
pneumotaxic center helps
control respiratory
pattern and rate
four cranial nerves originate
from the pons:
V (trigeminal),
VI (abducens),
VII (facial),
VIII (acoustic)
What are the functions of the midbrain?
contains the cerebral
aqueduct or aqueduct of
Sylvius
location of periaqueductal
gray, which may abolish
pain when stimulated
cranial nerve nuclei III
(oculomotor) and IV
(trochlear) located here
What are some inherited diseases?
Huntington
neuromuscular disorders
movement disorders
migraine headaches
epilepsy

(mutated ion channels for the last 4)

Alzheimers
multiple sclerosis
Which 2 diseases have been tied to neurofilament mutations?
Parkinson disease
amyotropic lateral sclerosis
Changes in ADLs might be a result of subtle changes in ____ function.
neurologic
It's important to find out if the patient is left-handed or right-handed because?
The client may be somewhat stronger on the 1____ side.
The effects of cerebral injury or disease are more pronounced if the 2____ hemisphere is involved
1 dominant
2 dominant
Assess the following 3 when assessing sensory function?
pain
temperature
touch
Assess the following when assessing mental status?
LOC
memory
attention
language and coping
cognition
When assessing cerebellar function, be sure to assess these 3?
coordination
gait
equilibrium
When assessing motor function, be sure to assess these 2?
muscle strength
cerebral/brainstem integrity
When taking a pain assessment, start with the ____ noxious irritation or pressure and move upward if patient doesn't respond...gently shake...if no response, move to these areas in this order?
least

supraorbital pressure
trapezius squeeze
mandibular pressure
sternal rub
How to apply supraorbital pressure (first method)?
place thumb under orbital rim in middle of eyebrow and push upward...don't use if client has orbital or facial fractures
The second technique to assess painful stimuli is to 1_____ or 2____ the trapezius muscle located at the angle of the shoulder and neck muscle. If client remains unresponsive, apply pressure to the 3_____ using index and middle fingers. If the client doesn't respond, make a fist and rub the 4_____ of the hand against the sternum in a twisting motion. The tissue in this area is tender, and 5_____ is not unusual. Therefore exercise judgment regarding the value of the information gained from frequent or prolonged sternal rubs.
1 pinch
2 squeeze
3 mandible
4 knuckles
5 bruising
The initial response to pain may be abnormal 1____ or 2____. Continued application of pain for no more than 3____ to ____ seconds may demonstrate that patient can localize or withdraw. If the client doesn't respond after 4____ to ____ seconds, it isn't necessary to continue applying the painful stimulus.
1 flexion
2 extension
3 20 to 30
4 20 to 30
If the client responds by moving, but not all extremities move, assess the ____ response to pain. Place a pen or pencil on top of the client's ___ ___ at the base of the cuticle and apply pressure. This maneuver is performed only on the extremity that did ___ move.
peripheral
nail bed
not