Neurology Eam #2

Front 1

What do you assess pre craniotomy?

Back 1

What do you assess pre craniotomy? Baseline neuro status

Front 2

Craniotomy post op, what is abnormal?

Back 2

Craniotomy post op, what is abnormal?

117 sodium level

Front 3

Infratentorial (area between cerebellum and brainstem) position?

Back 3

Infratentorial (area between cerebellum and brainstem) position? Flat or on their side for 24-48 hours

Front 4

Supratentorial (cerebrum) craniotomy position?

Back 4

Supratentorial (cerebrum) craniotomy position? HOB at 30 degrees

Front 5

S/S when a closed head injury becomes SIADH?

Back 5

S/S when a closed head injury becomes SIADH?

- JVD

Front 6

S/S when a closed head injury becomes Diabetes Insipidus?

Back 6

S/S when a closed head injury becomes Diabetes Insipidus? Polyuria

Front 7

ICP monitoring and its going up what secondary thing do you monitor for?

Back 7

ICP monitoring and its going up what secondary thing do you monitor for?
- Infection (open procedure)

Front 8

Brain tumor with ICP increasing, what are some things that can further aggravate this, that you can prevent with good nursing care?

Back 8

Brain tumor with ICP increasing, how can you protect the patient?

- Impaction, Vagal Stimulation
- HyperO2 patient with 100% and suction no more than 10 seconds, keep a quiet environment and STOOL SOFTENERS

Front 9

Intubated pt with increased ICP?

Back 9

Intubated pt with increased ICP?

- HyperO2 with 100% and suction no more than 10 seconds

Front 10

Pt with traumatic brain injury and comatose, how can you decrease ICP?

Back 10

Pt with traumatic brain injury and comatose, how can you decrease ICP? Keep PaCO2 @ 35

Front 11

Nurse is caring for Pt with increased ICP related to Ischemic stroke, how does nurse position head?

Back 11

Nurse is caring for Pt with increased ICP related to Ischemic stroke, how does nurse position head?

- Put pt head in midline and neutral with HOB 15 degrees

Front 12

Why do you place the head in midline and neutral?

Back 12

Why do you place the head in midline and neutral? Promote venous return

Front 13

Discharge instructions to mother of child who bumped their head?

Back 13

Discharge instructions to mother of child who bumped their head?
- Wake every 3-4 hours for 1st 2 days
- may have HA, dizzyness, and nausea every 24 hours

Front 14

Patient with brain attack, has dysarthria, what is it?

Back 14

Patient with brain attack, has dysarthria, what is it?

- slurred speech
- problem with communication

Front 15

To do for pt with impaired swallowing (what type of food/liquid to start with)?

Back 15

To do for pt with impaired swallowing (what type of food/liquid to start with)?

- Thick liquids and soft foods
- Custard

Front 16

Traumatic brain injury, what are you most concerned with?

Back 16

Traumatic brain injury, what are you most concerned with? Unilateral pupil changes

Front 17

Halo Sign?

Back 17

Halo Sign? Test for CSF. Take a drop of blood from nose or ear and drop onto a gauze pad, if the blood coagulates in the middle and a yellow colored "halo ring" forms around the outside = positive for CSF

Front 18

S/S of basilar skull fracture? Patient got beat up, what kind of physical signs would you expect?

Back 18

S/S of basilar skull fracture? Patient got beat up, what kind of physical signs would you expect?

- raccoon eyes and battle's signs

Front 19

Problem with chewing/swallowing, what do you assess for?

Back 19

Problem with chewing/swallowing, what do you assess for?

- Weight loss, get a baseline
- want to make sure patient does not lose too much weight
- weekly weights

Front 20

Head injury question, what do you notify MD about immediately?

Back 20

Head injury question, what do you notify MD about immediately?

- Pt is difficult to arouse
- LOC change

Front 21

Traumatic Brain Injury, what do you monitor for?

Back 21

Traumatic Brain Injury, what do you monitor for? Neuro status, VS, ABC's and increased ICP

Front 22

S/S of ICP?

Back 22

S/S of ICP? "Cushings Triad" = "Severe HTN", wide pulse pressure, "bradycardia" and bradypnea

Front 23

How do you suction a pt with increased ICP?

Back 23

How do you suction a pt with increased ICP? HyperO2 with 100% and then suction for no more than 10 seconds

Front 24

Patient with Stroke (Brain Attack), has right hemaplegia, if you take BP on right arm, will you get accurate reading?

Back 24

Patient with Stroke (Brain Attack), has right hemaplegia, if you take BP on right arm, will you get accurate reading?

- No, take BP on unaffected side as affected side will read bottomed out

Front 25

Left sided hemiplegia, how can you help with rehab (to prevent permanent deformities)?

Back 25

Left sided hemiplegia, how can you help with rehab (to prevent permanent deformities)?

- Positioning to prevent contractures, perform ROM
- splints, hands

Front 26

Stroke pt has double vision, how can you help?

Back 26

Stroke pt has double vision, how can you help? Cover the affected eye

Front 27

Stroke pt and MD orders bedrest, how can you prevent footdrop?

Back 27

Stroke pt and MD orders bedrest, how can you prevent footdrop?

- Splints and footboard

Front 28

Left hemisphere Stroke (left brain injury) S/S?

Back 28

Left hemisphere Stroke (left brain injury) S/S? Aphasia and slow and cautious

Front 29

Right hemisphere Stroke (Right Brain Injury) S/S?

Back 29

Right hemisphere Stroke (Right Brain Injury) S/S? Implusiveness and poor judgement

Front 30

Pt with Guillain Barre Syndrome, what do you ask about history (most likely predisposing factors)?

Back 30

Pt with Guillain Barre Syndrome, what do you ask about history (most likely predisposing factors)?
- Have you had "upper respiratory infection"
- Recent viral infection of any kind. Most likely gastroenteritis or upper respiratory infection
- Most clients report an acute illness before the development of GBS symptoms, such as gastroenteritis caused by Campylobacter jejuni bacteria or an upper respiratory infection

Front 31

Nurse is assessing Pt with GBS, what physical findings and symptoms does she expect to find?

Back 31

Nurse is assessing Pt with GBS, what physical findings and symptoms does she expect to find?

- Sudden onset of weakness in legs
- Ascending symmetric muscle weakness
- Dyspnea, diminished breath sounds, respiratory failure
- Paresthesias, muscle cramping, dysarthria, dysphagia, dipolpia
- Decreased or absent deep tendon reflexes, ataxia, incontinence (less common)

Front 32

Patient with possible diagnostic of GBS, what diagnostic test will be ordered?

Back 32

Patient with possible diagnostic of GBS, what diagnostic test will be ordered?
- Electromyography (EMG) shows repeated firing of the same motor unit instead of widespread sectional stimulation (electric current to test muscles)
- CSF analysis by lumbar puncture reveals elevated protein levels, peaking in 4-6 weeks
- Complete blood count shows leukocytosis with immature cells; increased immunoglobulin
- Nerve conduction tests show slowing

Front 33

Pt comes in with GBS and they are weak and tingly in both legs, what is the most important assessment for this patient?

Back 33

Pt comes in with GBS and they are weak and tingly in both legs, what is the most important assessment for this patient?
- AIRWAY ASSESSMENT, lungs and PULSE OX
- Assess respiratory status every 1-2 hours

Front 34

Pt has exacerbation of GBS and mild dyspnea, what nursing intervention do you do first?

Back 34

Pt has exacerbation of GBS and mild dyspnea, what nursing intervention do you do first? - Put them in a sitting position first and foremost
- Elevate HOB 45 degrees, suction as needed

Front 35

Patient is hospitalized with GBS, what nursing assessment would be most significant?

Back 35

Patient is hospitalized with GBS, what nursing assessment would be most significant?
- Airway - most important

Front 36

S/S of GBS getting better?

Back 36

S/S of GBS getting better?
- Even unlabored respirations

Front 37

What are symptoms of Myasthenia Gravis?

Back 37

What are symptoms of Myasthenia Gravis?
- DX pt with "diplopia, fatigue, dysphagia, and ptosis"
- Weak eye closure, ptosis, and dipolpia
- Skeletal muscle weakness and fatigue, increased through the day but decreases with rest (clent strongest in the morning)
- Weakness more intense during menses and after emotional stress, prolonged exposure to sunlight or cold, or infections
- Difficulty chewing, dysphagia, respiratory problems due to ineffective cough

Front 38

What age group is Myasthenia Gravis most common in each gender?

Back 38

What age group is Myasthenia Gravis most common in each gender?
- Women 20-30 (more often) and men 60-70
- Occurs slightly more often in women, women are more commonly affected in their 20s and 30s while men are usually affected in their 60’s and 70’s

Front 39

What is the Myasthenia Gravis Pathophysiology?

Back 39

What is the Myasthenia Gravis Pathophysiology?

- Autoimmune disease where the autoantibodies attack the acetycholine receptors
- It is an autoimmune disorder that is exacerbated by continuing activity and repeated movement and is relieved by rest

Front 40

What other medical conditions are often associated with Myasthenia Gravis?

Back 40

What other medical conditions are often associated with Myasthenia Gravis?
- is associated with the Thyroid
- Hyperthyroidism
- Bone marrow transplant
- Thyoma (encapsulated thymus gland tumor)

Front 41

The nurse would expect to see what in the patient’s medical history if they have Myasthenia Gravis?

Back 41

The nurse would expect to see what in the patient’s medical history if they have Myasthenia Gravis?

- Skeletal muscle weakness and fatigue, increased through the day but decreases with rest (clent strongest in the morning)

Front 42

Nurse is caring for patient with Myasthenia Gravis, what S/S will she immediately report to Primary healthcare provider?

Back 42

Nurse is caring for patient with Myasthenia Gravis, what S/S will she immediately report to Primary healthcare provider?
- Inability to swallow (Airway)
- Reports immediately to Doctor
- Evaluation by speech Therapist

Front 43

What is definitive test (diagnostic) for Myasthenia Gravis?

Back 43

What is definitive test (diagnostic) for Myasthenia Gravis?
- Tensilon test confirms a diagnosis of Myasthenia Gravis. Temporarily improves muscle function within 30 to 60 seconds after IV injection of edrophonium or neostigmine and lasting up to 30 minutes). Tensilon also distinguishes between MG crisis and Cholinergic crisis. If you get improvement its MG crisis and if you get worsening s its a cholinergic crisis
- Tensilon produces a temporary improvement in myasthenic crisis or worsening of symptoms in cholinergic crisis

Front 44

Patient with Myasthenia Gravis who has increased risk of respiratory complications, what would be an indication of what could be happening?

Back 44

Patient with Myasthenia Gravis who has increased risk of respiratory complications, what would be an indication of what could be happening?
- Ineffective cough
- Respiratory problems due to ineffective cough
- Ineffective cough indicates the patient is getting into respiratory distress

Front 45

Although an adverse reaction to Tensilon is considered rare, which medication should be readily available to give as an antidote in case the patient experiences complications?

Back 45

Although an adverse reaction to Tensilon is considered rare, which medication should be readily available to give as an antidote in case the patient experiences complications?
- Atropine sulfate – the antidote for anticholinesterase drugs, should be available in case these complications occur

Front 46

What are S/S of Myasthenia Crisis?

Back 46

What are S/S of Myasthenia Crisis?
- Restlessness
- Dyspnea
- Increased salivation and tearing
- Increased Pulse, Respirations, and Blood Pressure
- Anoxia, cyanosis
- Total Incontinence
- Decreased Urine output
- Absence of cough or swallow reflex

Front 47

What are S/S of Cholinergic Crisis?

Back 47

What are S/S of Cholinergic Crisis?
- Abdominal cramps
- Blurred vision
- Facial muscle twitching
- N/V/D
- Miosis
- Pallor, bradycardia, hypotension

Front 48

What drugs are given for Myasthenia Gravis?

Back 48

What drugs are given for Myasthenia Gravis?
- Anticholinesterase drugs, such as Neostigmine and Pyridostigmine

Front 49

Baselines to get prior brain tumor surgery (Craniotomy)?

Back 49

Baselines to get prior brain tumor surgery (Craniotomy)?
Neuro, VS and MOTOR STRENGTH

Front 50

TX for malignant tumor?

Back 50

TX for malignant tumor? Chemo, Radiation and Surgery

Front 51

What does Myasthenia Gravis, GBS and ALS all share in common?

Back 51

What does Myasthenia Gravis, GBS and ALS all share in common?
- They all cause Respiratory complications

Front 52

What is Tic Douloureaux?

Back 52

What is Tic Douloureaux?
- Trigeminal Neuralgia
- Affects the trigeminal, or 5th cranial nerve
- Usually unilateral and unually provoked by minimal stimulation

Front 53

What symptom is significant in Trigeminal Neuralgia (tic douloureaux)?

Back 53

What symptom is significant in Trigeminal Neuralgia (tic douloureaux)?
- Excruciating facial pain

Front 54

What are the S/S of Trigeminal Neuralgia (tic douloureaux)?

Back 54

What are the S/S of Trigeminal Neuralgia (tic douloureaux)?
- Unilateral presentation with excruciating, sharp, shooting, piercing, burning, and stabbing pain lasting seconds to minutes, with remissions, with no sensory or motor deficits on examination

Front 55

What are the S/S of Bell’s Palsy (Facial Paralysis)?

Back 55

What are the S/S of Bell’s Palsy (Facial Paralysis)?
- Acute paralysis of cranial nerve VII (facial nerve); may affect cranial nerves V and VIII
- Abrupt onset of unilateral, peripheral facial paresis or paralysis
- Monitor the buccal pocket for food on the affected side
- Inability to close eye, wrinkle forehead, smile, whistle, smile, or grimace on affected side
- May have loss of ability to tear or excessive tearing
- Masklike face with unilateral sagging
- Taste may be impaired; may have tinnitus

Front 56

TN involves how many branches total?

Back 56

TN involves how many branches total? 3

Front 57

What’s the first medication used to manage pain in Trigeminal Neuralgia?

Back 57

What’s the first medication used to manage pain in Trigeminal Neuralgia?
- gabapentin (Neurontin)
- Drug therapy with antiepileptic drugs: carbamazepine (Tegretol) and gabapentin (Neurontin) is used first

Front 58

Why should the nurse avoid walking really quickly past the client with Trigeminal Neuralgia (Tic douloureaux)?

Back 58

Why should the nurse avoid walking really quickly past the client with Trigeminal Neuralgia (Tic douloureaux)?
- Movement of air is painful to client (usually provoked by minimal stimulation)
- Movement of air can trigger an attack

Front 59

What would you teach the patient with Trigeminal Neuralgia in order to limit the pain?

Back 59

What would you teach the patient with Trigeminal Neuralgia in order to limit the pain?
- Teach patient to chew on unaffected side
- Instruct client to avoid talking, smiling, shaving, washing the face, and brushing the teeth (modify oral hygiene, rinse mouth)
- Avoid walking swiftly past client; no fans
- Provide small feedings of liquid or soft foods; no hot or cold fluids
- Drink with straw

Front 60

When you get patient with Trigeminal Neuralgia and they report pain, what do you do? #1 priority, even if going in for surgery?

Back 60

When you get patient with Trigeminal Neuralgia and they report pain, what do you do? #1 priority, even if going in for surgery?
- Pain management with Gabapentin (neurontin) (give them their pain medication) (terrible pain)

Front 61

The nurse is planning to care for a patient with Bell’s Palsy, what is going to be one of her major goals?

Back 61

The nurse is planning to care for a patient with Bell’s Palsy, what is going to be one of her major goals?
- Prevent Corneal damage
- Priority of care is to protect the cornea from dying

Front 62

What other condition do you prevent corneal damage (besides Bell's Palsy)?

Back 62

What other condition do you prevent corneal damage (besides Bell's Palsy)?
- Myasthenia Gravis

Front 63

If patient has diminished corneal reflex, what is nurse’s responsibility?

Back 63

If patient has diminished corneal reflex, what is nurse’s responsibility?
- eye drops or eye ointment
- Teach client to manually close eyelid at intervals
- Teach client to administer artificial tears or lubricant
- Eye may be patched or taped at bedtime

Front 64

If the patient says: “I have Bell’s Palsy and will probably have to take narcotics the rest of my life”, how would the nurse respond?

Back 64

If the patient says: “I have Bell’s Palsy and will probably have to take narcotics the rest of my life”, how would the nurse respond?
- Bell’s Palsy (pain isn’t severe) patients are medicated with Mild analgesics
- Non narcotics (tylenol and ibuprofen)

Front 65

Patient with Ischemic Stroke, pt on cardiac monitor, which cardiac dysrhythmia places the client at risk for emboli?

Back 65

Patient with Ischemic Stroke, pt on cardiac monitor, which cardiac dysrhythmia places the client at risk for emboli?
- Atrial Fibrillation

Front 66

What health problem does the nurse identify from an older patients history that tells her that he is at an increased risk for a brain attack (stroke)?

Back 66

What health problem does the nurse identify from an older patients history that tells her that he is at an increased risk for a brain attack (stroke)?
- Transient Ischemic Attacks (mini strokes)
- Repeated TIAs may damage the brain tissue, as seen on MRI or CT scans, and indicate high risk for stroke
- Atrial Fibrillation, HTN
- DM, smoking, cocaine, alcohol
- Obesity, sedentary lifestyle, contraceptives
- Hyperlipidemia, migraines, older age
- Male, African American

Front 67

Nurse is examining older client, what symptom makes the nurse think the patient might be having TIA?

Back 67

Nurse is examining older client, what symptom makes the nurse think the patient might be having TIA?
- Brief periods of Unilateral Weakness (one sided weakness)
- Unilateral weakness in the arm, hand, or leg
- Dysarthia (slurred speech)

Front 68

Stroke pt #1 risk factor?

Back 68

Stroke pt #1 risk factor? Obesity
- - Atrial Fibrillation, HTN
- DM, smoking, cocaine, alcohol
- Obesity, sedentary lifestyle, contraceptives
- Hyperlipidemia, migraines, older age
- Male, African American

Front 69

What symptom would you expect a person to exhibit that had a ruptured cerebral aneurysm?

Back 69

What symptom would you expect a person to exhibit that had a ruptured cerebral aneurysm?
- Severe headache (massive headache) (worst headache of my life)
- Sudden severe headache (hemorrhagic; aneurysm)

Front 70

If you have a person with a diagnosis of cerebral aneurysm and they report a sudden severe headache, what do you do first?

Back 70

If you have a person with a diagnosis of cerebral aneurysm and they report a sudden severe headache, what do you do first?
- CALL MD (call primary provider)

Front 71

Client is hospitalized with HTN and they turn on the call light, when nurse gets there, pt is slurring speech and has right sided weakness and saying they don’t feel right, what do you assess next?

Back 71

Client is hospitalized with HTN and they turn on the call light, when nurse gets there, pt is slurring speech and has right sided weakness and saying they don’t feel right, what do you assess next?
- Assess ABC's
- Priority is the ABC’s; maintain airway and administer oxygen as prescribed

Front 72

During recovery from stroke, a Patient is NPO to prevent aspiration, what cranial nerves will be assessed to confirm swallowing ability?

Back 72

During recovery from stroke, a Patient is NPO to prevent aspiration, what cranial nerves will be assessed to confirm swallowing ability?
- Cranial Nerve 9 (glossopharyngeal) and Cranial Nerve 10 (Vagus)

Front 73

A patient with a brain attack (Stroke) comes to the nurse in the ER and the patient is comatose, what other clinical indicator will you identify?

Back 73

A patient with a brain attack (Stroke) comes to the nurse in the ER and the patient is comatose, what other clinical indicator will you identify?
- Urinary incontinence (answer)
- maybe incontinent of stools

Front 74

What other condition causes Urinary incontinence (besides strokes (brain attacks))?

Back 74

What other condition causes Urinary incontinence (besides strokes (brain attacks))?
- Seizures

Front 75

What is Global Aphasia?

Back 75

What is Global Aphasia?
- is receptive aphasia (inability to understand spoken work) and expressive aphasia (inability to speak)
- Inability to use or comprehend either language or symbols

Front 76

Head nurse assigns a patient with a diagnosis of Global aphasia to a (UAP) CNA, is that ok?

Back 76

Head nurse assigns a patient with a diagnosis of Global aphasia to a (UAP) CNA, is that ok?
- No

Front 77

Teaching a Stroke patient to use a cane, what is cane for?

Back 77

Teaching a Stroke patient to use a cane, what is cane for?

- Stabilizer

Front 78

A patient with Myasthenia Gravis experiencing increased symptoms, how do you rule out cholinergic crisis?

Back 78

A patient with Myasthenia Gravis experiencing increased symptoms, how do you rule out cholinergic crisis?

-Tensilon Test

Front 79

Moving air across face causes pain, what is this disorder?

Back 79

Moving air across face causes pain, what is this disorder?

-Trigeminal Neuralgia

Front 80

The nurse is teaching a patient about an Endarterectomy, what does this mean?

Back 80

The nurse is teaching a patient about an Endarterectomy, what does this mean?

-surgical removal of fatty deposits, called plaque, from the walls of arteries, to prevent strokes

Front 81

Dysphagia?

Back 81

Dysphagia?

-Difficulty swallowing

Front 82

When caring for patient with head trauma and you notice clear liquid oozing from nose, what do you do?

Back 82

When caring for patient with head trauma and you notice clear liquid oozing from nose, what do you do?

- Check for glucose

Front 83

Pinkish drainage from the ear, what do you do?

Back 83

Pinkish drainage from the ear, what do you do?

- Test for Glucose

Front 84

Patient with basilar skull fracture, what physician's order would you question?

Back 84

Patient with basilar skull fracture, what physician's order would you question?

- Suction via the nasal/tracheal route PRN?

Front 85

Client with head injury, treated with Mannitol, what would you assess after?

Back 85

Client with head injury, treated with Mannitol, what would you assess after?

- Monitor I&O (Urinary Output)

Front 86

Patient assessing following head injury, what is most important clinical indicator?

Back 86

Patient assessing following head injury, what is most important clinical indicator?

- LOC

Front 87

Early S/S of ICP?

Back 87

Early S/S of ICP?

- (Not Sure)
- Severe Headache
- Deteriorating LOC (lethargy to coma), restlessness, irritability
- Dilated or pinpoint pupils, slow to react/nonreactive

Front 88

Assessing client with head injury, what do you assess for complete neurological status?

Back 88

Assessing client with head injury, what do you assess for complete neurological status?

- LOC, ABC's, increases ICP, "PERRLA (check pupil responses by shining light in eye)"

Front 89

Patient with Ischemic Stroke, pt on cardiac monitor, which cardiac dysrhythmia places the client at risk for emboli?

Back 89

Patient with Ischemic Stroke, pt on cardiac monitor, which cardiac dysrhythmia places the client at risk for emboli? - Atrial Fibrillation

Front 90

Teaching a Stroke patient to use a cane, what is cane for?

Back 90

Teaching a Stroke patient to use a cane, what is cane for? - Stabilizer

Front 91

A patient with Myasthenia Gravis experiencing increased symptoms, how do you rule out cholinergic crisis?

Back 91

A patient with Myasthenia Gravis experiencing increased symptoms, how do you rule out cholinergic crisis? -Tensilon Test

Front 92

Moving air across face causes pain, what is this disorder?

Back 92

Moving air across face causes pain, what is this disorder? -Trigeminal Neuralgia

Front 93

Increased ICP, late S/S (now have cardiac S/S)?

Back 93

Increased ICP, late S/S (now have cardiac S/S)?

- "Bradycardia, HTN", and Cushing's Triad

Front 94

Patient with closed-head injury, in a coma, what would nurse do to keep patient from having increased ICP?

Back 94

Patient with closed-head injury, in a coma, what would nurse do to keep patient from having increased ICP?

- Elevate head HOB 15 degrees
- Head in midline, neutral position to promote venous return
- Increase O2
- Suction for less than 10 seconds
- PaCO2 at 35
- Hyperventilate