Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
572 Cards in this Set
- Front
- Back
|
The eye is innervated by which 3 cranial nerves?
|
III, IV, VI
|
|
|
The nurse knows that the normal IOP is:
a) 2-6 mm Hg b) 8-12 mm Hg c) 10-21 mm Hg d) 15-25 mm Hg |
c) 10-21 mm Hg
|
|
|
The ability to focus and refocus is called:
a) accommodation b) assimilation c) vitreation d) clarifying |
a) accommodation
|
|
|
What are the names of the photoreceptor cells located in the sensory retina?
|
rods and cones
|
|
|
The ___ are mainly responsible for night vision or vision in low light, and the ___ are used for bright vision and color vision.
a) rods, rods b) cones, cones c) cones, rods d) rods, cones |
d) rods, cones
|
|
|
The optic nerve is known as cranial nerve:
a) I b) II c) III d) IV |
b) II
|
|
|
Fibers from the (left/right) visual field carry impulses to the right occipital lobe, while fibers from the (left/right) visual field carry impulses to the left occipital lobe.
|
Fibers from the LEFT visual field carry impulses to the right occipital lobe, while fibers from the RIGHT visual field carry impulses to the left occipital lobe.
|
|
|
What does it mean when someone says they have 20/200 vision?
|
They can see at 20 feet when a person with normal vision can see at 200 feet (Jessica).
|
|
|
How far are patients instructed to stand away from the Snellen chart?
a) 10 feet b) 15 feet c) 20 feet d) 25 feet |
c) 20 feet
|
|
|
What if a patient is able to only read the big "E" at the top of the Snellen chart, what would their visual acuity be recorded as?
a) 10/200 b) 20/20 c) 20/200 d) 200/20 |
a) 10/200
|
|
|
What is ptosis?
a) a drooping eyelid b) an oozing eyelid c) jiggling eye balls d) dissociation between the left and right eye |
a) a drooping eyelid
|
|
|
When performing an eye examination, the nurse observes nystagmus. What is this?
a) a drooping eyelid b) an oozing eyelid c) oscillating movement of the eyeballs d) dissociation between the left and right eye |
c) oscillating movement of the eyeballs
|
|
|
True or False: What might you monitor for, in the eyelid of a person with hypercholesterolemia or diabetes?
a) proteins b) glucose c) lipids d) blood |
c) lipids
|
|
|
What affect can digitalis have on the eyes?
|
It can cause acquired color vision loss.
|
|
|
A patient is given an Amsler grid at their yearly eye examination. They ask you what they are supposed to do with this grid. What do you tell them?
|
They are supposed to stare at the central fixation spot on the grid of squares and report any distortion in the squares. Report of wavy or faded lines indicates early macular problems, and should be reported to their doctor.
|
|
|
Patient teaching of the client preparing to undergo a color fundus photography test to detect and document retinal lesions includes:
a) you will need to sign a consent for for anesthesia b) you will loose you color vision for 1-2 hours c) your pupils will be widely dilated d) your eye lids will be held open with a special brace to prevent you from blinking |
c) your pupils will be widely dilated
|
|
|
Patient teaching of the client preparing to undergo a fluorescein angiogram includes:
a) this is not an invasive procedure b) your urine may turn yellow or orange c) dye will be injected into the globe of the eyeball d) dye is injected, and picture are taken in 1-2 following injection |
b) your urine may turn yellow or orange
|
|
|
When performing perimetry testing, scotomas are detected. What are scotomas?
|
blind spots
|
|
|
When performing an admission assessment, the patient tells you he has myopia. What is this?
a) far-sighted vision b) near-sighted vision c) an infection d) highly contagious |
b) near-sighted vision
|
|
|
A patient tells you he has hyperopia. What is this?
a) far-sighted vision b) near-sighted vision c) an infection d) highly contagious |
a) far-sighted vision
|
|
|
A patient with a shortened or elongated eyeball which prevents light rays from focusing sharply on the retina is know to have ____ errors.
a) visual b) conceptual c) functional d) refractive |
d) refractive errors
|
|
|
You know that the person with an astigmatism has:
a) uncoordinated eye movement b) irregular curvature of the cornea c) irregularly high IOP d) irregularly low IOP |
b) irregular curvature of the cornea
|
|
|
Legal blindness is a condition of impaired vision in which a person has a best corrected visual acuity (BCVA) that does not exceed ____ in the better eye.
a) 10/200 b) 20/200 c) 20/20 d) 10/20 |
b) 20/200
|
|
|
The most common causes of _____ among adults 40 years of age or older are diabetic retinopathy, macular degeneration, glaucoma, and cataracts.
a) blindness/visual impairment b) pain/discomfort c) headaches/poor acuity d) visual impairment/headaches |
a) blindness/visual impairment
|
|
|
Macular degeneration is more prevalent among ________, whereas glaucoma is more prevalent among _______.
a) asians, african Americans b) caucasians, african americans c) african american, caucasians d) asian, Norwegians |
b) caucasians, africans american
|
|
|
True or False: When speaking to a blind person, be sure not to use words like as "look" or "see" as it will hurt their feelings.
|
False: Do not be concerned about using those words.
|
|
|
True or False: When speaking to a blind person, be sure to raise your voice, as they will not have the added aide of seeing your lips while you speak.
|
False: They are blind, not deaf.
Seriously. |
|
|
A patient has recently been diagnosed with a disorder in which there is increased IOP caused by congestion of aqueous humor in the eye. What condition do they have?
|
glaucoma
|
|
|
____ is one of the leading causes of irreversible blindness in the world.
|
glaucoma
|
|
|
Glaucoma can be associated with the use of what medication?
a) NSAIDS b) corticosteroids c) blood thinners d) diuretics |
b) corticosteroids
|
|
|
A patient suspected of having glaucoma might complain of which of the following:
a) poor vision in bright lights b) seeing halos and poor low light vision c) seeing flashes of light d) seeing a "haze" in bright and low lights |
b) seeing halos and poor low light vision
|
|
|
True or False: Glaucoma has no diagnostic test. Only signs and symptoms can be correlated with it.
|
False: A perimetry test can be conducted with mapped results that can be compared with other maps of ocular diseases.
|
|
|
True or False: Initial treatment of glaucoma involves bilateral administration of topical beta-blockers.
|
False: Beta-blockers are administered to one eye at first, with the other eye used as a control in determining the efficacy of the medications.
|
|
|
What is a possible side effect of cholinergics (miotics) such as pilocarpine and carbachol?
a) difficulty seeing in the dark b) difficulty seeing in bright lights c) difficulty distinguishing colors d) difficulty distinguishing shades |
a) difficulty seeing in the dark
|
|
|
True or False: You know the patient needs further teaching when he say what about filtering procedures for chronic glaucoma
a) it will lower IOP b) sometimes there is incomplete healing of the surgical wound, which may require additional stitches at the follow up appointment c) hemorrhage is a complication d) drainage implants are shunts may need to be inserted to help hold the space open |
b) sometimes there is incomplete healing of the surgical wound, which may require additional stitches at the follow up appointment: Unlike other procedures, the goal of a filtering procedure is to achieve incomplete healing of the surgical wound. I.E. you want the hole to stay open to allow fluid to drain out, thereby lowing IOP.
|
|
|
Does glaucoma run in the family?
|
Yes!
|
|
|
A ___ is a lens opacity or cloudiness affecting nearly 20.5 million Americans who are 40 years of age or older.
|
cataract
|
|
|
What is the difference between nuclear and cortical cataracts?
|
Nuclear cataracts involve cloudiness in the center of the eye while cortical cataracts involve anterior or posterior areas of cloudiness in the eye.
|
|
|
A person with cataracts has the worst vision in:
a) low lighting b) bright lights c) color discrimination d) the rain |
b) bright lights
|
|
|
True or False: No nonsurgical treatment cures cataracts or prevents age related cataracts.
|
True :(
|
|
|
Is cataract surgery an inpatient or outpatient surgery?
|
outpatient: the procedure takes less than an hour and the patient is discharged 30 minutes or less after the surgery
|
|
|
True or False: When both eyes have cataracts, one eye is treated first, then several weeks later, the other eye is treated.
|
True: The delay allows for the patient and surgeon to evaluate whether the results from the first surgery are adequate to preclude the need for a second operation
|
|
|
The patient scheduled for a single-focus IOL needs further instruction when he says:
a) I will need to wear glasses after the surgery for distance or close vision b) the shape of the new lens can adjust to different angles as needed c) I should not experience halos or glare d) I will undergo surgery on one eye at a time, separated by sever weeks |
b) the shape of the new lens can adjust to different angles as needed: The shape of a SINGLE-FOCUS lens can only focus to a single distance and cannot change shape to focus at different distances. That is why you still have to wear glasses for close or distance focusing.
|
|
|
What is toxic endothelial cell destruction and what causes it?
|
It is non-infectious inflammation caused by a toxic agent after an uncomplicated surgery related to improperly rinsed surgical instruments soaked in enzymatic detergents, residue from instruments sterilized with plasma gas, abnormalities in the pH or ionic compositions of irrigation solutions.
|
|
|
What is difference in the onset of edema with regular endophthalmitis and toxic endothelial cell destruction?
|
With regular endophthalmitis, edema appears 48-72 hours after surgery and is bacterial in nature, while in toxic endothelial cell destruction, edema appears in less than 24 hours after surgery.
|
|
|
On what schedule are dilating drops administered prior to cataract surgery?
a) 2 times at 30 minute intervals starting 1 hour before surgery b) every 10 minutes for 4 doses at least 1 hour before surgery c) 1 times, 10 minutes before surgery d) 4 times, every 15 minutes before surgery |
b) every 10 minutes for 4 doses at least 1 hour before surgery
|
|
|
Following cataract surgery, the patient is required to wear a protective eye patch for:
a) 1 day b) 5 days c) 7 days d) 2 weeks |
a) 1 day
|
|
|
Following cataract surgery, the patient is required to wear eye glasses during the day, and a metal shield at night for how long?
|
1-4 weeks
|
|
|
The patient that underwent cataract surgery complains of blurred vision 8 days after the surgery. What do you do?
a) report this as a normal finding b) tell the patient something has gone terribly wrong c) refer the patient to the doctor d) tell the patient you don't give a crap about his eyes, its Friday |
a) report this as a normal finding: the patient may experience blurring of vision for several days to weeks!
|
|
|
True or False: Patient with IOL implants have functional vision on the first day after surgery.
|
True!
|
|
|
Home care teaching for the patient who underwent an IOL implant includes: Check all that apply:
a) wear glasses at all times following surgery until instructed by the doctor b) you may not bathe or shower for 1-2 days c) keep activity light d) do not lift/pull/push objects heavier than 15 lbs |
a) wear glasses at all times following surgery until instructed by the doctor
c) keep activity light d) do not lift/pull/push objects heavier than 15 lbs |
|
|
____ is a condition characterized by a conical protuberance of the cornea with progressive thinning on the protrusion and irregular astigmatism.
|
Keratoconus
|
|
|
What type of contact lenses can be prescribed for a patient with keratonconus?
a) soft b) pigmented c) medicated d) rigid |
d) rigid, gas permeable contact lenses correct irregular astigmatism and improve vision
|
|
|
Following a keratoplasty (corneal transplantation or corneal grafting) the patient is required to administer mydriaties (medications causing pupillary dilation) for how long?
a) 1 day b) 1 week c) 10 days d) 2 weeks |
d) 2 weeks
|
|
|
True or False, following a keratoplasty, the patient will be able to immediately see the natural and true colors of their environment.
|
False: They will see the true colors of their environment sever months after the surgery, but not right away.
|
|
|
What are early signs and symptoms of graft failure after a keratoplasty?
|
blurred vision, discomfort, tearing, or redness of the eye
|
|
|
How is graft rejection treated?
a) the graft is removed b) a new graft is inserted c) corticosteroids are given c) the patients old preserved cornea is put back on |
c) corticosteroids are given topically ever hour and peri ocular corticosteroid injections are given
|
|
|
Patient teaching of the client preparing to undergo a refractive surgery includes:
a) this will alter the normal aging process of the eye b) you will have to stop wearing your contact lenses for 2-4 weeks prior to surgery c) if you have high IOP you would not be a good candidate d) you must be at least 12 years old |
b) you will have to stop wearing your contact lenses for 2-4 weeks prior to surgery
|
|
|
True or False, compared to photorefractive keratectomy (PRK), LASIK has more postoperative discomfort, has more side effects, and is less safe.
|
False: LASIK causes less postoperative discomfort, has fewer side effects, and is safer than PRK.
|
|
|
What is a vision-threatening complication of LASIK surgery?
a) optic nerve detachment b) corneal gangrenous syndrome (CGS) c) diffuse lamellar keratitis (DLK) d) retinal detachment |
c) diffuse lamellar keratitis (DLK) is a noninfectious, inflammatory reaction in the lamellar interface after LASIK
|
|
|
Proliferative retinopathy is associated with:
a) retinal detachment b) macular edema c) blue/green color blindness d) halo vision in low light |
a) retinal detachment: between 5-10% of all retinal detachments are associated with proliferative retinopathy
|
|
|
What might the patient with the following symptoms have: sensation of a shade or curtain coming across the vision of one eye, cobwebs, bright flashing lights, or the sudden onset of a great number of floaters and NO complaints of pain.
|
retinal detachment
|
|
|
How is the patient positioned critical following a pneumatic retinopexy?
|
So that the injected bubble will float into a position overlying the area of retinal detachment, providing consistent pressure to reattach the retina
|
|
|
How is the patient positioned following a pneumatic retinopexy?
a) on their back b) on their side or face down c) on their back with their upper body raised 45 degrees d) on their stomach with their legs raised 45 degrees |
b) on their side or face down
|
|
|
True or False: Most visual loss associated with central retinal artery occlusion is mild and treatable.
|
False: Most visual loss associated with central retinal artery occlusion is severe and permanent!
|
|
|
____ is characterized by yellowish spots called drusen beneath the retina.
|
macular degeneration
|
|
|
In macular degeneration, ___ vision is generally affected the most.
a) black and white b) peripheral c) central d) color |
c) central
|
|
|
What antioxidants, given in megadoses can slow the progression of acute macular degeneration?
|
Vitamin C, E, and beta-carotene
|
|
|
What minerals, given in megadoses can slow the progression of acute macular degeneration?
|
zinc oxide
|
|
|
What is photodynamic therapy?
|
Photosensitive dye is injected into the eye vasculature and a laser is aimed at the extra areas of blood vessels to kill them.
|
|
|
Important teaching for the patient who underwent photodynamic therapy is?
|
Bring dark sunglasses, gloves, a wide-brimmed hat, long sleeved shirt, and slacks to the setting where the PDT will be performed: The dy within the blood vessels near the surface of the skin could become activated with expose to outdoor light, tanning booths, halogen lights...so the patient must cover all skin and avoid direct sunlight exposure for 5 days following treatment
|
|
|
What happens if the patient who underwent photodynamic therapy inadvertently is exposed to sunlight?
|
Their skin could blister severely and burn, which may require plastic surgery.
|
|
|
The patient in the ER has suffered blunt orbital trauma. What might you inspect their face for?
|
underlying fractures
|
|
|
What is proptosis and when would it occur?
|
Its the downward displacement of the eyeball which can occur after soft tissue injuries.
|
|
|
The nurse knows that orbital roof fractures are dangerous because of potential complication to the ____.
a) brain b) heart c) esophagus d) trachea |
a) brain
|
|
|
_____ is the leading cause of blindness among children and adults.
a) orbital trauma b) macular degeneration c) proliferative retinopathy d) ocular trauma |
d) ocular trauma
|
|
|
What is the first step you would take on scene, if a person got something lodged in their eye?
a) remove the object in one smooth and quick movement b) apply pressure to the eye with a saline or water soaked gauze c) if possible cover the eye with a dixie cup d) try to wiggle the object to determine how far in it is |
c) if possible cover the eye with a dixie cup to protect the object from jarring or movement to prevent further ocular damage until medical treatment can be obtained
|
|
|
True or False: In cases of a ruptured globe, the eye is paralyzed with cycloplegic agents, and a topical antibiotic is applied.
|
False: Those are avoided because of the potential toxicity to exposed intraocular tissue through the ruptured membrane.
|
|
|
True or False: Topical anesthetic eye drops are given to patient with eye injuries to help ease discomfort and decrease the urge to rub or itch the eye.
|
False: Topical anesthetic eye drops must not be given to the patient to take home for repeated use after corneal injury because their effects mask further damage, delay healing, and can lead to permanent corneal scarring.
|
|
|
What is done to prevent sympathetic ophthalmia ( an inflammation created in the uninjured eye by the affected eye that can result in blindness of the uninjured eye) ?
|
The injured eye is removed 2 weeks after the inital injury that penetrated the eye and caused it to lose its vision.
|
|
|
Which ocular burns, alkali or acid, is more dangerous and why?
|
Alkali burns (ammonia) result in the most severe injury because they penetrate the ocular tissues rapidly and continue to cause damage long after the initial injury is sustained.
|
|
|
What in chlamydial conjunctivitis caused corneal erosion and ulceration?
|
the inward turning of hair follicles that rub against the cornea and break it down
|
|
|
How is inclusion conjunctivitis spread?
|
oral-genital sex, or hand to eye transmission; indirect tranmission can occur in an inadequately chlorinated swimming pool :/
|
|
|
True or False: Epidermic keratoconjunctivitis is not easily transmitted from person to person, but has been know to be spread in individuals sharing eye liner.
|
False: It is a highly contagious conjunctivitis that is easily transmitted from one person to another among household members, school children, and health care workers.
|
|
|
What type of conjunctivitis requires urgent antibiotic therapy because if left untreated, it can lead to corneal perforation and blindness?
a) allergic b) toxic c) bacterial d) viral |
c) bacterial
|
|
|
Patient instructions of the client with viral conjunctivitis includes:
a) there will be no discharge b) symptoms will resolve in 2 weeks c) use hot compresses 4-5 times a days to soothe the pain d) you need to stay home from work or school for 3-7 days |
d) you need to stay home from work or school for 3-7 days
|
|
|
What genetic condition is characterized by a white pupil, which indicates a life-threatening tumor for which the only treatment is removal of one or both eyes?
|
Retinoblastoma
|
|
|
What visual problems do patients with Marfan syndrome have?
a) myopia b) hyperopia c) blue/green color blindness d) red/yellow color blindness |
a) myopia
|
|
|
Marfan syndrome are at an increased risk for:
a) lebar amaurosis b) retinal detachment c) orbital tumors d) conjunctivitis |
b) retinal detachment
|
|
|
What is enucleation?
|
Removal of the entire eye and part of the optic nerve.
|
|
|
True or False: During the enucleation, the prosthetic eye is put into socket.
|
False: After the diseased eye is removed (enucleation) an orbital implant or conformer (made of silicone rubber) is put into the socket to maintain the shape while the socket heals. After about 8 weeks, the prosthetic eye is put in put in.
|
|
|
Patients who undergo eye removal need to know that they will usually have:
a) a small pressure dressing worn for 2-3 days b) a small occlusive dressing c) a large ocular pressure dressing worn for a week d) a small ocular pressure dressing worn for 1-2 weeks |
c) a large ocular pressure dressing worn for a week
|
|
|
How is depth perception effected when a patient has a prosthetic eye?
a) it is decreased b) it is increased c) it no longer exists |
c) it no longer exists
|
|
|
Patients with prosthetic eyes are told to gaze ____ to bring the eye to the inferior eyelid margin for removal.
a) upward b) downward c) to the left d) to the right |
a) upward
|
|
|
True or False: Hygiene and comfort of the patient with the prosthetic eye are usually maintained with daily irrigation of the prosthesis in place with alcohol.
|
False: It is cleansed in the socket with normal saline, hard contact lens solution or artificial tears.
|
|
|
True or False: The patient's prosthetic eye can be repositioned with the use of their gloved hand.
|
False: They only need a clean hand, not gloved.
|
|
|
Proper wiping of the prosthesis should be a gentle ____ to ___ motion to avoid mal-position.
a) up to down b) down to up c) nasal to temporal d) temporal to nasal |
d) temporal to nasal
|
|
|
What is the major disadvantage of eye ointments?
a) they have a short half life b) they cause blurred vision c) they burn d) they are easily swept away by blinking |
b) they cause blurred vision
|
|
|
What do mydriatic and cycloplegic agents cause?
|
pupil dilation
|
|
|
Following an eye examination in which the pupils were dilated, what should the patient do?
a) take pcp or a psychedelic to enhance the visual experience b) wipe the medication from their eyes using sand paper c) return to their job as an air traffic controller d) wear a large pair of sunglasses |
Did you really flip this card over?
|
|
|
Hyperventilation is aimed at keeping a low level of serum ___ so that cerebral blood flow decreases and reduces cerebral blood volume, thereby reducing ICP.
a) O2 b) CO2 c) PCO2 d) CO3 |
c) PCO2
|
|
|
What IV fluids would you avoid administering in a patient with high ICP?
a) normal saline and 2% dextrose b) 5% dextrose and .22% sodium chloride c) 3% dextrose and saline d) 5% dextrose and normal saline |
b) 5% dextrose and .22% sodium chloride because these are hypotonic IV fluids that will cross the blood brain barrier resulting in increased cerebral edema and ICP
|
|
|
How does Mannitol work?
|
It causes the loss of sodium chloride and water.
|
|
|
What test is accepted as being able to diagnose a seizure disorder?
a) EKG b) EEG c) echo d) doppler study |
b) EEG
|
|
|
While working, you walk in on a child having a seizure. What is the first thing you do?
a) call for help b) assess the airway c) loosen restrictive clothing d) administer Valium |
a) call for help
|
|
|
The nurse knows that the most common cause of primary encephalitis are: Pick two:
a) mosquito b) poor hygiene c) herpes simplex d) intercranial surgery |
a) mosquito
c) herpes simplex |
|
|
How are patient's organs affected in Reye syndrome?
a) they are shrunken b) they are covered in fat c) they are hypersensitive d) they are occluded with calcium |
b) they are covered in fat
|
|
|
How is the ammonia, glucose and urea concentrations in the blood effected in Reye syndrome?
|
high ammonia (hyperalbuminemia)
low glucose (hypoglycemia) high urea (Azotemia) |
|
|
How is a diagnoses of Reye syndrome established definitively?
|
A liver biopsy.
|
|
|
How will the patient be positioned on the operating table for a liver biopsy?
|
on their back with their right arm under their head
|
|
|
How is the child positioned postoperatively after a liver biopsy?
a) flat on their back with HOB raised 30 degrees b) flat on their back with HOB flat c) on their left side, off of the incision site d) on their right side, on the incision site |
d) on their right side, on the incision site to help apply pressure and prevent bleeding
|
|
|
What would support a clinical diagnoses of Guillain-Barre syndrome?
a) low CSF protein and +CSF bacteria b) high CSF protein and +CSF bacteria c) low CSF protein and -CSF bacteria d) high CSF protein and -CSF bacteria |
b) high CSF protein and +CSF bacteria
|
|
|
What is a big issue with those with GBS?
a) dizziness b) peripheral neuropathy c) pain d) permanent vision loss |
c) pain: They require opioid analgesia that is administered on a scheduled basis to treat the severe neuralgia.
|
|
|
How could you visually detect possible Spina Bifida in an infant?
|
Look for a dimple or tuft of hair on the infant's back.
|
|
|
If an infant has a meningocele neural tube defect, they will have a ___ located on the cervical, thoracic or lumbar spine at the level of the defect.
a) protruding sac b) tuft of hair c) bruising d) edema |
a) protruding sac
|
|
|
In general, a child with spina bifida has ___ neurological function below the defect.
a) full b) partial c) no d) spastic |
c) no
|
|
|
The nurse observes a protruding membranous sac on an infant's back. He has a diagnoses of spina bifida. What is this sac mainly composed of?
a) serous fluid b) puss c) sanguineous fluid d) CSF |
d) CSF: It is imperative that this sac is not disturbed.
|
|
|
What lab test can be done during pregnancy to detect for neural tube defect?
a) beta-microprotein b) alpha-proteinkinase c) rhogam d) alpha-fetoprotein |
d) alpha-fetoprotein
|
|
|
Following birth, what does the nurse do to prevent injury of the sac in an infant with a neural tube defect?
|
The nurse immediately covers the sac with a sterile nonadherent dressing moistened with sterile saline to maintain moisture and prevent drying.
|
|
|
True of False: A newborn with a neural tube defect should have passive ROM exercises performed every 2 hours to prevent contractures.
|
False: The nurse should not perform ROM on the hips, as displacement is common. Passive ROM exercises may be performed on all other parts.
|
|
|
How does the nurse position the diaper over the sac to prevent it from rupturing?
|
She doesn't place a diaper over the defect at all! The infant is positioned on their stomach until surgery to prevent rupturing of the sac and further leakage of CSF and related risk of infection.
|
|
|
How can pregnant women decrease their risk of having a baby with spina bifida? Check all that apply:
a) avoid hot tubs b) maintain normal blood glucose levels c) review your antiseizure meds with your doctor d) take 400 mg of folic acid daily |
All of the above!
|
|
|
What causes hydrocephaly?
|
An increase in CSF production, an impedance to CSF absorption, or an obstruction of flow.
|
|
|
The nurse knows that hydrocephalus:
a) is a lifelong disorder b) is curable with surgery c) is curable with shunts d) occurs only during infancy |
a) is a lifelong disorder: Shunts will be put in, and have to be replaced and/or repositions many times
|
|
|
What should you tell the parents of a child with hydrocephalus who wants to play football?
a) he will have to wear a special helmet b) he cannot ever play contact sports c) he will can play sports after the shunts are put in d) he will have to take extra medications if he wants to play contact sports |
b) he cannot ever play contact sports
|
|
|
What condition is characterized by hips and legs that having scissoring(legs turned inward and cross at the knees)?
|
Cerebral palsy
|
|
|
An important sign of CP is persistence of:
a) primitive reflexes b) crawling without progression to walking c) non dominant hands d) baby teeth |
a) primitive reflexes (i.e. Moro and crossed extensor reflexes)
|
|
|
At what age do normal primitive infant reflexes disappear?
a) 1 month b) 3 months c) 6 months d) 12 months |
c) 6 months
|
|
|
The hallmark of ___ is an absence of external trauma to the head, face, and neck of an infant along with massive intracranial or intraocular bleeding.
|
shaken baby syndrome
|
|
|
___ is a non progressive neurological disorder that result from brain injury occurring before cerebral development is complete.
|
Cerebral palsy
|
|
|
The pediatric nurse is admitting a child with a history of seizure activity. The nurse is aware that seizure precautions must be assembled at the bedside, which includes:
a) ventilator machine b) suction equipment c) a padded tongue blade d) intubation equipment |
b) suction equipment
|
|
|
True or False: The use of prolonged video gaming has been found to be a high risk precipitating factor for seizures in children.
|
True!
|
|
|
What syndrome is the most common from of acquired acute paralysis in children?
|
Guillian Barre Syndrome.
|
|
|
Can patient drive home after an eye examine in which their pupils were dilated?
|
The ability to drive is dependent on the person's age, vision, and comfort level.
|
|
|
True of False: Absorption of eye drops by the nasolacrimal duct is favorable and facilitated by tilting the head back.
|
False: Absorption of eye drops by the nasolacrimal duct is undesirable because of the potential systemic side effects of ocular medications.
|
|
|
How do you prevent the eye drops from just flowing right into the nasolacrimal duct?
|
Occlude the duct for 1-2 minutes with your finger, following administration of eye drops.
|
|
|
What is the patient recommended to do if they are unable to feel the eye drops when they are instilling them?
|
They can refrigerate them because a cold drop is easier to detect.
|
|
|
The patient with multiple eye drop medications is recommended to wait ___ to ___ minutes before instilling another eye medication.
|
5-10 minutes
|
|
|
The external ear is separated from the middle ear by a disk-like structure called the ____.
|
tympanic membrane
|
|
|
The nurse knows that the organ for hearing is the:
a) ear b) semicircular canals c) cochlea d) tympanic membrane |
c) cochlea
|
|
|
What structure is responsible for providing feedback regarding the movements and the position of the head and body in space?
a) tympanic membrane b) vestibular apparatus c) cochlea d) stapes |
b) vestibular apparatus
|
|
|
What tool is used to inspect the tempanic membrane?
|
an otoscope
|
|
|
A person with conductive hearing loss hears the sound better in the (affected/unaffected) ear?
|
affected
|
|
|
The patient with sensorineural hearing loss hears the sound in the (affected/unaffected) ear.
|
unaffected
|
|
|
True or False: A person with conductive hearing loss hears air-conduction sounds longer than bone conduction sound.
|
False: A person with SENSORINEURAL hearing loss hears air-conduction sounds longer than bone conduction sound
|
|
|
True or False: A person with conductive hearing loss hears bone-conducted sound as long as or longer than air-conducted sound.
|
True!
|
|
|
In detecting hearing loss ____ is the single most important diagnostic instrument.
|
audiometry
|
|
|
The frequencies ranging from 500 to 2000 Hz are important in understanding what?
|
speech
|
|
|
A patient going down for an electronystagmography would need to withhold what medications 24 hours before the test?
|
Any vestibular suppressants such as sedatives, tranquilizers, antihistamines, and alcohol.
|
|
|
Hearing loss is greater in (men/women)?
|
men
|
|
|
_____ hearing loss usually results from an external ear disorder, such as impacted cerumen, or a middle ear disorder, such as otitis media or otosclerosis.
a) sensorineural b) conductive c) mixed |
b) conductive
|
|
|
____ hearing loss involves damage to the cochlea or vestibulocochlear nerve.
a) sensorineural b) conductive c) mixed |
a) sensorineural
|
|
|
What is the most common environmental factor that over time results in permanent sensorineural hearing loss?
a) noise b) water c) moisture d) penetrating trauma |
a) noise
|
|
|
_____ has been found to cause constriction of peripheral blood vessels, increased BP and heart rate and increased GI activity.
a) bright lights b) low lights c) loud noise d) quiet noise |
c) loud noise
|
|
|
The nurse knows that the minimum noise level known to cause noise-induced hearing loss, regardless of duration is about:
a) 30-40 dB b) 40-60 dB c) 85-90 dB d) 100-125 dB |
c) 85-90 dB
|
|
|
What might a symptom of hearing loss be?
a) fatigue b) weight gain c) clear fluid draining from the ear d) sanguineous drainage from ear |
a) fatigue: If a person tired easily when listening to conversation or to a speech, fatigue may be the result of straining to hear.
|
|
|
Risk factors for hearing loss include
a) low birth weight b) infrequent ear infections c) listening to music at 35 dB d) over sleeping |
a) low birth weight
|
|
|
What changes occur in the cerumen as we age?
|
it becomes harder and dryer
|
|
|
A doctor mentions that your patient has prebycusis. What is this?
|
Progressive hearing loss
|
|
|
What are some examples of ototoxic medications?
|
gentamicin, loop diuretics, aminoglycosides, aspirin and quinine
|
|
|
When preparing written material for the person who is hearing impaired whose speech is difficult to understand, you know that any written material should be written at:
a) a 3rd grade level b) a 5th grade level c) a 9th grade level d) a 12th grade level |
a) 3rd grade level
|
|
|
True or False: If a patient has an impacted ear(with earwax) they must be instructed not to insert anything more than 1/2 inch into the ear, as it will risk perforation of the ear drum.
|
False: They should be instructed not to insert ANY objects into the ear as it could cause trauma to the skin, infection, and damage to the tympanic membrane.
|
|
|
True or False: Cerumen removal by irrigation should be carried out with extreme caution if the eardrum is known to be perforated.
|
False: If the eardrum is perforated, you should don't use any liquid in the ear as it is not able to enter the middle ear and cause acute vertigo and infection.
|
|
|
What fluids can be instilled in the ear to help soften and facilitate removal of impacted earwax? Check all that apply:
a) betadine b) glycerin c) mineral oil d) alcohol e) half-strength hydrogen peroxide |
b) glycerin
c) mineral oil e) half-strength hydrogen peroxide |
|
|
Other than a perforated ear drum, under what other circumstances would irrigation be contraindicated?
|
If food or bugs were stuck in the ear, the liquid would cause them to swell causing further obstruction.
|
|
|
What is external otitis?
|
Inflammation of the external auditory canal.
|
|
|
On otoscopic examination, a patient with external otitis might have an ear canal that looks:
a) hairy and moist b) dark and sticky c) red and swollen d) pale and dry |
c) red and swollen
|
|
|
What color discharge can be expected of the person diagnosed with external otitis?
a) cloudy and white b) yellow and green c) red and brown d) clear |
b) yellow and green
|
|
|
True or False: If the tissue of the external canal are edematous a flexible stent should be inserted to keep the canal open so that liquid medication can be introduced.
|
False: A wick should be used.
|
|
|
What can be done to prevent ear infections after swimming?
a) gently plug the ears with Vaseline b) advise the client not to go underwater, (keep head above water) c) administer Swim Ear or Ear Dry d) administer 4-5 mL of alcohol after swimming |
c) administer Swim Ear or Ear Dry otic preparations for use after swimming
|
|
|
What common household item can be used as an astringent to help prevent infection after water exposure?
|
a few drops of alcohol after swimming
|
|
|
If otitis external is diagnosed, you would instruct the patient to avoid water sport activities for how long?
a) 1-2 days b) 1 week c) 7-10 days d) 12-14 days |
c) 7-10 days: to allow the canal to heal completely
|
|
|
What is thought to cause exostoses(small, hard, bony protrusions found in the lower posterior bony portion of the ear canal)?
|
cold water exposure such as when scuba diving or surfing.
|
|
|
In acute otitis media what is usually present in the middle ear, resulting in a conductive hearing loss?
a) bony prominence b) cerumen c) purulent exudate d) vegetative lesions |
d) vegetative legions
|
|
|
If acute otitis media occurs frequently, ___ may be inserted which temporarily takes the place of the eustachian tube in equalizing pressure.
a) a stent b) a ventilating tube c) a wick d) a wire canal |
b) a ventilating tube
|
|
|
Patient teaching of the patient who underwent mastoid surgery includes removal of the pressure dressing
a) in 6-8 hours b) in 24-48 hours c) when the wound has healed d) when there is no longer drainage |
b) in 24-48 hours
|
|
|
What would the priority nursing assessment be in the PACU with the patient who had a mastoidectomy?
a) pain b) skin breakdown c) facial paresis d) weakness |
c) facial paresis due to inadvertent injury to the facial nerve during the surgery
|
|
|
True of False: The nurse teaches the patient who had a mastoidectomy to call the doctor if they experience sharp shooting intermittently pains as it may indicate infection.
|
False: For the next 2-3 weeks after surgery, the patient may experience sharp, shooting pains intermittently as the eustachian tube opens and allows air to enter the middle ear; constant, throbbing pain accompanied by fever may indicate infection and should be reported to the doctor
|
|
|
The patient who had a mastoidectomy is given what instructions regarding showing after the surgery?
|
Place a petroleum covered cotton ball into the external auditory canal to prevent water from entering for the 6 weeks following surgery.
|
|
|
What type of medication can be given if a balance disturbance or vertigo occurs after mastoid surgery?
a) NSAIDs b) pain relievers c) diuretics d) antihistamines |
d) antihistamines
|
|
|
A patient who inadvertently experienced chorda tympani nerve disturbance during mastoid surgery would be expected to present with what symptoms for several months until the nerve regenerates?
a) jaw tingling and pain b) taste disturbance and dry mouth c) lock jaw and stiffness d) vertigo |
b) taste disturbance and dry mouth
|
|
|
True or False: Patient who underwent mastoid surgery are instructed to avoid heavy lifting, exertion, and nose blowing for 2-3 days after surgery to prevent dislodging the tympanic membrane.
|
False: They are recommended to avoid those activities for 2-3 WEEKS.
|
|
|
What is nystagmus?
|
Involuntary rhythmic movement of the eyes.
|
|
|
What disorder is characterized by an abnormal inner ear fluid balance caused by a malabsorption in the endolyphatic sac?
|
Meniere's disease
|
|
|
What symptoms are typical of Meniere's disease?
|
fluctuating sensorineural hearing loss, tinnitus, pressure and vertigo
|
|
|
What is usually the most troublesome complaint related to Meniere's disease?
a) vertigo b) tinnitus c) hearing loss d) nausea/vomiting |
a) vertigo
|
|
|
What might the dietary guidelines be for a person with Meniere's disease?
|
Limit coffee, tea, soft drinks, caffeine, alcohol and MSG
|
|
|
What is the primary treatment for Meniere's disease because of its relatively simple and safe basis?
a) anti-inflammatories b) shunting c) diuretics d) needle aspiration |
b) shunting or endolyphatic sac decompression
|
|
|
True or False: Ototoxic medications are never instilled into the ear due to the risk of total hearing loss.
|
False: ototoxic medications can be administered to patients by infusion into the middle and inner ear; these medications are used to destroy vestibular function and decrease vertigo.
|
|
|
____ provides the greatest success rate(98%) in eliminating attacks of vertigo.
|
Vestibular nerve sectioning.
|
|
|
What might a patient have that would suggest an impending attack?
a) a headache b) an aura c) dizziness d) confusion |
b) an aura
|
|
|
What can be done to minimize vertigo?
a) sedate the patient b) encourage frequent ambulation c) place pillows on either side of their head d) have the patient close their eyes when experiencing vertigo |
c) place pillows on either side of their head
|
|
|
The patient is recommended to ___ when lying down and experiencing vertigo.
a) close their eyes b) blink rapidly c) open their eyes and look straight ahead d) cover their eyes |
c) open their eyes and look straight ahead
|
|
|
What do the following conditions contribute to? thyroid disease, hyperlipidemia, vitamin B12 deficiency, psychological disorders(depression, anxiety), fibromyalgia, otologic disorders, and neurologic disorders
a) vertigo b) tinnitus c) headaches d) restlessness |
b) tinnitus
|
|
|
What do nitrogen mustard and cisplatin have in common?
|
They are ototoxic.
|
|
|
What type of medication are the following drugs: amikacin, gentamicin, kanamycin, netilmicin, neomycin, streptomycin and tobramycin.
|
They are all aminoglyosides antibiotics that cause ototoxicity.
|
|
|
What do gold, mercury and lead have in common!?!
a) they taste very nice b) they are worth a lot of money c) they are found in thermometers d) they are ototoxic |
d) they are ototoxic
|
|
|
A doctor diagnoses his patient with labyinthitis, what is this?
|
inflammation of the inner ear
|
|
|
Mumps, rubella, rubeola, and influenza are the most common viral causes of ___?
a) sinusitis b) tinnitus c) labyinthitis d) chronic otitis media |
c) labyinthitis
|
|
|
What are common causes of Benign Paroxysmal Positional Vertigo?
|
head trauma, infection, or other events
|
|
|
Does hearing impairment typically occur with benign paroxysmal positional vertigo?
|
No.
|
|
|
What activity level is recommended for patients with benign paroxysmal positional vertigo with acute symptoms?
|
bed rest
|
|
|
What is characterized by the following symptoms: sudden onset of incapacitating vertigo, usually with nausea and vomiting, various degrees of hearing loss, and possibly tinnitus.
|
labyinthitis
|
|
|
What test can be used to reposition the debris that causes vertigo in benign paroxysmal positional vertigo?
a) tilt table test b) canalith repositioning procedure c) vibratatory inducer d) vestibuloreflex positioning |
b) canalith repositioning procedure
|
|
|
Patients with acute vertigo may be treated with ____ for 1 to 2 weeks.
|
Meclizine
|
|
|
Patients with positional vertigo may undergo what type of therapy to assist their brain in compensating for the impairment to the balance system.
a) occupational therapy b) physical therapy c) sclerotherapy d) vertibulotherapy |
b) physical therapy
|
|
|
Who is at the highest risk for ototoxicity?
|
children, elderly,pregers and patients with kidney or liver problems
|
|
|
Do patients with acoustic neuromas have bilateral or unilateral tinnitus and hearing loss?
|
unilateral
|
|
|
What is the treatment of choice of patients with acoustic tumors?
a) chemotherapy b) radiation c) surgery d) immunosuppressants |
c) Surgical removal of acoustic tumors is the treatment of choice because these tumors do not respond well to radiation or chemotherapy.
|
|
|
What is aural rehabilitation?
|
Rehab for the hearing impaired that involves maximizing communication skills of the person with hearing impairment. Aural rehabilitation includes auditory training, speech reading, speech training, and the use of hearing aids and hearing guide dogs.
|
|
|
Hearing aides for sensorineural hearing loss:
a) depress the low frequencies and enhance hearing for the high frequencies b) depress the high frequencies and enhance hearing for low frequencies c) enhance the high and low frequencies d) depress the high and low frequencies |
a) depress the low frequencies and enhance hearing for the high frequencies
|
|
|
True or False: A hearing aid makes sound louder and improved a patients ability to discriminate words and understand speech.
|
False: They do makes sounds louder but have NO effect on improving speech understanding and discrimination
|
|
|
Before purchasing a hearing aid, what should the patient do?
a) inquire about mold fittings b) determine the cost of each hearing aide c) weight the pros and cons of each type of devise d) be evaluated by an MD |
d) be evaluated by an MD
|
|
|
What could be the cause of a whistling noise coming from a hearing aid?
a) loose ear mold b) improperly made hearing aid c) improperly worn d) worn out |
All of the above!
|
|
|
What type of hearing aid is generally used in a school setting, and consist of a separate receiver and microphone?
a) in the ear b) in the canal c) body |
c) body
|
|
|
What type(s) of hearing aid(s) require good manual dexterity to operate?
a) in the ear b) in the canal c) body |
a) in the ear
b) in the canal |
|
|
Patient with conductive hearing loss with chronic ear infections are not able to wear hearing aids so what type of devise would be recommended?
a) cochlear implant b) postauricularly implanted bone conduction devise c) in the ear hearing aide d) audi amplifier |
b) postauricularly implanted bone conduction devise
|
|
|
The patient planning on getting a bone conduction devise needs further teaching when they say:
a) I will no longer have to wear anything on my ears! b) My hearing will significantly improve c) I will need yearly follow up examinations for hearing screening d) I wont have to worry about changing those little batteries anymore |
a) I will no longer have to wear anything on my ears! The device is implanted postauricularly under the skin into the skull, and an external device-worn above the ear, transmits the sound through the skin.
|
|
|
The cochlear implant delivers sound:
a) through the skin b) through the external ear c) to the auditory nerve d) to the vestibular nerve |
c) to the auditory nerve
|
|
|
Patients who have had a cochlear implant are cautioned that a ___ will inactivate the implant.
a) CT-scan b) X-ray c) MRI d) echocardiogram |
c) MRI
|
|
|
What do hearing guide dogs do?
|
They are taught to react to the sound of a telephone, a doorbell, an alarm clock, a baby's cry, a knock at the door, a smoke alarm, or an intruder.
|
|
|
The division of the nervous system that is composed of the brain and the spinal cord is called the ____.
|
central nervous system
|
|
|
What are the three parts of the neuron?
|
cell body, axon, dendrite
|
|
|
What type of cells support, protect, and nourish neurons?
a) helper cells b) nurse cells c) astrocytes d) ganglions e) neuroglial cells |
e) neuroglial cells
|
|
|
Myasthenia gravis is associated with a decrease in what neurotransmitter?
a) acetylcholine b) GABA c) dopamine d) ATP |
a) acetylcholine
|
|
|
Alcohol withdrawl is associated with an increase in what neurotransmitter?
a) acetylcholine b) GABA c) dopamine d) ATP |
b) GABA
|
|
|
Parkinson's disease is associated with a decrease in what neurotransmitter?
a) acetylcholine b) GABA c) dopamine d) ATP |
c) dopamine
|
|
|
What structure in the brain is responsible for control of fine motor movements, including those of the hands and lower extremities?
a) thalamus b) hypothalamus c) basal ganglia d) cerebrum |
c) basal ganglia
|
|
|
What structure in the brain is responsible for maintaining temperature regulation by promoting vasoconstriction or vasodilation?
a) thalamus b) hypothalamus c) basal ganglia d) cerebrum |
b) hypothalamus
|
|
|
What structure in the brain is responsible for hunger, sleep-wake cycle, blood pressure, aggressive/sexual behavior, and emotional responses?
|
hypothalamus
|
|
|
True or False: Normal CSF normally contains a small number of RBC and minimal number of white blood cells.
|
False: Normally it contains no RBC and a minimal number of WBCs.
|
|
|
What is a frequent site of aneurysms in the brain?
|
circle of Willis
|
|
|
What is special about the circle of Willis in terms of artery occlusion?
|
The arteries of the circle of Willis can provide collateral circulation if one or more of the four vessels supplying it become occluded or are ligated.
|
|
|
Sympathetic stimuli are mediated by what neurotransmitter?
|
norepinephrine
|
|
|
Parasympathetic impulses are mediated by what neurotransmitter?
|
acetylcholine
|
|
|
If anterior horn motor cells are destroyed, is regeneration possible?
|
No; the nerves cannot regenerate and the muscles are never useful again.
|
|
|
What structure, which coordinates motor movements and posture, if damaged would result in exaggerated, uncontrolled movements?
|
basal ganglia
|
|
|
What is being tested, when the patient is asked to close their eyes and identify a variety of objects placed in their hands?
a) sternogenesis b) heterogensis c) tactile sensation c) fine motor discrimination |
a) sternogenesis
|
|
|
The brain consumes what percentage of the glucose the body uses?
a) 10% b) 35% c) 50% d) 80% |
d) 80%
|
|
|
What test involves an x-ray of the spinal subarachnoid space taken after the injection of a contrast agent into the spinal subarachnoid space through a lumbar puncture?
|
Myelogram
|
|
|
What is the recommended activity for a patient following a myelogram?
|
bedrest for 3 hours with HOB elevated 30-45 degrees
|
|
|
Into which location, is the needle usually inserted, for a lumbar puncture?
a) 1st-3rd lumbar vertebrae b) 2nd-4th lumbar vertebrae c) 3rd-5th lumbar vertebrae |
c) 3rd-5th lumbar vertebrae
|
|
|
What position is the patient put into for a lumbar puncture?
a) dorsal recumbent b) supine with knees flexed c) prone with arms raised d) lateral recumbent |
d) lateral recumbent
|
|
|
The cerebrum consists of two hemispheres that are incompletely separated by what structure?
|
the great longitudinal fissure
|
|
|
Which lobe of the brain is responsible for concentration, abstract thought, memory, and motor function?
a) occipital b) temporal c) frontal d) cerebrum |
c) frontal
|
|
|
What area is critical for motor control of speech?
|
Broca's area
|
|
|
What lobe of the brain contains the auditory receptive areas?
|
temporal lobe
|
|
|
What lobe of the brain is responsible for visual interpretation?
|
occipital
|
|
|
What structure connects the two hemispheres of the brain?
|
corpus callosum
|
|
|
Which lobe is responsible for a person's awareness of the body in space, as well as orientation in space and spatial relations?
|
parietal
|
|
|
What three structures make up the brain stem?
|
midbrain, pons and medulla
|
|
|
What are the three fibrous connective tissue layers of the brain from inside out?
|
Pia, Arachnoid, Dura
|
|
|
What layer of the brain is tough, thick, inelastic, fibrous, and gray?
a) pia b) arachnoid c) dura |
c) dura
|
|
|
Which layer of the brain is thin, transparent and hugs the brain closely extending into every fold of the brain's surface?
a) pia b) arachnoid c) dura |
a) pia
|
|
|
Which layer of the brain is white, extremely thin and delicate, and closely resembles that of a spider's web?
a) arachnoid b) pia c) dura |
a) arachnoid
|
|
|
The choroid plexus is an important structure in the arachnoid layer because of its production of:
a) WBC b) glial cells c) ganglions d) CSF |
d) CSF
|
|
|
In what space is CSF contained?
|
subarachnoid space
|
|
|
Each spinal nerve contains a ___ and ___ root.
a) superior, inferior b) deep, superficial c) ventral, dorsal d) hypoglossal, hyperglossal |
c) ventral, dorsal
|
|
|
The dorsal roots are (sensory/motor) and the ventral roots are (sensory/motor).
|
dorsal-sensory
ventral-motor |
|
|
A parasympathetic response would cause the pupils to dilate or constrict?
|
constrict
|
|
|
A sympathetic response would cause the pupils to dilate or constrict?
|
dilate
|
|
|
While conducting a neurological examination, the nurse shows the patient a pencil but he is unable to recognize it or know what it is called. What does this patient suffer from?
a) short term memory loss b) long term memory loss c) sternogenesis d) agnosia |
d) agnosia
|
|
|
A lesion in the occipital lobe would cause what kind of agnosia?
a) auditory b) visual c) tactile d) body parts and relationships |
b) visual
|
|
|
A patient with auditory agnosia most likely has a lesion in which area of the brain?
|
the temporal lobe
|
|
|
A patient with tactile agnosia most likely has a lesion in what area of the brain?
a) occipital b) temporal c) parietal d) frontal |
c) parietal
|
|
|
What reflex is being tested when a wisp of clean cotton is lightly touched to the corner of each eye on the sclera?
|
the corneal reflex
|
|
|
What might be needed if an active patient does not have a corneal reflex?
a) optical vasoconstrictors b) optical vasodilators c) glasses and lubrication d) optical corticosteroids |
c) glasses and lubrication to help prevent corneal damage
|
|
|
Normal plantar reflex involves stoking the lateral side of the foot with a tongue blade which should produce:
a) toe extension b) toe flexion c) ankle flexion d) ankle extension |
b) toe flexion
|
|
|
(Dementia/Delirium) is an acute change in mental status attributable to a treatable medical problem, while (dementia/delirium) is a chronic and irreversible deterioration of cognitive status.
|
delirium-acute and treatable
dementia-chronic irreversible |
|
|
To increase the chances of recording seizure activity, it is sometimes recommended that the patient be deprived of ___the night before the EEG.
a) food b) water c) medication d) sleep |
d) sleep
|
|
|
Why are coffee, tea, chocolate and cola drinks omitted in the meal before an EEG test?
|
Because of the caffeine.
|
|
|
True or False: An electromyography is a non-invasive x-ray that examines the cranial nerves.
|
False: It is graph obtained by inserting needle electrodes into the skeletal muscles to measure changes in the electrical potential of the muscles and nerves leading to them.
|
|
|
What is the recommended position for a patient that just underwent a lumbar puncture?
|
prone for 2-3 hours
|
|
|
What is a common complaint following a lumbar puncture, and how can you help prevent it?
|
headache, lie prone for 2-3 hours and increase fluid intake
|
|
|
Which of the following terms is used to describe rapid, jerky, purposeless movements of the extremities?
a) spondylosis b) chorea c) dyskinesia d) bradykinesia |
b) chorea
|
|
|
Which of the following terms is used to describe very slow voluntary movements and speech?
a) spondylosis b) chorea c) dyskinesia d) bradykinesia |
d) bradykinesia
|
|
|
Which of the following terms refers to impaired ability to execute voluntary movements?
a) spondylosis b) chorea c) dyskinesia d) bradykinesia |
c) dyskinesia
|
|
|
Of the following neurotransmitters, which demonstrates inhibitory action, helps control mood and inhibits pain pathways?
a) norepinephrine b) serotonin c) acetylcholine d) enkephalin |
b) serotonin
|
|
|
Upper motor neuron lesion cause
a) decreased muscle tone b) no muscle atrophy c) absent of decreased reflexes d) flaccid paralysis |
b) no muscle atrophy: they cause loss of voluntary control but do not cause muscle atrophy
|
|
|
Which of the following cranial nerves is responsible for facial sensation and corneal reflex?
a) facial b) trigeminal c) oculomotor d) vestibulocochlear |
b) trigeminal
|
|
|
Which of the following are sympathetic effects of the nervous system?
a) increased peristalsis b) decreased blood pressure c) decreased respiratory rate d) dilated pupils |
d) dilated pupils
|
|
|
A sympathetic response would cause increased or decreased peristalsis?
|
Decreased peristalsis
|
|
|
A patient suffering from ___ is in a state of unresponsiveness to the environment in which the patient makes no voluntary movement.
a) persistent vegetative state b) locked-in-syndrome c) akinetic mutism d) coma |
c) akinetic mutism
|
|
|
____ is a condition in which the unresponsive patient resumes sleep-wake-cycles after coma but is devoid of cognitive or affective mental function.
a) persistent vegetative state b) locked-in-syndrome c) akinetic mutism d) coma |
a) persistent vegetative state
|
|
|
___ results from a lesion affecting the pons and results in tetraplegia and inability to speak, while vertical eye movements and lid elevation remain intact and are used to indicate responsiveness.
|
b) locked-in-syndrome
|
|
|
What structure is in charge of controlling the heart, respirations and blood pressure?
a) basal ganglia b) thalamus c) hypothalamus d) brain stem |
d) brain stem
|
|
|
A patient presents with the following S+S: subtle behavioral changes, restlessness, increased anxiety and sluggish pupils. What might they be suffering from?
a) sympathetic response b) alternation in LOC c) hypoparasympathetic response d) all of the above |
b) alternation in LOC
|
|
|
The new nurse rates her patient with a 42 on the Glasgow Coma Scale. What do you conclude?
a) the patient is in a coma b) the patient is spastic c) the patient is on a ventilator d) the patient is a child e) the nurse doesn't know what she is doing |
e) the nurse doesn't know what she is doing: The scale ranges from 3 to 15 with 3 indicating severe impairment of neurologic function and 15 indicating a fully responsive patient
|
|
|
Lesions in the basal ganglia and upper brain stem would produce what type of breathing?
a) deep b) shallow c) Kussmaul d) Cheyne-Stokes |
d) Cheyne-Stokes
|
|
|
What would the eyes look like on the patient with increasing ICP?
|
Fixed dilated pupils
|
|
|
True or False: When taking the body temperature of an unconscious patient, position the thermometer on the opposite side of the endotracheal tube.
|
False: You never take the body temperature of an unconscious patient in the mouth. Take it rectally or tympanically. Axillary is the lease accurate method.
|
|
|
True or False: It is inappropriate for a nurse to blow a fan on a patient to facilitate cooling of an unconscious patient with a temperature as it will cause too rapid of a change in temperature.
|
False: An electric fan is an appropriate method of increasing surface cooling of the unconscious patient with a fever.
|
|
|
In which ventricles is ICP measured in, and what is a normal reading?
|
Lateral ventricles: 10-20 mm Hg
|
|
|
In the early stages of cerebral ischemia, blood pressure (rises/lowers) in response.
|
Rises in order to maintain cerebral blood flow.
|
|
|
Is increased ICP usually accompanied by a fast or slow pulse?
|
A slow bounding pulse.
|
|
|
Does high or low carbon dioxide result in increased ICP?
|
high carbon dioxide
|
|
|
Does high carbon dioxide cause vasoconstriction or vasodilation and what effect does this have on ICP?
|
High CO2 causes vasodilation, allowing more blood to enter the cranium thereby further INCREASING ICP.
|
|
|
When cerebral edema is present, how does the body try to compensate in the regulation of CSF?
|
It decreases the production of CSF to try to decrease pressure.
|
|
|
How is cerebral perfusion pressure calculated?
|
By subtracting the ICP from the mean arterial pressure.
|
|
|
What is the normal CPP?
a) 10-20 b) 30-60 c) 70-100 d) 100-120 |
c) 70-100
|
|
|
What has occurred in the patient presenting with the following symptoms: increasing systolic BP, widening pulse pressure, slowing of heart rate.
a) decreased ICP b) Addisonial reflex c) Cushings response d) intracranial collapse |
c) Cushings response
|
|
|
Why does Cushings response occur?
|
When cerebral blood flow decreases significantly.
|
|
|
What are the 3 components associated with Cushing's triad?
|
bradycardia, hypertension and bradypnea
|
|
|
Lumbar puncture is avoided in patients with:
a) Cushings b) mental retardation c) physical disabilities d) increased ICP |
d) increased ICP because the sudden release of pressure in the lumbar area can cause the brain to herniate
|
|
|
What would multiple A waves represent on fiberoptic monitor?
a) recurring elevations of ICP b) decreased intracranial compliance c) recurring depressions in ICP |
a) recurring elevations of ICP
|
|
|
What is an example of a key osmotic diuretic?
|
Mannitol
|
|
|
What effect on the heart do fluid volume and inotropic agents such as dobutamine hydrochloride(Dobutrex) and norepinephrine bitartrate (Levophed) have?
a) raise the BP b) raise the heart rate c) lower cardiac output d) raise cardiac output |
d) raise cardiac output
|
|
|
Which of the following would help to lower ICP:
a) hypoventilation of the patient b) hyperventilation of the patient c) fast IV fluid administration d) insertion of a foley catheter |
b) hyperventilation of the patient
|
|
|
The HOB should be elevated ___ degrees to aid in venous drainage to help decrease ICP.
a) 0-60 b) 60-80 c) 70-100 d) 100-120 |
a) 0-60
|
|
|
An increase of no more than __ mm Hg should occur during nursing interventions.
a) 10 b) 25 c) 35 d) 40 |
b) 25
|
|
|
True or False: Sedation and paralytic agents should be avoided in patient with increased ICP.
|
False: These may need to be used in patient with a potential for a significant increase in ICP before initiation of nursing activities.
|
|
|
When a fluid system is in place to monitor ICP, the transducer is maintained at the foramen of Monro. Where is this?
a) 1 inch above the ear b) 1 inch below the ear c) 1/2 inch above the mandible d) 1/2 inch below the mandible |
a) 1 inch above the ear
|
|
|
In what position is the patient put in to calibrate the transducer in the fluid system of ICP monitoring?
a) prone b) supine c) HOB elevated 30 degrees d) HOB elevated 90 degrees |
b) supine
|
|
|
What would vasopressin do if given to a patient with diabetes insipidus?
|
It would slow the urine output.
|
|
|
Does SIADH require fluid restriction or fluid replacement?
|
Fluid restriction.
|
|
|
What medication might be given to a patient preoperatively before intracranial surgery?
a) Heparin b) Coumadin c) Dilantin d) Vasopressin |
c) Dilantin: to reduce the risk of postoperative seizures
|
|
|
The nurse is aware that the peak time for cerebral edema following intracranial surgery is:
a) the first 3-4 hours after surgery b) the first 5-10 hours after surgery c) the first 24 hours after surgery d) the first 24-36 hours after surgery |
d) the first 24-36 hours after surgery
|
|
|
Which of the following activities can increase ICP? Check all that apply:
a) administering dilantin b) suctioning c) repositioning d) lowering the HOB e) lowering the lights |
b) suctioning
c) repositioning d) lowering the HOB |
|
|
Patients with a lesion around the pituitary or hypothalamus may develop:
a) cushings b) Addison's c) diabetes insipidus d) diabetes mellitis |
c) diabetes insipidus
|
|
|
To determine if leaked fluid is CSF or mucus, what testing device can be used, and what is it testing for?
|
A Dextrostix can be used, and it is testing for glucose. CSF contains glucose so a positive test indicated that the substance is in fact CSF.
|
|
|
How is the patient positioned following posterior fossa surgery?
a) on their back b) on their stomach c) on their side d) any way, as long as they remain on bedrest |
c) on their side: they must remain off their back
|
|
|
Because edema is a common consequence of intracranial surgery, what should the nurse do to minimize periorbital edema?
|
Elevate the HOB and apply cold compresses over the eyes.
|
|
|
What medication can be given to suppress the secretion of gastric acid in ulcer prone patients taking large doses of corticosteroids prior to brain tumor surgery?
a) Vitamin C b) probiotics c) uric acid d) H2 blockers |
d) H2 blockers ( histamine-2-receptor antagonists
|
|
|
What might a patient complain of if they have CSF dripping down their throat?
a) a harsh cough b) a burning sensation c) a salty taste d) esophageal numbness |
c) a salty taste
|
|
|
What discharge instructions should be given to the patient who underwent cranial surgery in regards to showering?
|
You may shower, but you should keep the head dry until all the sutures have been removed.
|
|
|
Complications of the manipulation of the pituitary gland during cranial surgery could result in:
a) prolonged unconsciousness b) hypoventilation c) transient diabetes insipidus d) metabolic acidosis |
c) transient diabetes insipidus: it is treated with vasopressin but occasionally persists
|
|
|
When planning for a transsphenoidal approach, what test should be preformed?
a) PT/INR b) PTT c) phagocyte count d) nasopharyngeal secretion culture |
d) nasopharyngeal secretion culture to make sure a sinus infection is not present before surgery as that would be a contraindication to the transsphenoidal approach
|
|
|
Following an intracranial procedure, the patient is advised to:
a) cough vigorously to mobilize stationary secretions b) suck liquids through a straw c) blow the nose strongly and swiftly d) avoid using the Valsalva maneuver |
d) avoid using the Valsalva maneuver which will increase ICP to possible cause a CSF leak; all the other activities should be avoided!
|
|
|
True or False: Gentle tooth brushing is pertinent following intracranial surgery via the transsphenoidal approach.
|
False: Usually the teeth are not brushed until the incision above the teeth has healed. Warm saline mouth rinses and the use of a cool mist vaporizer are helpful.
|
|
|
Teaching instruction of the patient who underwent intracranial surgery via the transsphenoidal approach includes removal of the packing in:
a) 1-2 hours b) 1-2 days c) 3-4 days d) 1-2 weeks |
c) 3-4 days
|
|
|
What neurological disorder can result from carbon monoxide and lead poisoning?
|
epilepsy
|
|
|
During what type of seizure is the patient known to have an epileptic cry, chew the tongue, and soil themselves?
|
grand mal
|
|
|
What is the postictal state and what happens during it?
|
It is the time after a seizure characterized usually by confusion, difficulty in arousing, headache, sore muscles, fatigue, and depression.
|
|
|
If an aura precedes the seizure
a) insert an oral airway b) put a neck brace on c) call the stroke team d) administer 12 mg valium |
a) inset an oral airway
|
|
|
When might women with epilepsy experience an increase in seizure frequency?
a) during pregnancy b) after pregnancy c) during menses d) during physical activity |
c) during menses due to the increase in sex hormones
|
|
|
What might you advise a woman of child bearing age taking antiseizure medications?
|
The effectiveness of contraceptives is decreased by antiseizure medications.
|
|
|
What might you assess patients taking antiseizure medications for?
a) increased sedrate b) insomnia c) osteoporosis d) gastric ulceration |
c) osteoporosis
|
|
|
What oral complication may occur with the long term use of Dilantin?
|
Gingival hyperplasia
|
|
|
What type of diet is recommended for seizure prone patients?
a) low salt, low protein b) low salt, high protein c) high protein, low carb c) low protein, low carb |
c) high protein, low carb
|
|
|
Seizures are known to occur with which of the following:
a) high potassium foods b) high salt foods c) excessive water intake d) alcohol intake |
d) alcohol intake
|
|
|
What factors might precipitate status epilepticus?
|
Fever, infection and withdrawl of antiseizure medication.
|
|
|
Which of the following is an example of a secondary headache:
a) a headache with no known cause b) a headache caused by a tumor c) all of the above d) none of the above |
b) a headache associated with an organic cause such as a brian tumor or an aneurysm
|
|
|
What are the 4 phases of a migraine with aura, in order?
|
1. Prodrome
2. Aura 3. Headache 4. Recovery |
|
|
True or False: Auras occur in 75% of patients with migraines.
|
False: They only occur in 31%
|
|
|
Who is Imitrex contraindicated in and why?
|
Patients with ischemic heart disease because it can cause chest pain, which would be difficult to differentiate between side effects and actual heart ischemia.
|
|
|
When in the course of a migraine should Ergotamine preparations be taken?
a) at the start b) at the peak c) after Imitrex has been ineffective for at least 1 hour d) when the migraine is mostly gone to prevent recurrence |
a) at the start: they must be taken early in the migraine to be effective
|
|
|
It is important to know that Ergotamine preparations should not be taken concurrently with:
a) aspirin b) NSAIDS c) tranquilizers d) triptans |
d) triptans such as Imitrex
|
|
|
When the nurse observes that the patient has extension and external rotation of the arms and wrists and extension, plantar flexion, and internal rotation of the feet, she records the patient's posture as:
a) decerebrate b) decorticate c) flaccid d) normal |
a) decerebrate
|
|
|
Monro-Kellie hypothesis refers to:
a) unresponsiveness to the environment b) a condition in which the patient is wakeful but devoid of conscious content c) the brain's attempt to restore blood flow by increasing arterial pressure to overcome ICP d) the dynamic equilibrium of cranial contents |
d) the dynamic equilibrium of cranial contents: This hypothesis states that because of the limited space for expansion within the skull, an increase in one of the cranial contents(brain tissue, blood, or cerebrospinal fluid) causes a change in the volume of the others.
|
|
|
Which of the following positions is employed to help reduce ICP?
a) rotating the neck to the far right with neck support b) extreme hip flexion supported by pillows c) avoiding flexion of the neck with use of a cervical collar d) keeping the head flat with use of no pillow |
c) avoiding flexion of the neck with use of a cervical collar which promotes venous drainage and prevent jugular vein distortion that will increase ICP
|
|
|
A patient who sleeps almost constantly but can be aroused and can follow simple commands is said to be:
a) lethargic b) obtunded c) comatose d) alert |
b) obtunded
|
|
|
A patient who sleeps does not respond to environmental stimuli is said to be:
a) lethargic b) obtunded c) comatose d) alert |
c) comatose
|
|
|
A patient who sleeps often and shows slowed speech and though processes is said to be:
a) lethargic b) obtunded c) comatose d) confused |
a) lethargic
|
|
|
A patient who has difficulty following commands, and may be agitated or irritable is said to be:
a) lethargic b) obtunded c) comatose d) confused |
d) confused
|
|
|
A patient that is unable to perform previously learned purposeful motor acts on a voluntary basis is said to be suffering from:
a) agnosia b) aphasia c) apraxia d) ataxia |
c) apraxia
|
|
|
A patient who has an impaired ability to coordinate movement, often seen as a staggering gait or postural imbalance is said to have
a) agnosia b) aphasia c) apraxia d) ataxia |
d) ataxia
|
|
|
What is hemianopsia?
|
Blindness of half of the field of vision in one or both eyes.
|
|
|
What is a penumbra region?
|
An area of low cerebral blood flow.
|
|
|
During an ischemic cascade what causes a change in the pH level?
|
A large amount of lactic acid is generated.
|
|
|
The influx of ___ and the release of ___ is the penumbra region during an ischemic cascade causes destruction of the cell membrane and vasoconstriction.
a) sodium, calcium b) calcium, glutamate c) glutamate, sodium d) calcium, GABA |
b) calcium, glutamate
|
|
|
Difficulty in forming words is known as:
a) ataxia b) dysphagia c) dysarthria d) receptive aphasia |
c) dysarthria
|
|
|
What might a nurse to enhance understanding in a patient with receptive aphasia?
a) speak slowly b) speak loudly c) speak in a high pitch d) speak in a low pitch |
a) speak slowly
|
|
|
What test is performed initially to determine if a stroke is hemorrhagic or ischemic?
a) MRI b) CT scan c) X-ray d) doppler flow study |
b) CT scan
|
|
|
Who is at most risk for a stroke?
a) 35 y.o.black woman b) 55 y.o white man c) 55 y.o white woman d) 22 year old diabetic e) 60 year old black man |
e) 60 year old black man
|
|
|
Which of the following people is most at risk for stroke:
a) a 55 y.o. woman who had a seizure once when she was 4 and had the flu b) a 60 y.o woman with gingivitis c) a newly diagnosed juvenile diabetic 6 y.o. d) a 50 y.o. male with a BMI of 19 who takes 81mg of baby aspirin daily |
b) a 60 y.o. woman with gingivitis as periodontal disease is linked with an increased risk for stroke
|
|
|
The nurse knows that the patient with a history of TIAs is at risk for:
a) seizures b) anemia c) DIC d) stroke |
d) stroke
|
|
|
What invasive procedure might a patient undergo following a TIA or stroke?
a) x-ray b) MRI c) Carotid doppler d) carotid endarterectomy |
d) carotid endarterectomy
|
|
|
What can be done overnight to a patient with hemiplegia to prevent flexion and maintain correct positioning during sleep?
a) position them on their back b) position a small pillow under the lumbar region of the back c) apply a posterior splint d) put the patient in trendelenburg |
c) apply a posterior splint
|
|
|
To help prevent hip flexion the nurse could position the pt on their stomach:
a) with no pillows except under the head b) with a pillow under the pelvis and calves c) with both arms gently positioned by their sides d) strictly with no pillows |
b) with a pillow under the pelvis and calves to promote hyperextension of the hip joints, which is essential for normal gain and helps prevent knee and hip flexion contractures.
|
|
|
A patient who had a recent stroke needs assistant getting OOB. You observe the nursing assistant gently lifting the patient by the weak shoulder and assisting him to sit in the chair. You:
a) ensure that there is a pressure relief cushion on the chair b) ask the nursing assistant to rate how much lifting assistance she had to provide on a scale of 1-10 and document it in the chart c) ask the patient how he thinks the transfer went d) remediate the nursing assistant |
d) remediate the nursing assistant: you should never lift the patient by the flaccid should or pull on the affected arm or shoulder
|
|
|
What might help improve the patient's morale during ambulation with physical therapy following a stroke?
a) tell them most stroke victims are doing much worst then them b) tell them with just a couple years of practice they might be able to drive again c) tell them not to worry, everything will be ok d) let them wear street clothes |
d) let them wear street clothes to allow them to feel more in control and normal and not the dependent hospitalized patient
|
|
|
The comprehension and formation of language occur in what area of the brain?
a) vernicke's area b) circle of willis c) Broca's area d) occipital lobe |
c) Broca's area
|
|
|
Patients with damage to the (left/right) side of the brain and paralysis on the (left/right) side of the body would most likely have speech disturbances.
a) left, left b) left, right c) right, right d) right, left |
b) left, right: So...Damage to the left side of the brain usually results in right sided paralysis and speech problems(due to the location of Broca's area).
|
|
|
True or False, If a patient has speech disturbances and is struggling to get their words out, try to help them out by finishing their sentences if you know what it is they are trying to say/name.
|
False: This just further frustrates the patient by not allowing them to speak.
|
|
|
True or False: The use of gestures is discouraged when talking to the aphasic patient as it will only further distract them.
|
False: Gestures may enhance comprehension.
|
|
|
What is a common site of aneurysms in the brain? Check all that apply:
a) circle of Willis b) bifurcations of large arteries c) small arteries d) thick walled arteries |
a) circle of Willis
b) bifurcation of large arteries |
|
|
Which of the following S&S would a patient with a hemorrhagic stroke display, which is different from an ischemic stroke?
a) numbness/weakness of the face, arm, leg b) severe headache, vomiting c) difficulty speaking d) visual disturbances |
b) severe headache, vomiting
|
|
|
A prevention effort is in place to increase the public's awareness about the association between phenylpropanolamine (PPA) and hemorrhagic stroke. What common items PPA found in?
|
appetite suppressants and cough/cold agents
|
|
|
The nurse knows that she needs to be on alert for ___ which occurs 4-14 days following a hemorrhagic stroke.
a) vasospasm b) vasodilation c) bradycardia d) TIA |
a) vasospasm: The administration of calcium-channel blockers during the critical period in which vasospasm may occur can prevent delayed ischemic deterioration.
|
|
|
Preventing sudden systemic ____ is critical in the management of intracerebral hemorrhage.
a) vasodilation b) bradycardia c) hypotension d) hypertension |
d) hypertension
|
|
|
Because ___ cause elevation of blood pressure, anti___ medications are often administered prophylactically.
a) diarrhea b) cough c) seizure d) sleep |
c) seizure
|
|
|
True or False, supportive management of a patient with hemorrhagic stoke includes bed rest and sedation to prevent agitation and stress.
|
True!
|
|
|
Which of the following are cerebral aneurysm precautions implemented for the patient with a diagnosis of aneurysms? Check all that apply:
a) absolute bed rest b) restricted visitors c) promote gentle valsalva maneuvers d) thigh-high elastic stockings e) all care is administered by RN |
a) absolute bed rest
b) restricted visitors d) thigh-high elastic stocking e) all care is administered by the RN |
|
|
After subarachnoid hemorrhage, what electrolyte imbalance is found in 10-40% of patients?
a) hypernatremia b) hyponatremia c) hypercalcemia d) hypocalcemia |
b) hyponatremia
|
|
|
Which of the following insults or abnormalities most commonly causes ischemic stroke?
a) trauma b) arteriovenous malformation c) intracerebral aneurysms rupture d) cocaine use |
d) cocaine use
|
|
|
The nurse knows that children younger than ___ should be restrained in an age/size appropriate system in the back seat.
a) 3 b) 5 c) 10 d) 12 |
d) 12
|
|
|
An epidural hematoma is considered an extreme emergency because it can result in:
a) mild neurological deficit b) respiratory arrest c) pounding headache d) heart palpitations |
b) respiratory arrest
|
|
|
The nurse knows that subacute subdural hematomas produce clinical manifestations usually:
a) 1-2 minutes after injury b) 1-2 hours after injury c) 2-4 weeks after surgery d) 48 hours- 2 weeks |
d) 48 hours to 2 weeks after surgery
|
|
|
Any patient with a head injury is presumed to have a ___ until proven otherwise.
a) subdural hematoma b) decreased LOC c) erratic behavior d) cervical spine injury |
d) cervical spine injury
|
|
|
What are the three cardinal signs of brain death on clinical examination?
|
coma, absence of brain-stem reflexes, and apnea
|
|
|
A score of ___ or less is generally accepted as indicating a severe head injury according to the Glasgow Coma Scale.
a) 2 b) 4 c) 6 d) 8 |
d) 8
|
|
|
What happens to the heart rate, blood pressure and pulse pressure in a patient with increasing ICP?
|
<Heart rate: slows
<Blood pressure: systolic increases <Pulse pressure: widens |
|
|
A patient with anosmia would:
a) have difficulty seeing his clock b) have difficulty recognizing a fork c) have difficulty with long term memory d) have difficulty with smell |
d) have difficulty with smell
|
|
|
Which of the following is an accepted method of preventing injury in a confused patient with a head injury?
a) apply mits b) apply 4 point restraints c) administer the maximum doses of all ordered sedatives d) withhold food and fluid to prevent soiling of the bed linens and further agitation |
a) apply mits to prevent self-injury and dislodging of tubes; restraints are avoided because straining against them can increase ICP or cause other injury; opioids are avoided as a means of controlling restlessness
|
|
|
True or False: To help decrease agitation in the confused patient with a head injury, turn off then lights when possible to provide a dark environment.
|
False, adequate lighting is provided to prevent visual hallucinations.
|
|
|
What effect does systematic hypotension have on the blood vessels(vasoconstriction or dilation) and on CPP?
|
It causes vasoconstriction and a significant decrease in CPP. It is treated with IV fluids
|
|
|
When does swelling peak following a head injury?
|
48-72 hours after the injury
|
|
|
What are common fluid and electrolyte inbalances that occur with a patient with a head injury in terms of sodium, potassium and glucose?
|
hyponatremia, hypokalemia and hyperglycemia
|
|
|
Who is most at risk for a spinal cord injury?
|
young male alcohol/drug users
|
|
|
The nurse knows that the muscles contributing to respiration and use of the diaphragm are controlled by which areas of the spinal cord:
a) C1-C3, and C5 b) T1-T11, and C4 c) L1-L5, and C2 |
b) Ti-T11, and C4: So you know that if a patient has a spinal cord injury in this area, respiration will be effected
|
|
|
A patient with Central Cord Syndrome will have complete loss of motor power and sensation:
a) from the chest down b) in the upper chest and arms c) on one half of the body |
b) in the upper chest and arms
|
|
|
A patient with Anterior Cord Syndrome will have complete loss of motor power and sensation:
a) from the chest down b) in the upper chest and arms c) on one half of the body |
a) from the chest down
|
|
|
A patient with Lateral Cord Syndrome(Brown-Sequard Syndrome) will have complete loss of motor power and sensation:
a) from the chest down b) in the upper chest and arms c) on one half of the body |
c) on one half of the body
|
|
|
A patient with a spinal cord injury at what level will require full assistance in eating, dressing, elimination, and mobility.
a) C1-C4 b) C5-C8 c) T1-T5 d) T6-T10 |
a) C1-C4
|
|
|
When a patient is brought into the emergency room with a suspected spinal cord injury, how should they be positioned?
a) on their side b) flat on their back c) flat with the HOB raised 30 degrees d) sitting with HOB raised 45 degrees |
b) flat on their back; no sitting up is allowed; they are kept on the hard transfer board to maintain an extended position and prevent any portion of the body from being twisted or turned
|
|
|
What medication, if given within 8 hours after a spinal cord injury, can significantly improve motor and sensory outcomes?
a) aspirin b) antibiotics c) corticosteroids d) NSAIDs |
c) corticosteroids: specifically methylprednisolone
|
|
|
What can be used to help stimulate the diaphragm in patient with a high spinal cord injury to help them breath?
|
Diaphragmatic pacing
|
|
|
What can be used with the patient with an acute spinal cord injury to prevent external rotation of the hip joints?
|
Trochanter rolls: applied from the crest of the ilium to the midthigh of both hip joints
|
|
|
Patients with lesions above the midthoracic level have loss of sympathetic control of peripheral vasoconstrictor activity leading to hypotension. What can you do to help prevent complications?
a) restrict fluids b) encourage slow position changes c) administer atropine d) massage their legs to promote venous return |
b) encourage slow position changes
|
|
|
What can be given to the patient with a spinal cord injury to allow them to see from the supine position?
|
Prism glasses
|
|
|
What group of people have the highest prevalence of pressure ulcers in the United States?
a) disables children b) elderly c) vented patients d) patients with SCI |
d) patients with SCI (spinal cord injuries)
|
|
|
True or False: Upon discharge family members are taught intermittent catheterization for the patient with spinal cord injury.
|
False: They are taught this at an early stage so they can participate in the care and be able to recognize any complications early on.
|
|
|
What should always be kept readily available for a patient in halo traction?
a) lidcaine cream b) screw driver c) wire cutters d) sterile oil |
b) screw driver
|
|
|
True or False: Prior to applying the vest for halo traction, apply a small amount of powder to the skin for protection.
|
False: Powder is not used inside the vest, because it may contribute to the development of pressure ulcers.
|
|
|
What is characterized by a pounding headache with paroxysmal hypertension, profuse diaphoresis, nausea, nasal congestion, and bradycardia.
|
Autonomic dysreflexia
|
|
|
What is the most common cause of autonomic dysreflexia?
a) constipation b) something in the sheets c) distended bladder d) poor pain management |
c) distended bladder
|
|
|
Which of the following factors increase your chances for bacterial meningitis?
a) recent UTI, fever b) smoking, viral URI c) subdural hematoma, UTI d) smoking, fever |
b) smoking, viral URI
|
|
|
How is the CSF changed in bacterial meningitis in terms of WBC, glucose and protein?
|
Decreased glucose, increased protein and increased white blood cells.
|
|
|
How would you test Kernig's sign?
|
Have the patient lie down and with the thighs flexed on the abdomen try to straighten the leg. With meningitis, the leg cannot be completely extended
|
|
|
How would you test Brudzinski's sign?
|
Flex the patients neck, if meningitis is present flexion of the knees and hips will also be produced.
|
|
|
The nurse knows that a common symptom of meningitis is:
a) yeast infections b) photophobia c) insomnia d) gum hyperplasia |
b) photophobia
|
|
|
A patient and his wife comes to the emergency room. He is diagnoses with meningitis. What might you suggest?
a) that they have their house clean professional before returning home b) the their kids live with a relative for 1-2 weeks c) that the wife take Rifadin d) none of the above |
c) that the wife take Rifadin: People in close contact with patients with meningococcal meningitis should be treated with antimicrobial chemoprophylaxis using Rifadin, Cipro or Rocephin.
|
|
|
What type of precautions are instituted and for how long, if a patient is determined to have meningitis?
a) standard, always b) contact, 2-3 days c) airborne, 24 hours d) droplet, 24 hours after antibiotic therapy |
d) droplet, 24 hours after antibiotic therapy
|
|
|
What are the most common predisposing conditions for abscesses among immunocompetent adults?
|
otitis media and sinusitis
|
|
|
What is the most prevailing symptom of a brain abscess?
a) fever b) tachycardia c) headache d) weakness |
c) headache, usually worse in the morning
|
|
|
What is the most common cause of acute encephalitis?
a) step throat b) URI c) UTI d) Herpes simplex |
d) Herpes simplex
|
|
|
HSV-1 encephalitis causes inflammation and hemorrhagic necrosis of the ___ lobe.
a) frontal b) temporal c) occipital d) parietal |
b) temporal
|
|
|
What is the primary vector of arthropod-borne virus encephalitis?
a) mosquito b) fly c) red ant d) pin worm |
a) mosquito
|
|
|
How is fungal encephalitis spread?
|
spores via inhalation
|
|
|
Insect repellent should contain at least ___% DEET to decrease mosquito and tick bites.
|
25%
|
|
|
What disease belongs to a group of degenerative, infectious neurologic disorders resulting from ingestion of infected beef?
a) MS b) Cerebral Palsy c) TB d) Creutzfeld-Jakob Disease |
d) Creutzfeld-Jakob Disease
|
|
|
What is the prognosis for Creutzfeld-Jakob Disease?
a) severe neurological deficit b) complete recovery c) near complete recovery d) it is fatal |
d) it is fatal, there is no definitive treatment
|
|
|
What is the primary issue in Creutzfeld-Jakob Disease?
a) brain tissue degeneration b) motor neuron demyelination c) sensory neuron degeneration d) nerve fiber proliferation |
a) brain tissue degeneration
|
|
|
What is the typical age of onset, and sex, of people affected with MS?
a) 20-40 y.o women b) 20-40 y.o. men c) 50-70 y.o women d) 50-70 y.o. men |
a) 20-40 y.o. women
|
|
|
Which of the following are common symptoms of MS?
a) red rash and agnosia b) fatigue and ataxia c) agnosia and peripheral numbness d) periodic delirium and eventually dementia |
b) fatigue and ataxia
|
|
|
What is the diagnoses of MS based mainly on?
a) presenting symptoms b) presence of plaques c) numbness of the periphery d) blood test results |
b) presence of plaques: multiple plaques in the central nervous system observed on an MRI
|
|
|
What disorder is characterized by varying degrees of weakness of the voluntary muscles?
|
Myasthenia Gravis
|
|
|
In Myasthenia gravis, antibodies directed at the _____ receptor sites impair transmission of impulses across the myoneural junction.
a) GABA b) epinephrine c) ATP d) acetylcholine |
d) acetylcholine
|
|
|
What are the initial manifestations of myasthenia gravis?
a) double vision and ptosis(drooping of the eyelids) b) ataxia, apraxis c) ptosis and yellow eye discharge d) blurred vision and dizziness |
a) double vision and ptosis
|
|
|
What might the face of a person with myasthenia gravis look like?
a) red and blotchy b) drooping and weak c) bland and expressionless d) hyperflexed and sensitive |
c) bland and expressionless
|
|
|
What needs to be on hand for the patient undergoing an acetylcholinesterase inhibitor test?
|
atropine: To control the side effects of the edrophonium which is injected.
|
|
|
What part of the body may be enlarged in myasthenia gravis?
a) thymus b) thyroid c) spleen d) liver |
a) thymus gland
|
|
|
What type of medications are used to treat myasthenia gravis? What is an example?
|
Anticholinesterase medications such as Pyridostigine bromide (Mestinon).
|
|
|
What would you advise the patient with myasthenia gravis going for a dental visit?
|
Novocain should be avoided and your dentist should know your diagnosis.
|
|
|
Patient teaching of the patient with myasthenia gravis who underwent a thymus gland removal includes:
a) you should begin to notice the effects within 1-2 weeks b) the T cells will die off in 2-3 months c) it will take up to 3 years to notice changes d) they thymus gland will regenerate after 5-10 years |
c) it will take up to 3 year to notice changes
|
|
|
What is the primary concern in the patient in myasthenic crisis?
a) bradycardia b) low blood pressure c) ventilation d) LOC |
c) ventilatory assistance takes precedence in the immediate management
|
|
|
What cell in the peripheral nervous system produces myelin?
a) astrocyte b) nurse cells c) ganglions d) Schwann |
d) Schwann
|
|
|
What disorder is described by acute, rapid segmental demyelination of peripheral/cranial nerves?
|
Guillain-Barre Syndrome
|
|
|
Which of the following describes the progression of weakness in Guillain-Barre Syndrome?
a) ascending weakness b) descending weakness c) medial to lateral d) lateral to medial |
a) ascending weakness
|
|
|
What is common in the history of people with Guillain-Barre Syndrome?
a) a recent viral illness b) refusal of vaccination c) participation in a paid drug testing program d) family history of MS |
a) a recent viral illness
|
|
|
What procedure or medication can be used to directly lower the peripheral nerve myelin antibody level in people affected with Guillain-Barre Syndrome?
a) plasmapheresis b) corticosteroids c) immunosuppresants |
a) plasmapheresis
|
|
|
What word best describes Guillian-Barre Syndrome?
a) fatal b) infectious c) autoimmune d) life-long |
c) autoimmune
|
|
|
Due to the autonomic dysfunction, in Guillain-Barre Syndrome, what should the nurse do?
a) administer atropine as needed b) apply telemetry c) administer nerve blocking agents d) avoid anticoagulant administration |
b) apply telemetry due to the cardiovascular risks posed by autonomic dysfunction
|
|
|
Trigeminal Neuralgia is a condition of which cranial nerve?
|
fifth
|
|
|
Describe the facial pain of Trigeminal Neuralgia.
|
unilateral shooting and stabbing
|
|
|
What type of activities exacerbate pain in Trigeminal neuralgia?
|
Face washing, shaving, brushing your teeth, eating an drinking. Even a draft of cold air can set it off!
|
|
|
______ agents such as ___ relieve pain in most patients with trigeminal neuralgia by reducing the transmission of impulses at certain nerve terminals.
a) anticonvulsants, Valium b) antihypertensive, Isodil c) NSAID, ibuprofen d) antiseizure, Tegretol |
d) antiseizure, Tegretol
|
|
|
How should Tegretol be taken?
a) before meals b) after meals c) with meals d) with 1 full glass of water |
c) with meals
|
|
|
What is special about the food preparation and ingestion for patients with Trigeminal neuralgia?
|
All food and fluids should be taken at room temperature and chewed on the unaffected side.
|
|
|
Bell's Palsy involves unilateral inflammation of which cranial nerve?
|
seventh
|
|
|
What should the nurse encourage at night to the Bells Palsy patient?
a) administering anesthetic eye drops b) wearing a protective eye shield c) taping both eyes shut d) avoiding eye ointment |
b) wearing a protective eye shield
|
|
|
Nursing management of the patient with new variant Creutzfeldt-Jakob Disease focuses on:
a) initiating isolation procedures b) providing supportive care c) administering amphotericin B d) preparing for organ donation |
b) providing supportive care
|
|
|
A patient with fungal encephalitis receiving amphotericin B complaints of fever, chills, and body aches. The nurse know that these symptoms
a) indicate the need for immediate blood and CSF cultures b) may be controlled by the administration of Benadryl and Tylenol 30 minutes before administration of the amphotericin c) indicate renal toxicity and a worsening of the patient's condition d) are primarily associated with infection with coccidioides immitis and Aspergillus species |
b) may be controlled by the administration of Benadryl and Tylenol 30 minutes before administration of the amphotericin
|
|
|
The patient receiving mitoxantrone (Novantrone) for treatment of MS is monitored for
a) renal insufficiency b) mood changes and fluid/electrolyte alteration c) leukopenia and cardiac toxicity d) hypoxia |
c) leukopenia and cardiac toxicity
|
|
|
The nurse knows that Parkinson's disease is associated with decreased levels of _____.
|
dopamine
|
|
|
Is acetylcholine excitatory or inhibitory?
|
excitatory
|
|
|
Is dopamine excitatory or inhibitory?
|
inhibitory
|
|
|
What are the three cardinal signs of Parkinson's disease?
|
tremor, rigidity and bradykinesia
|
|
|
What is bradykinesia?
|
abnormally slow movements
|
|
|
Elderly people with Parkinson's exhibit more psychiatric manifestations that are similar to those of:
a) delirium b) Trigeminal neuralgia c) Alzheimer's d) major depression |
c) Alzheimer's
|
|
|
Describe some of the changes that occurs while Parkinson's progresses, in terms of writing, facial features and speech.
|
Their handwriting becomes smaller and smaller(micrographia) as dexterity decreases; their face becomes increasingly mask like and expressionless and their speech becomes soft, low pitched and slurred(dysphonia).
|
|
|
Confusion, hallucinations, depression and sleep alterations are associated with prolonged use of what antiparkinsonian medication?
|
Levodopa
|
|
|
What is dyskinesia and how is it associated with Parkinson's.
|
It is abnormal involuntary movements including facial grimacing, rhythmic jerking movements of the hands, head bobbing, chewing and smacking that develops as a response to long term use of antiparkinsonian medications.
|
|
|
Anticholinergic agents such as Apo-Trihex and Cogentin are effective in controlling:
a) focal seizures b) difficulty swallowing c) confusion and dementia d) tremor and rigidity |
d) tremor and rigidity
|
|
|
What type of medication is amantadine hydrochloride (Symmetrel)?
a) antiviral b) antiseizure c) CNS depressant d) dopamine antagonist |
a) antiviral medication used in the early treatment of early Parkinson's disease to reduce rigidity, tremor, bradykinesia and postural changes
|
|
|
What do the following medication do? Bromocriptine mesylate (Parlodel) and pergolide (Permax).
|
They are dopamine agonists.
|
|
|
How do MAO inhibitor help people with Parkinson's?
a) they are dopamine antagonists b) they are antivirals c) they inhibit dopamine breakdown d) they stop the progression of Parkinson's |
c) they inhibit dopamine breakdown and are thought to slow the progression of the disease
|
|
|
How are COMT inhibitors used in the treatment of Parkinson's?
a) used independently to treat tremors b) used as an adjuvent to Levodopa c) cause excitatory stimulation of the basal ganglia d) restrict serotonin reuptake at the axon terminal |
b) used as an adjuvent to Levodopa
|
|
|
Which of the following is most likely to be a nursing diagnoses for a patient with Parkinson's?
a) Inbalanced Nutrition: Less then the body's requirement b) Inbalance Nutrition: More than the body's requirement c) Ineffective tissue perfusion d) Risk for skin breakdown |
a) Inbalanced Nutrition: Less than the body's requirement because of their difficulty swallowing, chewing, and eating being a long and slow process.
|
|
|
What dietary modifications should be make for the patient with Parkinson's having difficulty chewing and swallowing?
a) liquid diet, thickened b) solid food, with limited liquids c) semisolid diet with thickened liquids d) semisolid diet with thin liquids |
c) semisolid diet with thickened liquids: thin liquids should be avoided
|
|
|
What disorder is associated with the premature death of cells in the striatum basal ganglia which causes abnormal involuntary movements (chorea), intellectual decline and emotional disturbance?
|
Huntington's Disease
|
|
|
The nurse knows that each child of a parent with Huntington's disease has a __ % chance of contracting it.
a) 25% b) 50% c) 75% d) 100% |
b) 50%
|
|
|
Personality changes associated with Huntington's disease include:
a) euphoria and manic behavior b) nervous and irritable c) fearful and uneasy d) manic and depressive |
b) nervous and irritable
|
|
|
What is another common name for amyotrohic lateral sclerosis? *Hint: baseball
|
Lou Gehrig's disease
|
|
|
Why might you pad the sides of the bed for a patient with Huntington's disease?
|
Because the uncontrolled motor movements might cause them to hurt themselves if too close to the side rails.
|
|
|
Is intellectual function impaired in the patient with ALS?
|
No
|
|
|
What is muscular dystrophy?
|
disorders characterized by progressive muscle weakening and wasting
|
|
|
What can be done to help prevent contractures for the patient with muscular dystrophy?
|
physical therapy, night splints, and an orthopedic jacket
|
|
|
What is an important focus of the adolescent with muscular dystrophy?
a) ensuring social relationships b) ensuring friends and family are well educated on the disorder c) letting them pick their medication regime d) encouraging job training |
d) encouraging job training: Nursing goals include assisting the adolescent to make the transition to adult values and expectations while provide age-appropriate care. The nurse may need to help build the confidence of an older adolescent or adult patient by encouraging him or her to pursue job training to become economically independent.
|
|
|
What is the test of choice for diagnosing a disk problem?
a) CT scan b) x-ray c) MRI d) doppler flow study |
c) MRI
|
|
|
Herniation of cervical and lumbar disks occur most commonly and are usually managed with:
a) opioids and surgery b) bed rest and medication c) intense physical therapy d) active ROM qh |
b) bed rest and medication
|
|
|
A person with a herniated cervical disk would benefit most from:
a) a soft mattress b) a firm mattress c) a semisoft mattress d) a semi-firm mattress |
b) a firm mattress may bring dramatic relief from pain
|
|
|
Why is a cervical collar, cervical tractions or a brace required for treatment of a herniated cervical disk?
|
To hold the head in a neutral position and allow maximal opening of the intervertebral foramina for healing.
|
|
|
True or False: A patient who underwent a cervical discectomy would be expected to have a small amount of serosanguineous drainage on the dressing.
|
False: This suggests a dural leak, which can lead to meningitis. Also be on the look out for a headache which also suggests a dural leak
|
|
|
Patient teaching of the patient who underwent a cervical discectomy includes that they will have to wear a cervical collar for:
a) 1-2 days b) 1-2 weeks c) 6 days d) 6 weeks |
d) 6 weeks
|
|
|
What instructions might you give to the patient who underwent a cervical discectomy in regard to sleeping?
|
Avoid sleeping on your stomach and avoid use of pillows.
|
|
|
What is the straight leg-raising test and what does a positive result confirm?
|
You have the patient lie on their back and attempt to raise a leg in a straight position, if pain radiates into the leg, it suggests a herniated lumbar disk.
|
|
|
After a lumbar disk excision, what activity is allowed and not allowed?
|
They can walk to the bathroom on the same day as surgery and they are discouraged from sitting except for defecation.
|
|
|
How long after a lumbar disk excision are patients allowed to drive?
a) 1-2 days b) 2 weeks c) 4 weeks d) 6 weeks |
d) 6 weeks or until healing has taken place
|
|
|
True or False: Postpolio syndrome is characterized by weakness, fatigue, and musculoskeletal pain.
|
True
|
|
|
What specific medication and/or surgical treatment is available for those effected by postpolio syndrome?
|
None!!! :(
|
|
|
What disorder is associated with postpolio syndrome?
a) dementia b) delirium c) paraplegia d) osteoporosis |
d) osteoporosis
|
|
|
A patient's eyes are dilated, fixed, and unequal. What state of consciousness are they most likely in?
a) alert b) lethargy c) stuporous d) comatose |
d) comatose
|
|
|
What does the Glasgow Coma scale rate?
|
LOC
|
|
|
What are the three assessment parts of the Glasgow Coma Scale?
|
eye opening, verbal response and motor response
|
|
|
When doing a Glasgow Coma Scale, the patient left side scores differently then their right side. How do you score this response?
a) take an average of the two scores b) take the lower of the two scores c) take the higher of the two scores d) re due the test, there must be an error |
c) take the higher of the two scores
|
|
|
What score do you put for the verbal response in the glasgow coma scale if the patient is intubated?
a) 1 b) 1T c) 1S d) 3P |
b) 1T
|
|
|
What score do you put for the eye opening response in the glasgow coma scale if the patients eyes are swollen shut?
a) 1 b) 1T c) 1S d) 3P |
c) 1S
*remember S for swollen |
|
|
What score do you put for the motor response in the glasgow coma scale if the patient is chemically paralyzed?
a) 1 b) 1T c) 1S d) 3P |
d) 3P
*remember P for paralyzed |
|
|
What are the two parts of the autonomic nervous system?
|
Sympathetic nervous system
and Parasympathetic nervous system |
|
|
During a sympathetic response, what happens to the smooth muscle activity of the bronchioles, GI tract, and urinary tract?
a) it is excited b) it is relaxed c) it is not effected |
b) it is relaxed
|
|
|
During a parasympathetic response, what happens to the smooth muscle activity of the bronchioles, GI tract, and urinary tract?
a) it is excited b) it is relaxed c) it is not effected |
a) it is excited (causes smooth muscle contraction)
|
|
|
When a CSF tap was done, 4 tubes were collected. Which tubes should the nurse send down for hematology and microbiology tests?
a) any tubes b) the first two tubes c) tubes 2 and 3 d) tubes 3 and 4 |
d) tubes 3 and 4 because this reduces the chances of a falsely elevated white cell count caused by a traumatic tap (bleeding into the subarachnoid space at the puncture site, and contamination of the bacterial culture by skin germs or flora.
|
|
|
A CSF tap is done, and the color is determine to be straw. How do you interpret this?
a) normal b) abnormal c) inconclusive |
b) abnormal: It should be clear: Presence of any color, including straw indicates the presence of bilirubin, hemoglobin or red blood cells.
|
|
|
Results of a CSF tap reveal a glucose level of 60 mg/dL. How do you interpret this?
a) normal b) too high c) too low d) more information is needed |
a) normal: The CSF glucose should be 2/3 of the fasting plasma glucose and any reading below 40 mg/dL indicates trouble.
|
|
|
Why do 10-30% of patients who underwent a CSF tap complain of a headache(i.e. what causes it)?
|
leaking of CSF through the puncture site
|
|
|
Who does autonomic dysreflexia occur in?
a) all SCI patients b) patients with any type of neurological damage c) could be any person, with or without a SCI d) patients with SCI at or above T6 |
d) patients with SCI at or above T6
|
|
|
How will you know when you have removed the cause of the autonomic dysreflexia?
|
They will stop sweating, and their blood pressure will lower immediately(or within the hour if their BP was very high)
|
|
|
The nurse knows that a common side effect of most anticonvulsants, anticoagulants and antiplatelets is:
a) liver damage b) thrombocytopenia c) Ataxia c) Steven-Johnson System |
b) thrombocytopenia
|
|
|
What type of medication is phenobarbital (Solfoton)?
a) opioid analgesic b) anticonvulsants c) antiplatelet d) barbiturate |
d) barbiturate: with side effects of respiratory depression, apnea, bradycardia, angioedema, and Steven-Johnson syndrome
|
|
|
Which antiseizure medication has side effects of blurred or double vision, skin rashes, dizziness, drowsiness and nausea?
a) Ativan b) Carbatrol (carbamazepine) c) Depakene (valproate) d) Depakote (divalproex sodium) e) Diomax ( acetaxolamide) |
b) Carbatrol (carbamazepine)
|
|
|
Which of the following medications has these side effects: Clumsiness, insomnia, motor twitching, nausea, rash, gum overgrowth, hairiness, thickening of features.
a) Felbatol (felbamate) b) Gabitril (tiagabine) c) Dilantin (phenytoin) d) Keppra (levetiracetam) |
c) Dilantin (phenytoin)
|
|
|
The diagnosis of MS is based on which of the following?
a) MRI b) electrophoresis of CSF c) evoked potentials d) urodynamic studies |
a) MRI
|
|
|
The nurse knows that measures need to be put into place to protect the patent with Myasthenia Gravis from:
a) self injury b) aspiration c) loss of consciousness d) hearing deficit |
b) aspiration
|
|
|
Tic douloureux is another name for what condition?
|
Trigeminal neuralgia
|
|
|
Carbamazepine (Tegretol), gabapentin (Neurontin), phenytoin, Dantrein or baclofen (Lioresal) are medications used to treat:
a) Trigeminal neuralgia b) Bells Palsy c) peripheral neuropathy d) Myasthenia Gravis |
a) Trigeminal neuralgia
|
|
|
True of False: Trigeminal neuralgia is a condition of the seventh cranial nerve.
|
False: fifth cranial nerve
|
|
|
Which of the following is not a cardinal sign of Parkinson's?
a) tremor b) dementia c) bradykinesia d) rigidity |
b) dementia
|
|
|
True or False: The earliest sign of increasing ICP is change in level of consciousness.
|
True
|
|
|
What is normal CCP pressure?
|
70-100
|
|
|
The patient's MAP is 110 mm Hg with an ICP of 16 mm Hg. Calculate the CPP.
a) 86 b) 90 c) 94 d) 98 |
c) 94
MAP-ICP=CPP so 110-16=94 |
|
|
What is the main osmotic diuretic used to decreased cerebral edema and lower ICP?
|
Mannitol
|
|
|
What type of seizure does the following describe: common in children, staring, transient loss of consciousness, eyelid fluttering and myoclonic jerks.
|
absence seizures
|
|
|
True or False: The RN is able to delegate teaching to an LPN but not a CNA.
|
False: The RN must perform all initial teaching, and can delegate reinforcement teaching to the LPN.
|
|
|
A nurse is assessing a client and finds pill-rolling tremor of the hands, muscle rigidity, and loss of facial expression. The nurse expects the client to have a diagnosis for:
a) muscular dystrophy b) parkinson's disease c) MS d) myasthenia gravis |
b) parkinson's disease
|
|
|
A client has just returned from the X-ray department, where a cervical myelogram with a water-based dye was performed. Which intervention should the nurse perform after this procedure?
a) force fluids b) monitor blood glucose level for 24 hours c) maintain the client flat in bed for 12 hours d) turn the client from side to side after 2 hours |
a) force fluids: drinking liberal amounts of fluid will help to rehydrate and replace cerebrospinal fluid
|
|
|
What might you do for a client diagnosed with a stroke complicated by dysphagia?
a) offer semisoft foods b) place food on the affected side of the mouth c) have the patient hyperextend his neck with swallowing d) offer liquids with food |
a) offer semisoft foods which can be swallowed more easily
|
|
|
A nurse is administering neostigmine (Prostigmin) to a client with myasthenia gravis. What intervention is a key to correctly administering this muscle stimulant?
a) administering the medication at exactly the right times b) regulating the doses as the client needs them c) monitoring the client's physical activity d) monitoring for renal and hepatic adverse reactions |
a) administering the medication at exactly the right times as if they aren't given the drug on time, they may be too weak to swallow
|
|
|
What type of respirations are characterized by deep and rapid without pauses and may be caused by diabetic ketoacidosis or pain?
a) Cheyne-Stokes b) Biot's c) Kussmaul d) Apneustic |
c) Kussmaul
|
|
|
What type of respirations are characterized by slow, shallow breaths and periods of apnea?
a) Cheyne-Stokes b) Biot's c) Kussmaul's d) Apneustic |
a) Cheyne-Stokes
|
|
|
A nurse is developing a teaching plan for a client with Parkinson's disease who's taking levodopa (L-dopa). Which instruction should the nurse include?
a) change positions slowly b) increase intake of foods with vitamin B6 c) increase the dose if twitching worsens d) call the physician if symptoms don't improve in 1 week |
a) change positions slowly
|
|
|
A nurse is teaching a client and his family about dietary practices related to Parkinson's disease. A priority for the nurse to address is the risk of:
a) fluid overload and drooling b) aspiration and anorexia c) chocking and diarrhea d) dysphagia and constipation |
d) dysphagia and constipation
|
|
|
A patient with a history of a recent stroke is heard having snoring like respirations. Which of the following would take priority?
a) assess the client's ability to communicate his needs b) position the client on his side, with the HOB slightly elevated c) place the client in Fowler's position, with the HOB at a 45-degree angle |
b) position the client on his side, with the HOB slightly elevated: turning the client on his side should clear the tongue obstruction.
|
|
|
Into which muscle should you administer a I.M. injection in a person with a SCI?
a) deltoid b) dorsal gluteal c) vastus lateralis d) ventral gluteal |
a) deltoid
|
|
|
A nurse is developing a teaching plan for a client undergoing electromyography to diagnose Guillain-Barre syndrome. The nurse should include which instruction?
a) "Don't have anything to eat or drink after midnight" b) "You may experience discomfort when needle electrodes are inserted into a muscle" c) "You'll receive a sedative such as diazepam (Valium) before the procedure" d) "You'll need to lie perfectly still throughout the procedure." |
b) "You may experience discomfort when needle electrodes are inserted into a muscle"
|
|
|
The nurse, caring for a client receiving a cholinergic drug, should observe for increased symptoms of which of the following processes?
a) cardiac dysrhythmias b) heart failure c) renal failure d) liver failure |
b) heart failure
|
|
|
The nurse administers dopamine (Inotropin) to a client. What data collected by the nurse demonstrates that the drug is effective?
a) constriction of the pupils b) lowering of heart rate c) lowering of blood pressure d) increasing of heart rate and blood pressure |
d) increased heart rate and blood pressure: Dopamine is a sympathetic drug
|
|
|
A client asks if convulsions and seizures are the same. The nurse's response is based on the knowledge that:
a) the terms can be used interchangeably b) convulsions always involve violent skeletal muscle activity c) seizures always involve violent skeletal movements d) all of the above |
b) convulsions always involve violent skeletal muscle activity: seizures do not
|
|
|
A client receiving digoxin (Lanoxin) therapy is being treated for status epilepticus with diazepam (Valium). The nurse places priority on:
a) keeping the client in a high fowler's position b) holding the digoxin until the seizure has subsided c) monitoring the client for nausea and GI cramping d) instructing the client to eat foods high in potassium |
c) monitoring the client for nausea and GI cramping
|
|
|
The nurse recognizes that the primary inhibitory transmitter in the brain is ____.
|
GABA
|
|
|
The nurse completes a history and physical on a client admitted with exacerbation of a seizure disorder. What supplement should the nurse question the patient if he is taking?
|
Ginkgo biloba because it decreases the effectiveness of anti-seizure medication
|
|
|
The nurse giving discharge teaching for a client receiving carbamazepine (Tegretol) should include:
a) expect an orange discoloration of the urine b) report unusual bleeding or bruising c) urinary retention is an expected side effect d) proper teeth brushing is crucial due to gum hyperplasia |
b) report unusual bleeding or bruising
|
|
|
Which of the following nursing interventions are appropriate during a seizure? Check all that apply:
a) provide privacy b) make the immediate environment safe c) insert an oral airway d) restrain the client to protect from injury |
a) provide privacy
b) make the immediate environment safe |
|
|
What should the nurse do if her patient just had a seizure? Check all that apply:
a) administer Valium b) ensure a patent airway c) reorient the client to the environment d) reassure a client who is agitated postictal (post seizure) |
b) ensure a patent airway
c) reorient the client to the environment d) reassure a client who is agitated postictal (post seizure) |
|
|
Which of the following is a significant risk for patient's with Alzheimer's?
a) risk for injury related to decreased cognitive function b) ineffective tissue perfusion related to poor pumping action of the heart c) memory deficit related to poor retainment of information d) inbalance nutrition: more than bodies requirement |
a) risk for injury related to decreased cognitive function
|
|
|
What disease is characterized by a slow, shuffling, and propulsive gait?
|
Parkinson's disease
|
|
|
The nurse knows that Myasthenia gravis has a strong association with which endocrine disorder?
a) hypothyroidism b) hyperthyroidism c) Addisons d) Cushings |
b) hyperthyroidism
|
|
|
Which of the following tests is used to diagnose Myasthenia gravis?
a) CT scan b) MRI c) Tensilon testing d) Myelin-strength testing |
c) Tensilon testing
|
|
|
What would indicate a positive Tensilon test?
|
Marked improvement of a small IV dose of Tensilon.
|
|
|
How should Pyridostigmine (Mestinon) be taken in regard to food?
a) with meals b) after meals c) 1 hour after meal d) 45 minutes before meals |
d) 45 minutes before meals to strengthen chewing and reduce aspiration risks
|
|
|
A nurse has instructed a client with myasthenia gravis regarding risk factors for myasthenia gravis exacerbations. Which of the following client statements indicates a need for further instruction?
a) "I should take my medication 45 minutes before eating" b) "I have suction equipment at home in case I get really choked" c) "It will be really relaxing to take a long soak in the hot tub when I get home" d) "I have ordered a medical alert bracelet and I will wear it every day" |
c)"It will be really relaxing to take a long soak in the hot tube when I get home": Heat can trigger for the development of myasthenic symptoms. The client should be instructed to avoid soaking in a hot tube.
|
|
|
What syndrome might a client complain of "crawling skin" due to inappropriate sensory signals creating pain and tingling sensations?
|
Guillain-Barre Syndrome
|
|
|
The nurse knows that the progression of Guillain-Barre Syndrome is from:
a) head to toe b) toe to head c) medial to lateral d) lateral to medial |
b) toe to head
|
|
|
How is MS diagnosed?
|
MRI
|
|
|
Which of the following client findings for the patient with ALS should the nurse expect? Check all that apply:
a) muscle weakness b) gradual loss of sensation c) fluctuations in blood pressure d) muscle atrophy e) incontinence f) ineffective cough g) loss of cognitive function |
a) muscle weakness
pressure d) muscle atrophy e) incontinence f) ineffective cough |
|
|
How would norepinephrine and dopamine effect blood pressure?
|
They will raise it.
|
|
|
What changes in heart rate do you need to monitor for in a patient suspected of neurogenic shock?
|
Monitor for bradycardia and hypotension.
|
|
|
When assessing a client with cataracts, the nurse would expect to find which of the following in the patient:
a) glare and sensitivity to light b) myopia c) hyperopia d) white pupil e) red pupil reflex |
a) glare and light sensitivity
b) myopia e) white pupil |
|
|
Which of the following medications are used to treat glaucoma?
a) Azatilomide (Diamox) b) epinephrine c) Cartilol (Ocupres) d) Diparlocarpine (Pilocar) e) Timol Maleate (Timoptic) |
a) Azatilomide (Diamox)
c) Cartilol (Ocupres) d) Diparlocarpine (Pilocar) e) Timol Maleate (Timoptic) |
|
|
A patient complains of hearing a flutter sound in his ear, what is the first thing you do?
|
Inspect the ear with an otoscope.
|
|
|
True or False: A nurse who walks into a room to find her patient having a tonic-clonic seizure should place a pillow under their head for forward flexion.
|
True
|
|
|
What are Baclofen and Dantrium used for?
a) guillian barre b) muscle spasticity c) muscle weakness d) myasthenia gravis |
b) muscle spasticity
|
