Neuro Detective
A patient's neurologic status is worsening. What assessment finding is often one of the most important indicators of a change in brain function?
Change in level of consciousness (LOC)
A temporary interruption of blood flow to the brain causes neurologic symptoms that resolve. What condition is this?
TIA
A patient reports sensitivity to light during a migraine. What is this symptom called?
Photophobia
A patient understands what the nurse says but struggles to produce words. What type of aphasia is this?
Expressive/Broca aphasia
Tremor, rigidity, bradykinesia, and postural instability are characteristic of what disease?
Parkinson’s disease
The nurse asks a patient to smile, raise both arms, and squeeze both hands. What is the nurse primarily comparing?
Symmetry of motor function
A cerebral artery becomes blocked by a clot. Why can permanent neurologic damage occur?
Brain tissue loses blood flow, oxygen, and glucose, causing ischemia and eventually infarction/cell death.
During a migraine, a patient reports seeing flashing lights before the headache begins. What is this warning symptom called?
An aura
A patient speaks fluently, but the words make little sense and the patient does not understand what the nurse says. What type of aphasia is this?
Receptive/Wernicke aphasia
In Alzheimer’s disease, abnormal beta-amyloid and tau contribute to what major problem in the brain?
Impaired neuronal transmission and progressive cognitive decline
A patient's GCS score decreases from the previous assessment. What should the nurse do with this finding?
Recognize it as neurologic deterioration and promptly report/respond to the change.
A patient develops sudden neurologic deficits from a clot that traveled from the heart to a cerebral artery. What type of ischemic stroke is occurring
Embolic stroke
A patient with migraine asks why the nurse is reducing noise and dimming the lights. What symptoms make these interventions helpful?
Photophobia and phonophobia
After a stroke, a patient repeatedly ignores food on one side of the plate and does not recognize one side of the body. What problem should the nurse suspect?
Unilateral neglect/inattention
A patient with Parkinson’s takes a long time to begin walking and moves very slowly. Which characteristic manifestation does this represent?
Bradykinesia
A patient suddenly develops facial droop and arm weakness during your assessment. What is the nurse's priority response?
Recognize a possible acute stroke and initiate the facility's emergency/stroke response immediately.
A patient with suspected acute stroke arrives in the ED. Why is a head CT obtained early in the evaluation?
To help determine whether the stroke is ischemic or hemorrhagic/identify bleeding before treatment decisions.
A patient says, “This is the worst headache I have ever had,” and the headache began suddenly. Why should the nurse treat this differently from the patient's usual migraine?
A sudden severe headache may indicate an acute neurologic emergency such as hemorrhage and requires immediate evaluation.
A stroke patient has difficulty judging distances and is impulsive when attempting to get out of bed. What is the nurse's major concern?
Injury/fall risk requiring increased safety measures.
A patient with Alzheimer’s becomes increasingly confused and agitated in the evening. What phenomenon is the nurse recognizing?
Sundowning
During neuro checks, a previously alert patient becomes increasingly difficult to arouse. The pupils also change from the previous assessment. What should guide the nurse's action?
These are acute neurologic changes requiring immediate evaluation/intervention rather than waiting for the next scheduled neuro check.
A patient had unilateral weakness and aphasia for 20 minutes, but both resolved before arrival at the ED. The patient says, “I'm fine now, so I can go home.” What is the nurse's best response?
The resolved symptoms may represent a TIA and require urgent evaluation because a TIA can precede a stroke.
A patient with a history of migraine reports a headache that is suddenly very different from previous headaches and is accompanied by a new neurologic deficit. What should the nurse do first?
Treat the change as a possible neurologic emergency and obtain immediate evaluation rather than assuming it is the patient's usual migraine.
A patient with aphasia becomes frustrated while trying to answer the nurse. What nursing approach best supports communication?
Allow adequate time to respond and use simple communication strategies without speaking for or rushing the patient.
A hospitalized patient with known Alzheimer’s suddenly becomes much more confused than baseline. Should the nurse assume this is progression of dementia?
No. Assess for an acute cause of delirium because a sudden change is not the expected gradual progression of Alzheimer’s disease.