Brain Games
Warning! Frazzled Nerves Inside!
Trauma Troubles
Are you Broca's aphasia? Because you leave me speechless!
Perfusion Potpourri
100
You are the primary RN performing a neurological assessment using the Glasgow Coma Scale. During the assessment you documented that the patient’s eyes opened in response to their name, was able to localize pain, but used inappropriate words that did not relate to the conversation or topic when talking. You record a score of: A. 8 B. 11 C. 14 D. 9
B. 11
100
A patient is diagnosed with Bell’s palsy, what in the patient’s history supports this diagnosis? A. Asthma B. Positive Herpes Simplex Virus Type I test result C. Living in a climate with extreme heat D. A minor head injury 3 years prior
B. Positive Herpes Simplex Virus Type I test result
100
The nurse is caring for a client with a closed head injury. Which of the following would contribute to intracranial hypertension? A. hypoventilation B. elevating the head of the bed C. hypernatremia D. quiet darkened environment
A. Hypoventilation leads to vasodilation and increased intracranial pressure.
100
The nurse is caring for a client diagnosed with Broca aphasia due to a stroke. Which of the following deficits would the nurse correctly attribute to Broca aphasia? SATA. A. Client coughs and gasps when swallowing food and liquids B. Client is easily frustrated while attempting to speak C. Client is unable to understand speech and is completely nonverbal D. Client misunderstands and inappropriately responds to verbal instruction E. Client's speech is limited to short phrases that require effort
Answer: B, E. Damage to the frontal lobe of the brain may cause Broca (expressive) aphasia. Clients with this condition demonstrate effortful and sensible speech characterized by short, limited sentences, with retained ability to comprehend speech. This impairment often causes clients with Broca aphasia to be frustrated when speaking.
100
"The worst headache of my life" is most often associated with this.
What is subarachnoid hemorrhage?
200
These are the components of Cushing's Triad.
What are bradycardia, increased SBP, decreased RR?
200
The nurse is caring for a patient with peripheral nerve damage to the lower extremity. The postoperative positioning and handling of the extremity include this.
What is joint flexion to keep tension off the suture site?
200
The client is admitted with a brain abscess. Which diagnostic assessment intervention does the nurse question as nonspecific to the diagnosis? A. Bone scan B. Electroencephalogram (EEG) C. Throat culture D. Sinus x-rays
A. Bone scan A bone scan is done to determine new areas of bone growth, areas of metastatic lesions, and osteoporosis
200
This results in the inability to comprehend the spoken and/or written word. Clients exhibit a long, but meaningless, speech pattern.
What is Wernicke aphasia?
200
When anoxia is related to a witnessed cardiac arrest in a patient, which intervention must be implemented by the nurse? A. Inducing a barbiturate coma B. Placing an intraventricular catheter C. Performing therapeutic hypothermia D. Performing decompressive craniectomy
Answer: C. Perform therapeutic hypothermia. When anoxia is related to a witnessed cardiac arrest, performing therapeutic hypothermia is the most useful. The purpose of therapeutic hypothermia is to rapidly cool the patient to a core temperature of 89.6° and 93.2°F (32° to 34° C) for 24 to 48 hours after a primary brain injury. A barbiturate coma, or barb coma, is a temporary state of unconsciousness brought on by a controlled dose of a barbiturate drug. Intraventricular catheter is a monitoring device that allows accurate measurement of intracranial pressure (ICP). In extreme cases, in which the patient’s ICP cannot be controlled, the physician may elect to perform a decompressive craniectomy (removal of a section of the skull) to remove ischemic brain tissue or the tips of the temporal lobes.
300
3. One hour after receiving pyrodostigmine bromide (Mestinon), a client reports difficulty swallowing and excessive respiratory secretions. The nurse notifies the physician and prepares to administer which medication? A. additional pyrodostigmine bromide B. atropine C. Edrophonium (Tensolon) D. acyclovir
B. Atropine. Symptoms suggest cholinergic crisis (excessive acetylcholinesterase medication). Atropine is an anticholinergic medication.
300
A patient presents with facial pain, which she describes as excruciating and jabbing. She reports that for 3 weeks she has had difficulty brushing her teeth, washing her face, or eating because these activities result in intense pain. What medication do you anticipate the doctor will prescribe? A. Acetaminophen B. Memantine C. Propranolol D. Carbamazepine
D. Carbamazepine. Carbamazepine is the drug of choice for the initial treatment of trigeminal neuralgia.
300
The client is admitted to the medical floor with a diagnosis of closed head injury. Which nursing intervention has priority? A. Assess neuro status. B. Monitor pulse, respiration, and blood pressure. C. Initiate IV access. D. Maintain an adequate airway.
D. Maintain an adequate airway. The most important goal in the management of a client with a head injury is to establish and maintain an adequate airway.
300
The clinic nurse is caring for an elderly client who is overweight and being treated for hypertension. What is most important for the nurse to emphasize to prevent a stroke? A. Consume a low-fat, low-salt diet B. Do not smoke cigarettes C. Exercise and lose weight D. Take prescribed antihypertensive medications
D. Take prescribed antihypertensive medications The single most important factor in preventing strokes is controlling hypertension.
300
One week ago a client was involved in a motor vehicle crash (MVC)and was brought to the Emergency Department (ED). In the emergency department, the client received two stitches to the forehead and was sent home. Today the client’s spouse notes the client “acts like he is drunk” and cannot control his right foot and arm. What does this scenario suggest? A. meningitis B. absence seizure C. subdural hematoma D. Meniere’s Disease
C. Subacute subdural hematoma. Head injury with slow venous bleed and the body does not have symptoms until compensation is exhausted.
400
Electrolyte imbalances and dehydration are common side effects of this strong osmotic diuretic used in the treatment of ICP.
What is mannitol?
400
Respiratory failure, muscle weakness, vomiting, diarrhea, cramping, and blurred vision are symptoms of this crisis.
What is cholinergic crisis?
400
According to the American Academy of Neurology which of the following prerequisites is one of the four guidelines for establishing a brain death diagnosis? A. Coma of a known cause as established by history, clinical examination, laboratory testing, and neuroimaging. B. A total score of 7 or less on the Glasgow Coma Scale for five consecutive days. C. A core body temperature of less than 96.8 F (36 C) on three separate readings. D. Upon assessment the patient is: unresponsive to pain, pupils are nonreactive, and breath sounds are diminished anteriorly and posteriorly.
A. Coma of a known cause as established by history, clinical examination, laboratory testing, and neuroimaging.
400
The nurse is assisting the patient who is recovering from an acute stroke and has right-side hemiplegia to transfer from the bed to the wheelchair. Which action by the nurse is appropriate? A. Positioning the wheelchair next to the bed on the patient's right side B. Placing the wheelchair parallel to the bed on the patient's left side C. Setting the wheelchair directly in front of the patient, who is sitting on the side of the bed D. Moving the wheelchair a few steps from the bed and having the patient walk to the chair
Correct Answer: B Place the wheelchair parallel to the bed on the patient's left side. Placing the wheelchair on the patient's left side will allow the patient to use the left hand to grasp the left arm of the chair to transfer. If the chair is placed on the patient's right side or in front of the patient, it will be awkward to use the strong arm, and the patient will be at increased risk for a fall. Because the patient has hemiplegia, it is not appropriate to place the chair where the patient will need to walk to it.
400
A client returns from the postanesthesia care unit (PACU) after a craniotomy for removal of a left parietal lobe tumor. How will the nurse position the client after surgery? A. Flex the client’s knees to decrease intra-abdominal pressure and cerebral hypertension. B. Keep the client on the left side to prevent surgical site bleeding or cerebrospinal fluid leakage. C. Elevate the client’s head to at least 30 degrees to promote cerebral venous drainage. D. Hyperextend the client’s neck to maintain the airway and prevent aspiration regardless of supine or side-lying positioning.
Answer: C. Elevate Head to at least 30 degrees. Elevation of the backrest allows both CSF and cerebral venous blood to drain out of the cranium. Avoid placing a client who has undergone a craniotomy on the operative side. Avoid hip and knee flexion because this increases intracranial pressure, and increased intracranial pressure from edema is common in clients after cranial surgery. Hyperextension of the neck will reduce CSF and venous outflow from the cranium.
500
A client is being monitored for transient ischemic attacks. The client is oriented, can open the eyes spontaneously, and follows commands. What is the Glasgow Coma Scale score?
What is 15 points?
500
2. The patient with Guillain-Barre syndrome is in the plateau period. Which intervention is best for the nurse to delegate to the UAP? A. Perform passive range of motion every 2 to 4 hours B. turn the patient every 2 hours and assess for skin breakdown C. remove the antiembolism stockings every 24 to 48 hours and perform skin care D. make a communication board for the patient with a list of common requests.
A. Perform passive range of motion every 2 to 4 hours.
500
A patient is admitted with signs of a stroke (CVA). On admission, vital signs were blood pressure 128/70, pulse 68, and respirations 20. Two hours later the patient is not awake, has a blood pressure of 170/70, pulse 52, and the left pupil is now slower than the right pupil in reacting to light. These findings suggest which of the following? A. impending brain death B. decreasing intracranial pressure C. stabilization of the patient's condition D. increased intracranial pressure
Correct Answer: D Rising systolic blood pressure, falling pulse, and a pupil that has become sluggish suggest increasing intracranial pressure (IICP). This is an emergency situation that requires notification of the physician. This is an emergency situation that requires intervention as the patient's condition is becoming more unstable. Brain death is diagnosed by lack of brain waves and inability to maintain vital function.
500
A patient with a history of several transient ischemic attacks (TIAs) arrives in the emergency room with hemiparesis and dysarthria that started 2 hours previously. The nurse anticipates the need to prepare the patient for A. intravenous heparin administration. B. transluminal angioplasty. C. surgical endarterectomy. D. tissue plasminogen activator (tPA) infusion.
Correct Answer: D. tPA infusion. The patient's history and clinical manifestations suggest an acute ischemic stroke and a patient who is seen within 3 hours of stroke onset is likely to receive tPA (after screening with a CT scan). Heparin administration in the emergency phase is not indicated. Emergent carotid transluminal angioplasty or endarterectomy are not indicated for the patient who is having an acute ischemic stroke.
500
A hospitalized client develops acute hemorrhagic stroke and is transferred to the ICU. What nursing interventions should be included in the plan of care? SATA. A. Administer PRN stool softeners B. Administer scheduled enoxaparin injection C. Implement seizure precautions D. Keep client NPO until swallow screen is performed E. Perform frequent neurologic assessments
Correct answers: A, C, D, E. A hemorrhagic stroke occurs when a blood vessel ruptures in the brain and causes bleeding. The perform frequent neurologic assessments, keep the client NPO, maintain seizure precautions and strict bedrest, and limit any activity that may increase bleeding (eg anticoagulant administration) or ICP (eg stimulation, straining during bowel movements).
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