Basic Neuro
: A patient arrives to the ED after a motor vehicle accident. The patient’s arms are extended and the hands and toes are pointed outward. Based on this assessment finding, which part of the brain has been affected?
A. Lesions in cortical pathways
B. Medulla
C. Brainstem
D. Cerebrum
What is C
Rationale:
Brainstem: The patient is in decerbrate posture with extremities pointed outward, which is more severe than decorticate, when the extremities are turned in to the core.
What are three preventive therapies used to manage headaches or migraines (select all that apply) ?
Anticonvulsants
Dihydroergotamine
Triptan
Beta-Blockers
Calcium channel blockers
What Is 1, 4, 5
Rationale: 1,4,5 are used a preventative treatments for headaches/migraines and are taken everyday , Triptans and Dihydroergotamine are given at the onset/ early phases of the occurrences.
1, 4, 5
The nerve cells in the lumbosacral region of the spinal cord supply which body part? Select all that apply.
A.Legs
B. Pelvis
C. Bowel & bladder
D.Abdominal muscles
What is A, B, C
What neurotransmitter is synthesized by the parasympathetic neurons?
What is Acetylcholine
You are a newly registered nurse working night shift at the ED. Your patient has a BMI of 34 and is a chronic cigarette smoker, complaining of weakness on the right side of the body. The Doctor orders a CT scan of the head and chest and it comes back negative of any abnormalities. After taking Lacey’s med-surg class, you remember that a negative CT scan is indicative of what type of stroke? What other diagnostic tests will you recommend to confirm your suspicion?
Ischemic stroke, MRI. A CT scan is the Gold Standard for determining whether hemorrhage is the cause of symptoms. An MRI is performed for patients with suspected ischemic stroke to capture an image of necrotic tissue and areas of the brain that are hypoperfused.
Pg 836.. Table 39.9
What occurs when there is segmental demyelination?
A. There is a delay in the message being received and action potential
B. There is an increase in the message being sent but a decrease in action potential
C. There is no problem that occurs
D. There is a delay in the message being received but an increase in action potential
What is A
Rationale:The myelin sheath has begun to break down which leads to decrease or a slower conduction in messages transmitted to the CNS. This is irreversible
Why is treating Encephalitis with Ganciclovir a safety risk ?
Ganciclovir is carcinogen, teratogen, and mutagen
SAFETY CHECK BOX PAGE 759
The nurse monitors for which clinical manifestations of MS? Select all that apply.
A. Blurred vision
B. Speech problems
C. Muscle weakness
D. Bradycardia
E.Fasciculations
What is A, B, C
Rationale: A, B, and C are all clinical manifestations of MS, depending on the location and extent of demyelination. Bradycardia is not observed and fasciculations are muscle twitching not associated with MS.
What is also known as the “ rest and digest” portion of the nervous system?
What is Parasympathetic nervous system
The day shift nurse reports off to you stating, “last night around 2240, this patient was unconscious and unresponsive for nearly 30 minutes. After further examination, the attending Dr. determined that the patient had a GCS of 12”. What type of TBI did the patient experience last night?
Moderate TBI is characterized by a GCS of 9-12 and a loss of consciousness between 30 min- 6 hours. A mild TBI is characterized by a GCS of 13-15 and a loss of consciousness for less than 30 minutes. Although the patient’s time categorizes this injury as mild, a traumatic brain injury should be categorized by GCS first, therefore grouping this incident as a moderate TBI.
Pg 844-845
The nurse recognizes that patients with major changes in personality most likely have damage in which lobe of the brain?
A. Frontal
B. Occipital
C. Parietal
D. Temporal
What is A
Rationale: the Frontal lobe is responsible for voluntary motor movement, Broca’s speech, personality, and behavior. The Occipital lobe is primarily responsible for vision. The parietal lobe is responsible for sensory input and integration and spatial relationships. The temporal lobe is responsible for auditory sensation and perception, memory, and Wernicke’s speech center.
What are the four discernible symptoms of Parkinson’s disease?
What is Resting tremors, muscle rigidity, bradykinesia or aknesia, postural instability
Which interventions are indicated to treat the loss of vasomotor tone in the patient with an acute spinal cord injury? Select all that apply
A. Positive inotropes
B. Corticosteroids
C. Antispasmodics
D. IV fluids
E.Vasopressors
What is A, D, E
Rationale: loss of vasomotor tone causes blood to pool in the vessels and results in low blood pressure. Intravenous fluids, vasopressors, and inotropes are often used to provide adequate fluid resuscitation, increase tone, and increase cardiac output.
What medications are contraindicated in giving to patients with myasthenia Gravis?
A.Some antibiotics
B. Corticosteroids
C. Calcium channel blockers
D. Neostigmine
What is A, C
Rationale: A, C are correct because CCB blocks calcium which is needed for normal neuromuscular transmission . You give corticosteroids for immunotherapy and Neostigmine is given when there is a compromise in the GI system but it is not given orally!
You are a preceptor for a recently graduated RN. You are monitoring the new RN as she cares for a patient with a severe TBI due to a subdural hematoma. Johnny, the new RN, administers Mannitol, places the patients head at 20 degrees, assists the patient into a hyperventilated state, and monitors temperature q1 hour. Which of these actions will you correct?
Do not place the patients head at 20 degrees, the patient should be elevated to between 30 to 45 degrees. Mannitol is administered to pull water out of the extracellular space of edematous brain tissue. Hyperventilation is induced after the first 24 hours to constrict the vessels and decrease the intracranial pressure. Therapeutic hypothermia (89.6-93.2 degrees) is induced to reduce metabolic demands on the brain and prevent molecular and biochemical cascade.
Pg 850-851
Which of these statements about neurotransmitters is correct? (select all that apply)
A. Excitatory neurotransmitters open up sodium channels
B. Acetylcholine is associated with memory and learning
C. Inhibitory neurotransmitters open up sodium channels
D. Norepinephrine is associated with control of movements, motivation and reward, addiction
E. Serotonin is associated with how you process emotions
What is A, B, E
Rationale:A, B, E are correct, C is incorrect because inhibitory neurotransmitters open chloride channels not sodium. D is incorrect because norepinephrine is associated with attentiveness, emotions, sleeping, dreaming and learning.
What is a late sign in the disease process of Alzheimer's and how do you know it's occurring?
What is Prosopagnosia, the patient is no longer able to recognize familiar faces
A patient is experiencing increasing flaccid upper arms while the lower extremities periodically cramp and contract. On which health problem should the nurse focus when assessing this patient?
Amyotrophic Lateral Sclerosis (ALS)
What are the three stages of Gillain-barre syndrome?
What is Acute stage, plateau stage, recovery stage
Name the 3 patient symptoms expressed as a late sign of increased ICP.
Cushing’s Triad: systolic hypertension with widening pulse pressure, decreased heart rate, and decreased respiratory rate
Powerpoint slides
Which cranial nerves are correctly matched with what they are and how you test them? (select all that apply)
A. Cranial nerve I is the optic nerve and you use the 6 cardinal fields of gaze
B. Cranial nerve II is the optic nerve and you ask the patient to read a sentence
C. Cranial nerve III is the oculomotor nerve and you use PERRLA
D. Cranial nerve IV is the trigeminal nerve and you ask the patient to smile or raise their eyebrows
E. Cranial nerve V is the trochlear nerve and you use the 6 cardinal fields of gaze
F.Cranial nerve VI is the abducens nerve and you use the 6 cardinal fields of gaze
What is B, C, F
Rationale: B,C,F are correctly matched with their nerve and how you test each of them. A is the olfactory nerve not the optic and you ask the patient “ can you smell…”. D is the trochlear nerve and you use the 6 cardinal fields of gaze. E is the trigeminal nerve and you ask the patient to smile or raise their eyebrows.
What are the 5 need to know seizure precautions?
What is IV Access, 3 padded side rails, oxygen equipment ready and at the bedside, suction equipment ready and at the bedside, oral airway at the bedside
The nurse recognizes which factor as placing a patient at the greatest risk for new onset of low back pain?
A.Sedentary lifestyle
B. Recent long-distance car trip
C. Prolonged standing
D. Cigarette smoking
What is D
Rationale: conditions that may contribute to low back pain are obesity, smoking, poor posture, stress, poor physical condition, and poor sleeping conditions.
What is a motor disorder that is an acquired autoimmune neuromuscular function disorder characterized by fluctuating, localized skeletal muscle weakness and fatigue?
What is Myasthenia Gravis
You are a nurse caring for a preoperative patient headed to surgery for a hip fracture. The patient has a history of recurrent TIA’s. When reviewing the patient’s at-home medication regimen, they mention they took Clopidogrel with a sip of water 3 hours ago. As a nurse, should you call the Dr. to postpone surgery, verify the patient took the medication with a family member, or continue to prepare for surgery with bleeding precautions?
Prepare for surgery with bleeding precautions as clopidogrel is an anticoagulant. Clopidogrel is the #1 med we do not hold prior to surgery due to risk of recurrent transient ischemic attack.
Powerpoint slides