Neurologic Injuries
This injury is caused by the rapid shift of the brain inside the skull (MVA, Sports, Shaken Baby) which often leads to COMA
What is Diffuse Axonal Injury (DAI)
Occurs with injuries above T6. The injury disrupts the sympathetic pathways, resulting in unopposed parasympathetic tone (vagal nerve dominance). This causes profound, life-threatening hypotension and bradycardia, along with warm, dry skin due to vasodilation. It is a perfusion crisis requiring vasopressors.
What is Neurogenic Shock (Hemodynamic Failure)
This level primary functional impact is the diaphragm and breathing , clinical risk is respiratory failure/death
What is C3-C5
Following a head injury, a client begins passing 500 mL of dilute urine per hour and has a serum sodium level of 158 mEq/L. Which condition does the nurse suspect, and what is the anticipated treatment?
A. SIADH; treated with fluid restriction and salt tablets.
B. Diabetes Insipidus; treated with desmopressin and hypotonic fluids.
C. SIADH; treated with ADH receptor antagonists ("vaptans")
D. Diabetes Insipidus; treated with sodium restriction and diuretics.
Correct Answer: B
Reasoning: The clinical presentation of significant diuresis with dilute urine and hypernatremia (high sodium) is characteristic of Diabetes Insipidus (DI), which is caused by a deficiency of ADH. DI management involves hypotonic fluids and synthetic ADH (desmopressin). SIADH would present with fluid retention, concentrated urine, and hyponatremia
What is Mannitol
Which intracranial hemorrhage is characterized by a 'lucid interval' where the patient loses consciousness, briefly regains it, and then rapidly deteriorates?
A. Epidural Hematoma
B. Intraventricular Hemorrhage
C. Subdural Hematoma
D. Subarachnoid Hemorrhage
Correct Answer: B
Reasoning: This classical clinical presentation occurs due to the arterial bleeding between the dura and the skull, leading to rapid pressure buildup after an initial recovery
This assessment tool its used to monitor TBI's ; less than 8 is CRITICAL!
What is..Glasgow Coma Scale
Occurs after the resolution of spinal shock, generally in injuries at or above T6. It is triggered by a noxious stimulus below the level of injury (e.g., full bladder, tight clothing). This triggers a massive, uninhibited sympathetic response, leading to severe hypertension
What is Autonomic Dysreflexia (Sympathetic Surge)
This primary function impacts all four limbs (tetraplegia) , clinical risk is neurogenic shock
What is C1-C8
A nurse is providing discharge teaching for a client newly prescribed levodopa-carbidopa for Parkinson’s disease. Which statement by the client indicates a need for further teaching?
A. "I should rise slowly from a sitting position to avoid feeling dizzy."
B. "I will take this medication with a high-protein snack to prevent stomach upset."
C. "I understand this medication may become less effective over time."
D. "I will tell my doctor if I notice an increase in involuntary movements."
Correct Answer: B
Reasoning: This medication should be taken with food to increase absorption, they explicitly warn that it should NOT be taken with protein or B vitamins because these can decrease the medication's absorption and efficacy. Orthostatic hypotension is a common side effect (A), the drug can lose efficacy over time (C), and it aims to balance dopamine to manage involuntary movements (D)
Diabetes insipidus is managed with this drug , a synthetic form of ADH
What is desmopressin
What is the hallmark physiological imbalance in Parkinson’s Disease that pharmacotherapy aims to correct?
A. Degeneration of lower motor neurons in the spinal cord
B. Excess dopamine and a deficiency of acetylcholine
C. Deficiency of dopamine and an over-activity of acetylcholine
D. Destruction of the myelin sheath by autoimmune antibodies
C. Deficiency of dopamine and an over-activity of acetylcholine
Reasoning: Normal movement requires a balance between inhibitory dopamine and excitatory acteylcholine; loss of dopamine-producing cells leads to cholinergic dominance
A patient has ICP , what vital signs would present Cushing's Triad?
What is.. decrease HR, decrease RR, increased BP (with widening scale ex: 180/60)
Injurys above T6 could lead to a hypertensive crisis if poorly managed. What are the nurses priorities when managing this crisis?
What is high flowers, straight cath and/or manual disimpactation
This primary functional impacts affects the trunk and upper body, clinical risk is autonomic dysreflexia
What is T5/T6 and above
A nurse is caring for a client newly diagnosed with Guillain-Barré Syndrome (GBS). The client currently reports bilateral leg weakness and "pins and needles" sensations in the feet. Which assessment finding is most critical for the nurse to monitor to detect life-threatening progression?
A. Diminished deep tendon reflexes in the lower extremities.
B. New onset of difficulty swallowing or speaking.
C. Changes in vital capacity and respiratory rate.
D. Presence of bowel sounds and last bowel movement.
Correct Answer: C
Reasoning: GBS is an acute autoimmune attack characterized by ascending weakness. If the weakness progresses upward and reaches the diaphragm, it can lead to respiratory failure. Therefore, the nurse's highest priority is to closely monitor the client's respiratory and oxygenation status for the potential need for mechanical ventilation
Most commonly ordered to treat the severe hypertensive crisis seen in Autonomic Dysreflexia
What is Nitrates and Calcium Channel Blockers (Amlodipine, Nifedipine)
A patient newly prescribed Levodopa-carbidopa for Parkinson’s Disease should be given which dietary instruction?
A. Avoid taking the medication with high-protein meals or b vitamins
B. Take the medication only on a empty stomach too ensure rapid onset
C. Consume a high-protein Diest to assist with muscle rigidity
D. Restrict fluid intake to prevent orthostatic hypotension
Reasoning: Both protein and vitamin b can interfere with the absorption and effectiveness of Levodopa-carbidopa
The level of injury determines the symptoms, ranging from tetraplegia (cervical) to paraplegia (lumbar)
What is Spinal Cord Injury (SCI)
Occurs immediately after spinal injury. The spinal cord ceases functioning below the injury, causing temporary, total loss of reflex activity, motor function, and sensation
What is Spinal Shock (Temporary Neural Shutdown)
This primary functional impact is the lower body(paraplegia), clinical risk is trunk control
What is T1-L5
Depending on the nature of the damage, patients may develop this kind of _______ bladder that empties spontaneously or a ________ bladder that retains urine and distends, both requiring specific catheterization and medication protocols
Spastic and Flaccid
SIADH is managed with ____ ____ and these ______
What is salt tablets and ADH receptor antagonists (often ending in "-vaptan")
Which clinical progression is most characteristic of Guillain-Barré Syndrome (GBS)?
A. Descending paralysis starting from the cranial nerves
B. Ascending weakness and hyporeflexia that may lead to respiratory failure
C. Unilateral tremors that worsen with intentional movement
D. Rapid cognitive decline followed by motor loss
Correct Answer: B
Reasoning: GBS classically presents as symmetric weakness starting in the lower extremities and moving upward, potentially affecting the diaphragm
What Cranial Nerve is associated with oculocephalic reflex associated with "Dolls Eyes"
What is #9
1.A neurological condition characterized by weak, limp muscles (reduced muscle tone) and loss of reflexes, often resulting from lower motor neuron damage. Potential for respiratory failure
2. This is found in what type of shock?
1.What is Flaccid Paralysis
2.What is Spinal Shock
This primary function impact is on the legs and pelvic organs, clinical risk is bowel/bladder/sexual dysfunction
What is Lumbar/Sacral
A nurse is preparing a discharge teaching plan for a client diagnosed with Relapsing-Remitting Multiple Sclerosis (RRMS). Which instruction is most critical for the nurse to include to prevent a "pseudo-exacerbation" or disease flare?
A. "Ensure you engage in vigorous outdoor exercise during the afternoon to maximize vitamin D absorption."
B. "Maintain a consistent body temperature and avoid hot showers or overheating."
C. "Limit your oral fluid intake to less than 1,000 mL per day to manage a spastic bladder."
D. "Stop your interferon therapy immediately if you begin to experience flu-like symptoms."
Correct Answer: B
Reasoning: In Multiple Sclerosis, the degradation and damage to the myelin sheath impairs the conduction of electrical impulses. A key goal of nursing management is to prevent exacerbations. Specifically note that heat causes a "pseudo-exacerbation" of symptoms, which is relieved by cooling down. Therefore, avoiding extremes in temperature (both hot and cold) is a priority teaching point to maintain stability
Used in the management of neurogenic shock to stabilize cardiovascular instability
What is Vassopressors (Norepinephrine)
To qualify for Acute Rehabilitation according to standard criteria, a patient must be able to tolerate how much therapy?
A. 3 hours of PT , 5 days a week
B. 2 hours of OT daily for 7 days
C. A maximum of 30 minutes of activity to prevent fatigue
D. 1 hour of PT , 3 days a week
Correct Answer: A
Reasoning: Acute rehab requires patients to tolerate a high intensity of multidisciplinary therapy as a prerequisite of admission