Act FAST!
A patient presents with sudden severe headache, vomiting, and neck stiffness. A CT scan confirms a hemorrhagic stroke. Which of the following is the MOST common risk factor for this type of stroke?
A. Diabetes Mellitus
B. Hypotension
C. Uncontrolled Hypertension
D. High cholesterol
C. Uncontrolled Hypertension
Uncontrolled hypertension is the most common risk factor for hemorrhagic strokes. Hypotension and hypercholesterolemia are not commonly associated with hemorrhagic strokes, although hypercholesterolemia does increase the risk of ischemic stroke. Diabetes (D) is a risk factor for both hemorrhagic and ischemic strokes and may contribute to uncontrolled hypertension, but hypertension is the most common risk factor for hemorrhagic strokes.
What type of med puts a person at a higher risk for stroke?
A. BP meds
B. PPIs
C. Birth control
D. Vitamins
C. Birth control
Hormonal birth control, particularly estrogen-containing pills, vaginal rings, and patches, can increase the risk of stroke due to the potential for blood clots.
In a patient who has just sustained a severe head injury in a high-speed MVC, which should be a high-priority concern?
A.myocardial contusion
B.cerebral edema
C. Diabetes
D. status epilepticus
B.cerebral edema
TBI can result in increased intracranial volume. This can be related to clot or hematoma development, breakdown in the blood-brain barrier or accumulation of intracellular fluid. This results in an increase in intracranial pressure, which can ultimately lead to cerebral tissues being oxygen deprived. The other options are not high priorities but are of clinical concern.
This type of aphasia results in difficulty expressing language but preserved comprehension.
A. Wernicke's Aphasia (Receptive/Sensory)
B. Broca’s aphasia
C. Anomic Aphasia:
D. Global Aphasia:
B. Broca’s aphasia
Broca's aphasia is a non-fluent expressive aphasia due to damage in the frontal lobe. Comprehension remains intact.
When providing care to a patient with status epilepticus, the nurse should recognize that usually A. it is a state of continuous seizures lasting more than 2 minutes.
B. the patient comes out of the post ictal state between seizures.
C. it results from abrupt discontinuation of anti-seizure medications.
D. the cause of death is due to cerebral hemorrhage
C. it results from abrupt discontinuation of anti-seizure medications.
Abrupt discontinuation of anti-seizure medications can cause continuous seizures
or status epilepticus. In status epilepticus, the continuous seizures last at least five minutes. The patient remains in status epilepticus while in the post ictal state. The cause of death is usually related to cerebral hypermetabolism.
**DOUBLE DOUBLE**
This acronym helps identify early stroke symptoms.
What is FAST (Face, Arms, Speech, Time)?
FAST helps identify stroke symptoms quickly to get early intervention—especially critical for tPA eligibility.
Which of the following would indicate late signs of increased Intracranial Pressure (ICP)?
A. Vision changes
B. Change in Level of Consciousness (LOC)
C. Pupillary changes
D. Lethargy
C. Pupillary changes
Early signs of increased Intracranial Pressure (ICP) include restlessness, confusion, lethargy, headache, nausea or vomiting, and visual abnormalities (i.e., diplopia). Change in Level of Consciousness (LOC) is the most important indicator of elevated ICP, but not a late sign.
Changes in vital signs may occur. Systolic blood pressure increases as the body attempts to maintain cerebral perfusion, and heart rate and respiratory pattern alterations may emerge as ICP worsens. Pupillary changes are usually late signs of increased ICP.
Which may cause development of fixed pupils?
A. hyperoxia
B. opiates
C. hypothermia
D. olfactory damage
C. hypothermia
Hypothermia may cause fixed pupils. Hyperoxia (oxygen toxicity) does not result in fixed pupils. However, hypoxia may cause wide and fixed pupils due to midbrain damage. Opiates may cause pinpoint pupils, but they are not fixed. The olfactory nerve is responsible for the sense of smell.
Which of the following accurately describes the key components of Cushing's Triad?
A. Narrowing pulse pressure, hyperthermia, bradypnea
B. Tachycardia, hypotension, shallow breathings
C. Bradycardia, widening pulse pressure, and abnormal respirations
D. Tachycardia, HTN, Kussmaul's respirations
C. Bradycardia, widening pulse pressure, and abnormal respirations
Tachycardia and hypotension generally indicate shock. Kussmaul respirations are often associated with metabolic acidosis not elevated ICPs.
A patient with an anterior cerebral arterial embolism will MOST LIKELY develop
A. aphasia.
B. hemiplegia.
C. visual loss.
D. motor loss.
B. hemiplegia
The anterior cerebral artery supplies the medial portions of the frontal and parietal lobes and corpus callosum. The frontal lobe is partially responsible for voluntary movement. Visual loss is associated with an embolism in the posterior cerebral artery. Aphasia is associated with an embolism in the middle cerebral artery. Sensory loss is associated with an embolism in the posterior cerebral artery.
A patient with intraventricular hemorrhage (IVH) and subsequent hydrocephalus is MOST likely to be treated with:
A. Placement of lumbar drain
B. A suboccipital craniectomy
C. Placement of external ventricular drain
D. Administer antiepilectic drugs
C. Placement of external ventricular drain
Intraventricular blood may create a blockage in the ventricular drainage system, and cause
cerebrospinal fluid (CSF) to build up (obstructive or noncommunicating hydrocephalus). Acute obstructive hydrocephalus may be managed by placing an external ventricular drain or a ventriculoperitoneal (VP) shunt.
Cerebellar hemorrhage (not intraventricular) may require a suboccipital craniectomy to evacuate the clot and decrease pressure on vital structures.
AEDs are recommended for patients who experience seizures or who show evidence of seizures on EEG. Occasionally, a patient with a basilar skull fracture will require lumbar drainage of CSF to decrease pressure on the healing dura.
A fixed and dilated pupil indicates compression of which cranial nerve?
A. I
B. II
C. III
D. IV
C. III
Oculomotor nerve. Motor limb of the pupillary light reflex; causes constriction of the pupil. Eyelid elevation. It controls four of the six eye muscles.
A victim of an MVC is admitted with an acute intracranial bleed. The patient has hypotension and tachycardia. These findings are MOST LIKELY the result of
A. shock from multiple trauma.
B. extensive bleeding into the intracranial vault.
C. neurogenic shock.
D.increased intracranial pressure.
A. shock from multiple trauma.
This patient has risk factors for and manifestations of shock. The patient is hypotensive and tachycardic. Patients with multiple traumas will typically have hypovolemic shock, characterized by hypotension and tachycardia. Extensive bleeding into the intracranial vault would result in increased intracranial pressure, manifested, in part, by bradycardia. Neurogenic shock is a type of distributive shock where the patient has bradycardia. An increase in intracranial pressure is associated with bradycardia, which is part of Cushing’s triad.
Which type of generalized seizure is characterized by rhythmic muscle jerking?
A. Clonic
B. Tonic
C. Atonic
D. Absent
A. Clonic
Generalized seizures are characterized
by abnormal electrical discharge that rapidly affects both hemispheres. There are several types of generalized seizures:
-Absence: Sudden lapse of consciousness and activity that lasts 3 to 30 seconds; commonly described as a staring spell
-Myoclonic: Sudden, brief muscle jerking of one or more muscle groups. Commonly associated with metabolic, degenerative, and hypoxic causes
-Atonic (also called drop attacks): Sudden loss of muscle tone
-Clonic: Rhythmic muscle jerking
-Tonic: Sustained muscle contraction
-Tonic-clonic: Muscle activity varies between sustained contraction and jerking
A 60 yo patient has been diagnosed with a glioblastoma multiforme. The patient begins to experience severe headaches, nausea, and blurred vision. What is the MOST likely cause of these symptoms?
A. Brain Herniation
B. Subdural Hematoma
C. Cerebral aneurysm
D. Hydrocephalus
D. Hydrocephalus
The s/s are indicative of increased intracranial pressure. This could be caused by the malignancy itself, but could also be caused by hydrocephalus, a common complication of brain tumors.
A left-field visual loss would indicate damage to which cranial nerve?
A. Cranial nerve III
B. Cranial nerve IV
C. Cranial nerve II
D. Cranial nerve VI
The optic nerve (cranial nerve II) is responsible for visual fields and visual acuity. Thus, left-field visual loss indicates damage to the optic nerve. Assessing pupil size and reaction to light provides information about the function of the optic nerve and oculomotor (cranial nerve Ill) nerves. Both eyes should be tested for direct and consensual response. A normal direct pupillary response is brisk constriction of the pupil followed by dilation when a bright light is shone directly into one eye, and a consensual pupillary response is when the opposite eye constricts then dilates similarly to the eye being tested. Assessing both of these responses provides information about which cranial nerve (optic or oculomotor, left or right) is affected.
The oculomotor nerve is responsible for extraocular eye movements, as well as contraction of the iris in response to light. The trochlear nerve (cranial nerve IV) is responsible for eye movement down and toward the nose, and Cranial nerve VI (abducens) is responsible for lateral eye movement.
A blood clot located between the dura and the skull is known as a(n):
A. Subdural Hematoma
B. Subarachnoid Hemorrhage (SAH)
C. Confusion
D. Epidural Hematoma
D. Epidural Hematoma
Epidural hematoma (EDH) refers to a blood clot located between the dura and the skull. EDH is associated with skull fractures that lacerate an underlying artery and is most common in the temporal region due to tearing of the middle meningeal artery.
In a subdural hematoma (SDH), bleeding occurs within the subdural space between the dura and arachnoid layer, creating direct pressure on the brain. SDH results from the rupture of the bridging veins between the brain and dura, bleeding from contused or lacerated brain tissue, or extension from an intracerebral hematoma. SDH can be acute, subacute, or chronic.
In a Subarachnoid Hemorrhage (SAH), bleeding occurs within the subarachnoid space, the area between the arachnoid membrane and the pia mater surrounding the brain. This may occur as a result of a head injury or spontaneously, usually from a ruptured cerebral aneurysm.
What is the MOST common cause of ischemic stroke?
A. Hypertension
B. Thrombosis
C. Bleeding
D. Embolism
B. Thrombosis
Thrombosis is the most common cause of ischemic stroke and is generally due to atherosclerosis and the formation of plaque within an artery. A thrombus, or blood clot, forms at the site of the plaque and causes brain tissue ischemia along the course of the affected vessel, resulting in infarct if not reversed quickly.
Embolism is the occlusion of a cerebral vessel. The occlusion can be from a blood clot or infectious particles, fat, air, or tumor fragments. Hypertension and diabetes are risk factors for stroke.
One month after VP shunt replacement, a patient is admitted with a positive Kernig’s sign and positive Brudzinski’s sign. These signs indicate
A. a CNS infection B. blockage in the shunt.
C. peritonitis.
D. noncommunicating hydrocephalus.
A. a CNS infection.
Positive Kernig’s sign (straightening of the knee with hip and knee in a flexed position produces pain in the back and neck regions) and Brudzinski’s sign (passive flexion of the neck produces neck pain and increased rigidity) may be manifested in patients with meningitis. The other conditions will not cause the symptoms described in this scenario.
A 45-year-old female patient has been diagnosed with bacterial meningitis. She is febrile with a stiff neck, photophobia, and a petechial rash. Despite aggressive treatment with appropriate antibiotics, her neurological condition worsens without any new obvious symptoms developing. What common complication of bacterial meningitis is MOST likely to account for her deteriorating condition?
A. Viral encephalitis
B. Sepsis
C. Subarachnoid Hemorrhage
D. Hepatic failure
C. Subarachnoid Hemorrhage
In bacterial meningitis, the inflammation of the meninges can lead to vascular complications like subarachnoid hemorrhage, which could worsen the patient's condition. Viral encephalitis is not caused by or related to bacterial meningitis. Hepatic failure is not a common complication of bacterial meningitis. While sepsis can be a complication of bacterial meningitis, it would likely lead to systemic symptoms that would be recognizable, unlike subarachnoid hemorrhage, which could be masked by meningitis symptoms.