NUR 216 Q1

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TomWruble
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NUR 216 Q1
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2013-11-17 21:54:22
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Quiz chapters 43 44
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nervous system assessment; Pts with CNS problems - brain
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  1. Odor Of Orangutan Terrified Tarzan After Forty Voracious Gorillas Viciously Attacked Him
    • Olfactory
    • Optic
    • Oculomotor
    • Trochlear
    • Trigeminal
    • Abducens
    • Facial
    • Vestibulocochlear
    • Glossopharyngeal
    • Vagus
    • Accessory
    • Hypoglossal
  2. Olfactory
    I

    Smell
  3. I
    Olfactory

    Smell
  4. Optic
    II

    Vision and visual field
  5. II
    Optic

    Vision and visual field
  6. Oculomotor
    III

    Extraocular eye movement (EOM)
  7. III
    Oculomotor

    Extraocular eye movement (EOM)
  8. Trochlear
    IV

    EOM, movement of the eyeball downward and laterally
  9. IV
    Trochlear

    EOM, movement of the eyeball downward and laterally
  10. Trigeminal
    V

    Sensation of cornea, skin of face and nasal mucosa
  11. V
    Trigeminal

    Sensation of cornea, skin of face and nasal mucosa
  12. Abducens
    VI

    EOM, moves eyeball laterally
  13. VI
    Abducens

    EOM, moves eyeball laterally
  14. Facial
    VII

    Facial expression, taste, anterior two-thirds of tongue
  15. VII
    Facial

    Facial expression, taste, anterior two-thirds of tongue
  16. Vestibulocochlear
    VIII

    Equilibrium, Hearing
  17. VIII
    Vestibulocochlear

    Equilibrium, Hearing
  18. Glossopharyngeal
    IX

    Swallowing ability, tongue movement, taste
  19. IX
    Glossopharyngeal

    Swallowing ability, tongue movement, taste
  20. Vagus
    X

    Sensation of pharynx and larynx, swallowing, vocal cord movement
  21. X
    Vagus

    Sensation of pharynx and larynx, swallowing, vocal cord movement
  22. Accessory
    XI

    Head movement, shrugging of shoulders
  23. XI
    Accessory

    Head movement, shrugging of shoulders
  24. Hypoglossal
    XII

    Protrusion of tongue, moves tongue up and down and side to side
  25. XII
    Hypoglossal

    Protrusion of tongue, moves tongue up and down and side to side
  26. Motor speech, aka Broca's area
  27. Written speech
  28. Auditory receiving area, aka Wernicke's area
  29. Auditory interpretation area
  30. Visual receiving area
  31. Visual interpretation
  32. Sensory area (pain touch, etc.)
  33. Motor cortex, aka primary motor area or motor strip
  34. Cranial nerves are numbered in the order that they leave the brain. The first A1 from the A2, then B1 from B2, C1 from C2, and D1 from D2.
    • A) 2, cerebral hemispheres
    • B) 2, midbrain
    • C) 4, pons
    • D) 4, medulla
  35. Mnemonic for remembering which cranial nerves are S=sensory, M=motor, or B=both.
    • Some
    • Say
    • Marry
    • Money
    • But
    • My
    • Brother
    • Says
    • Bad
    • Business
    • Marry
    • Money
  36. A basic reflex arc, includes the AAA, BBB, CCC, DDD, and EEE.
    • A) sensory stretch receptor
    • B) afferent sensory neuron
    • C) interneuron
    • D) efferent motor neuron
    • E) quadriceps muscle (effector organ).
  37. Examples of upper motor neuron diseases are AAA, BBB, and CCC.
    • A) cerebrovascular accident
    • B) cerebral palsy
    • C) multiple sclerosis
  38. Upper motor neurons are located ...
    completely within the CNS
  39. Lower motor neurons are located AAA. The cell body of the lower motor neuron is located in the BBB, but the nerve fiber extends from CCC.
    • A) mostly in the peripheral nervous system
    • B) anterior gray column of the spinal cord
    • C) there to the muscle.
  40. Examples of lower motor neuron diseases are AAA, BBB, and CCC.
    • A) spinal cord lesions
    • B) poliomyelitis
    • C) amyotrophic lateral sclerosis - Lou Gehrig's disease in the United States– is a debilitating disease with varied etiology characterized by rapidly progressive weakness.
  41. Muscle Strength 5
    full ROM against gravity and resistance
  42. Muscle Strength 4
    full ROM against gravity and a moderate amount of resistance
  43. Muscle Strength 3
    full ROM against gravity only
  44. Muscle Strength 2
    full ROM against gravity is eliminated
  45. Muscle Strength 1
    weak muscle contraction when muscle is palpated, but no movement
  46. Muscle Strength 0
    complete paralysis
  47. MEDULLA acts to AAA and BBB. It has cranial nerves CCC emerging from it.
    • A) Cardiac-slowing center
    • B) Respiratory center
    • C) XI thru X11
  48. PONS acts to AAA, BBB, and CCC. It has cranial nerves DDD emerging from it.
    • A) Cardiac acceleration
    • B) vasoconstriction centers
    • C) Pneumotaxic center helps control respiratory pattern and rate
    • D) V thru VIII
  49. MIDBRAIN has cranial nerves AAA emerging from it. It is the location of periaqueductal gray, which may abolish pain when stimulated.
    A) III and IV
  50. Rapid Neurologic Assessment includes:
    • Glasgow Coma Scale
    • Response to painful stimuli
    • Level of consciousness
    • Decortication
    • Decerebration
    • Pupil assessment
  51. Glasgow Coma Scale: groups and & max value. Beginning of coma?
    • Eyes (opening)
    • 4, spontaneous
    • 3, sound
    • 2, pain
    • 1, never

    • Verbal
    • 5, X3
    • 4, confused
    • 3, word salad
    • 2, sounds only
    • 1, none

    • Motor
    • 6, obeys commands
    • 5, localizes pain (e.g. Purposeful movements towards painful stimuli)
    • 4, normal flexion - withdrawal from pain
    • 3, abnormal flexion (decortication)
    • 2, extension (Decerebration)
    • 1, none
  52. Decerebration is usually associated with ...
    dysfunction in the brainstem area.
  53. Decortication is abnormal posturing seen in the patient with lesions that ...
    interrupt the corticospinal pathways
  54. T/F: The EEG (Electroencephalography) may be normal even when a pathologic condition is present
    True
  55. Electroencephalography is performed to: (4 things)
    A) Determine the general activity of the cerebral hemispheres

    B) Determine the origin of seizure activity (epilepsy)

    C) Determine cerebral function in pathologic conditions other than epilepsy, such as tumors, abscesses, cerebrovascular disease, hematomas, injury, metabolic diseases, degenerative brain disease, and drug intoxication

    D) Differentiate between organic and hysterical or feigned blindness or deafness
  56. EEG evoked potentials (also called evoked response) measure the electrical signals to the brain generated by ...
    • hearing
    • touch
    • sight
  57. EEG evoked potentials tests are used to ...
    assess sensory nerve problems and confirm neurologic conditions including multiple sclerosis, brain tumor, acoustic neuroma (small tumors of the inner ear), and spinal cord injury.

    Evoked potentials are also used to test sight and hearing (especially in infants and young children), monitor brain activity among coma patients, and confirm brain death.
  58. For a Cerebral blood flow (CBF) test with radioactive substances, explain the test, and ask the physician if ...
    central nervous system (CNS) depressants and stimulants should be withheld for24 hours before the test.
  59. Lumbar puncture (spinal tap) is the insertion of a spinal needle into the subarachnoid space between the third and fourth (sometimes the fourth and fifth) lumbar vertebrae. A lumbar puncture is used to ...
    A) Obtain cerebrospinal fluid (CSF) pressure readings with a manometer

    B) Obtain CSF for analysis

    C) Check for spinal blockage caused by a spinal cord lesion

    D) Inject contrast medium or air for diagnostic study

    E) Inject spinal anesthetics

    F) Inject certain drugs

    G) Reduce mild to moderate increased ICP in certain conditions
  60. Lumbar Puncture: Prepare by AAA. Contraindicated for pts. with BBB. CCC is a possible side effect.
    • A) empty bladder
    • B) increased ICP
    • C) headache
  61. Intracranial hemodynamics can be evaluated through the use of the trans cranial Doppler (TCD). It uses sound waves to measure blood flow through the arteries. The test is particularly valuable in evaluating cerebral vasospasm or narrowing of arteries. TCD is ...
    safe and repeatable and is an inexpensive alternative to angiography.
  62. Angiography uses AAA to visualize BBB.
    • A) radio-opaque contrast agent into the blood vessel and imaging using X-ray based techniques such as fluoroscopy
    • B) blood flow
  63. The nurse can best assess the patient’s cognition by:

    A) Asking the patient about how he was transported to the clinic
    B) Asking the patient to count backward from 100 by 7s
    C) Writing down a simple command and giving it to the patient
    D) Asking the patient about the meaning of various proverbs
    D) Asking the patient about the meaning of various proverbs

    Rationale: Asking the patient about the meaning of various proverbs would assess the patient's abstract reasoning, which is part of cognition.

    Asking the patient about how he came to the clinic would assess memory.

    Counting backward from 100by 7s would assess the patient’s attention.

    Giving the patient a simple written command would assess language and copying skills.
    (this multiple choice question has been scrambled)
  64. The most common cause responsible for changes in an older patient’s mental state is:

    A) Changes in extracellular electrolytes
    B) Insufficient oxygen
    C) Sedative agents
    D) Changes in acetylcholine levels
    B) Insufficient oxygen
    (this multiple choice question has been scrambled)
  65. Approximately how much cerebrospinal fluid (CSF) is produced daily by the choroid plexus?

    A) 500 ml
    B) 200 ml to 300 ml
    C) <100 ml
    D) 125 ml to 150 ml
    A) 500 ml

    Approximately125 to 150 ml of cerebrospinal fluid is constantly circulating in the ventricles and subarachnoid space and reabsorbed.
    (this multiple choice question has been scrambled)
  66. The nurse provided colostomy care instruction to an older adult yesterday. Today, the nurse observes that the patient is not applying the colostomy collection device correctly. The nurse should:

    A) Request the patient’s daughter learn how to care for the patient’s colostomy.
    B) Re-instruct the patient on the care of the colostomy.
    C) Offer to complete the colostomy care for the patient.
    D) Ask the patient what he remembers about the colostomy care instruction he received the day prior.
    B) Re-instruct the patient on the care of the colostomy.

    Intellect does not decline as a result of aging. However, subtle memory changes such as difficulties with short-term recall are typical with many older adults. When providing new information to an older adult, he or she may need more time or more repetition to process the new information. Thus offering to re-instruct the patient on the care of the colostomy may be needed for the older adult.

    Completing the colostomy care may be helpful, as may be offering instruction to the patient’s daughter. Asking the patient what he remembers will also give the nurse information about the patient’s short-term memory or retention of new information.
    (this multiple choice question has been scrambled)
  67. Which assessment variable is the best indicator of a change in a patient’s neurologic status?

    A) Lethargic but arousable
    B) Alert and oriented to place, person, time
    C) Alert but not oriented to place, person, or time
    D) Deep stimulation needed to arouse patient
    C) Alert but not oriented to place, person, or time

    A change in level of consciousness (LOC) is the first indication that central neurologic function has declined.

    A patient maybe alert but not oriented to person, place, or time. Patients who are less than alert are labeled lethargic, stuporous, or comatose. A lethargic patient is drowsy or sleepy but is easily awakened. One who is arousable only with vigorous or painful stimulation is stuporous. The comatose patient is unconscious and cannot be aroused.
    (this multiple choice question has been scrambled)
  68. Neuroglial cells provide AAA and they are part of BBB.
    • A) protection, structure, and nutrition for the neurons.
    • B) blood brain barrier
  69. During a client’s neurologic assessment, the nurse finds that he is arousable only if his trapezius muscle is pinched. How will the nurse document this client’s level of consciousness?

    A. “Lethargic”
    B. “Drowsy”
    C. “Stuporous”
    D. “Comatose”
    C. “Stuporous”

    This client’s level of consciousness is considered stuporous - one who is arousable only with vigorous or painful stimulation.

    A lethargic client is drowsy or sleepy but is easily awakened.

    A comatose client is unconscious and cannot be aroused; in this situation, the client can be aroused with the application of painful stimuli.

    A client who is drowsy is best described as having a lethargic level of consciousness.
    (this multiple choice question has been scrambled)
  70. A client with possible Alzheimer’s disease is scheduled to have a positron emission tomography (PET) scan. The daughter asks the nurse how this test is different from a CT scan. What is the nurse’s best response?

    A. “The CT scan makes a lot of noise and the PET scan is quieter.”
    B. “The PET scan is a newer test that can see the brain more clearly.”
    C. “The PET scan provides information about brain function rather than structure.”
    D. “The CT scan requires a contrast medium to be injected and the PET scan does not.”
    C. “The PET scan provides information about brain function rather than structure.”

    A PET scan is a diagnostic tool that is not available in all medical centers. Its benefit over a CT scan or MRI is that it provides information about the function of the brain, specifically glucose and oxygen metabolism and cerebral blood flow.

    CT scans provide information about the structure of the central nervous system (CNS), which includes the brain. A CT scan allows the practitioner to see the structure of the brain more clearly.

    A PET scan is noisier than a CT scan.

    A PET scan involves injecting the client with contrast medium.
    (this multiple choice question has been scrambled)
  71. PERRLA
    pupils equal, round, reactive to light and accommodation
  72. The patient asks about complications from the lumbar puncture.
    Risks associated with lumbar puncture include increased pain, paralysis, and infection. The nurse should explain that he will be encouraged to remain on bed rest and increase fluid intake for 4 to 8 hours after the procedure. If he develops a "spinal headache," he will be given analgesics for relief.
  73. One of the tests possible with a lumbar puncture is a measure of CSF pressure. What is a normal value?
    The normal pressure for CSF should be less than 20 cm H2O.
  74. What assessments should the nurse make following a lumbar puncture with positive findings, e.g. pressure above 20 cm H2O.
    Monitor vital signs, comfort level, neurologic status, and patient’s risk for injury related to ambulation. Monitor for complications, especially increased intracranial pressure (severe headache, nausea, vomiting, photophobia, change in level of consciousness). Observe the needle insertion site for leakage.
  75. Lumbar puncture CSF protein of 15-45 mg/dL (up to 70 mg/dl in older adults)
    normal
  76. Lumbar puncture CSF protein of 45-100 mg/dL
    paraventricular tumor
  77. Lumbar puncture CSF protein of 50-200 mg/dL
    viral infection
  78. Lumbar puncture CSF protein > 500 mg/dL
    bacterial infection or Guillain-Barre syndrome
  79. Lumbar puncture CSF protein < 15 mg/dL
    meningismus - nuchal rigidity (neck stiffness), photophobia (intolerance of bright light) and headache present w/o infection or inflammation

    pseudotumor cerebri - older name: benign intracranial hypertension

    hyperthyroidism

    normal finding after lumbar puncture
  80. The client has just returned from a cerebral angiography. Which symptom does the client display that causes the nurse to act immediately?

    A) Urge to void
    B) Severe headache
    C) Bleeding
    D) Increased temperature
    C) Bleeding

    If bleeding is present in the client who has had a cerebral angiography (where a catheter is inserted into a large artery, such as the femoral artery, and threaded through the circulatory system to the carotid artery, where a contrast agent is injected), maintain manual pressure on the site and notify the physician immediately.
    (this multiple choice question has been scrambled)
  81. The client has received contrast medium. Which teaching will the nurse provide to avoid any neurologic health problems after the procedure?

    A) "Drink at least 1000 to 1500 mL of water today."
    B) "Practice memory drills this afternoon."
    C) "Rest in bed for 24 hours."
    D) "Avoid sunlight."
    A) "Drink at least 1000 to 1500 mL of water today."

    Drinking an adequate amount of water helps flush the contrast out of the body.
    (this multiple choice question has been scrambled)
  82. After a single-photon emission computed tomography (SPECT) the pt ...
    can return to their usual activities immediately after the test.
  83. Older adults experience AAA sleeping during the night as a result of aging.
    A) decreased
  84. The test for eye accommodation includes these 2 results ...
    Focused on a distant object, the pupils should dilate. When focus is shifted to a close object (8-12"), the axis of the eyes should converge and the pupils should constrict.
  85. The nurse has just received change-of-shift report about a group of clients on the neurosurgical unit. Which client will the nurse attend to first?

    A) Young adult post-motor vehicle accident client who is yelling obscenities at the nursing staff
    B) Middle-aged adult post-cerebral aneurysm clipping client who is increasingly stuporous
    C) Adult postoperative left craniotomy client whose hand grips are weaker on the right
    D) Older adult-old post-carotid endarterectomy client who is unable to state the day of the week
    B) Middle-aged adult post-cerebral aneurysm clipping client who is increasingly stuporous

    A change in level of consciousness (LOC) is the first indication that central neurologic function has declined; the neurologic status of this client should be assessed and the physician notified about the change in status.
    (this multiple choice question has been scrambled)
  86. The nurse has just received report on a group of clients on the neurosurgical unit. Which client will be the nurse's first priority?

    A) Older adult client who consistently demonstrates decortication when stimulated
    B) Adult client whose deep tendon reflexes have become hyperactive
    C) Young adult client whose Glasgow Coma Scale (GCS) rating has changed from 15 to 10
    D) Middle-aged client who displays plantar flexion when the bottom of the foot is stroked
    C) Young adult client whose Glasgow Coma Scale (GCS) rating has changed from 15 to 10

    The change in the Glasgow Coma Scale (GCS) indicates a significant change in the client's neurologic status that should be immediately assessed further and reported to the physician.

    This client will need to be assessed, but displaying decortication when stimulated does not represent a serious change that requires immediate attention.
    (this multiple choice question has been scrambled)
  87. The nurse has just t received report on a group of clients. Which client will the nurse assess first?

    A) Adult who had a cerebral arteriogram and has a cool, pale right leg
    B) Young adult who was in a car accident and has a 13 Glasgow Coma Scale score
    C) Middle-aged adult who has a headache after undergoing a lumbar puncture
    D) Older adult who has expressive aphasia after a left-sided stroke
    A) Adult who had a cerebral arteriogram and has a cool, pale right leg

    A cool, pale leg after an arteriogram could indicate clot formation at the catheter insertion site and loss of blood flow to the extremity.

    All others need assessment, but the data does not indicate a serious complication.
    (this multiple choice question has been scrambled)
  88. The nurse is reviewing the chart of a client who is scheduled for cerebral angiography. The nurse plans to report his condition to the health care provider. Which information will be most important for the nurse to communicate to the physician for a client who is scheduled for cerebral angiography?

    A) Allergy to penicillin
    B) Creatinine > 1.5 mg/dL
    C) History of bacterial meningitis
    D) The client's dose of metformin (Glucophage) was held today.
    D) The client's dose of metformin (Glucophage) was held today.
    B) Creatinine > 1.5 mg/dL

    Normal creatinine is ~0.5 - 1.2 for <60 years. Higher levels (> 1.5) puts pt at higher rish for contrast induced nephropathy.
    (this multiple choice question has been scrambled)
  89. The nurse is reviewing the chart of a client who is scheduled for cerebral angiography. The nurse plans to report his condition to the health care provider. Which information will be most important for the nurse to communicate to the physician for a client who is scheduled for cerebral angiography?

    A) The client's dose of metformin (Glucophage) was held today.
    B) Poor skin turgor and dry mucous membranes
    C) Allergy to penicillin
    D) History of bacterial meningitis
    B) Poor skin turgor and dry mucous membranes

    The client's assessment indicates dehydration. To prevent contrast-induced nephropathy, angiography should not be done until the client is hydrated.

    All other conditions will need to be reported but do not indicate the need to intervene before the surgery
    (this multiple choice question has been scrambled)
  90. The nurse anticipates that the health care provider will/will not request which test before the brain biopsy?
    Magnetic resonance imaging (MRI) or computed tomography (CT) is done before a brain biopsy to assist with identification and visualization of the affected area.

    Trans cranial Doppler ultrasonography (TCD) is used to evaluate intracranial hemodynamics.
  91. The results of a client's lumbar puncture indicate that the client's protein level is 150 mg/dL. The nurse suspects that the client may have which condition?

    A) Viral infection
    B) Meningismus
    C) Paraventricular tumor
    D) Guillain-Barré syndrome
    A) Viral infection

    greater than 500 mg/dL is indicative of a bacterial infection or Guillain-Barrésyndrome.

    less than 15 mg/dL is indicative of meningismus.

    45 to 100 mg/dL are indicative of a paraventricular tumor

    50 to 200 mg/dL are indicative of a viral infection.
    (this multiple choice question has been scrambled)
  92. Wernicke's area in the temporal lobe is associated with language comprehension. When damaged in the person's dominant hemisphere, receptive (receiving area, not interpretation) aphasia results. The person hears sound, but it has no meaning, like hearing a foreign language.

    Broca's (anterior), Wernicke's (posterior)
  93. Broca's area in the frontal lobe mediates motorspeech. When injured in the dominant hemisphere, expressive aphasia results; the person cannot talk. The person can understand language and knows what he or she wants to say, but can produce only a garbled sound.
  94. Migraine Pain may be preceded by a variety of neurologic changes,
    • Numbness
    • tingling of the lips or tongue
    • Acute confusional state
    • Aphasia
    • Vertigo
    • Unilateral weakness
    • Drowsiness
  95. Once migraine symptoms during the aura are assessed ...
    Abortive therapy: alleviating pain during the early aura phase includes prescribing ergotamine derivatives, NSAIDs, triptans, isometheptene combinations.

    Acetaminophen and NSAIDs are usually effective for mild migraine headaches

    • Preventive Therapy:
    • NSAID prescription
    • Beta-adrenergic blocker
    • Calcium channel blockers
  96. Tension headaches are the most common type of chronic ...
    long-duration headache, lasting more than 4 hours
  97. Cluster headaches are manifested by brief intense unilateral pain that generally occurs in the spring and fall. It is classified as the most common chronic ...
    short-duration headache with pain lasting less than 4 hours.
  98. AAA types of BBB seizures may occur and involve CCC.
    • A) Six
    • B) generalized
    • C) both cerebral hemispheres
  99. The AAA seizure lasting BBB begins with a tonic phase that causes stiffening or rigidity of the muscles, particularly of the arms and legs, and CCC. Clonic or rhythmic jerking of all extremities follows. The patient may bite his or her tongue and may become incontinent of urine or feces. Fatigue, acute confusion, and lethargy may last DDD after the seizure.
    • A) tonic-clonic
    • B) 2 to 5 minutes
    • C) immediate loss of consciousness
    • D) up to an hour
  100. A tonic seizure is an abrupt increase in muscle tone, loss of consciousness, and autonomic changes lasting AAA
    A) from 30 seconds to several minutes
  101. The clonic seizure lasts AAA and causes muscle contraction and relaxation.
    A) several minutes
  102. The AAA is more common in children and tends to run in families. It consists of brief (BBB) periods of loss of consciousness and blank staring as though the person is daydreaming.
    • A) absence seizure
    • B) often just seconds
  103. The AAA causes a brief jerking or stiffening of the extremities that may occur singly or in groups. Lasting for just a few seconds, the contractions may be symmetric(both sides) or asymmetric (one side).
    A) myoclonic seizure
  104. In AAA seizure, the patient has a sudden loss of muscle tone, lasting for BBB, followed by postictal (after the seizure) confusion. In most cases, these seizures cause the patient to fall, which may result in injury. This type of seizure tends to be CCC.
    • A) anatonic (akinetic)
    • B) seconds
    • C) most resistant to drug therapy
  105. Partial seizures, also called focal or local seizures, begin AAA.
    A) in a part of one cerebral hemisphere.
  106. Some partial seizures can become AAA. Partial seizures are most often seen in BBB and generally are CCC when compared with other types.
    • A) generalized tonic-clonic, tonic, or clonic seizures
    • B) adults
    • C) less responsive to medical treatment
  107. Unclassified, or idiopathic, seizures account for AAA of all seizure activity. They occur for no known reason and do not fit into the generalized or partial classifications.
    A) about half
  108. Epilepsy is defined by the National Institute of Neurological Disorders and Stroke as AAA experienced by a person. It is a chronic disorder in which repeated unprovoked seizure activity occurs. It may be caused by an abnormality in electrical neuronal activity, an imbalance of neurotransmitters, especially BBB, or a combination of both.
    • A) two or more seizures
    • B) gamma aminobutyric acid (GABA),
  109. Primary or idiopathic epilepsy is AAA.
    A) not associated with any identifiable brain lesion or other specific cause
  110. Secondary seizures result from AAA. They may also be caused by: (list)
    A) an underlying brain lesion, most commonly a tumor or trauma

    • Metabolic disorders
    • Acute alcohol withdrawal
    • Electrolyte disturbances (e.g., hyperkalemia, water intoxication, hypoglycemia)
    • High fever
    • Stroke
    • Head injury
    • Substance abuse
    • Heart disease

    Seizures resulting from these problems are not considered epilepsy. Various risk factors can trigger a seizure, such as increased physical activity, emotional stress, excessive fatigue, alcohol or caffeine consumption, or certain foods or chemicals.
  111. Care of the Patient During a Tonic-Clonic or Complete Partial Seizure:
    • Protect the patient from injury.
    • Do not force anything into the patient's mouth.
    • Turn the patient to the side to keep the airway clear.
    • Loosen any restrictive clothing the patient is wearing.
    • Maintain the patient's airway and suction as needed.
    • Do not restrain or try to stop the patient's movement; guide movements if necessary.
    • Record the time the seizure began and ended.

    • At the completion of the seizure:
    • Take the patient's vital signs.
    • Perform neurologic checks.
    • Keep the patient on his or her side.
    • Allow the patient to rest.
  112. Acute Seizure Management (drugs)
    • Lorazepam (Ativan)
    • Diazepam (Valium)
    • Diastat (Diazepam rectal gel)
    • IV phenytoin ( Dilantin)
    • fosphenytoin (Cerebyx)
  113. Status Epilepticus?
    • Medical emergency
    • Prolonged seizures lasting more than 5 minutes or repeated seizures over the course of 30 minutes
    • Establish an airway
    • ABCs
    • IV push lorazepam, diazepam; rectal diazepam
    • Loading dose IV phenytoin
  114. After Status Epilepticus...
    To prevent additional tonic-clonic seizures or cardiac arrest, a loading dose of IV phenytoin (Dilantin) is given and oral doses administered as a follow-up after the emergency is resolved.

    Initially, give phenytoin at no more than 50 mg/min using an infusion pump. An alternative to phenytoin is fosphenytoin (Cerebyx), a water-soluble phenytoin prodrug. It is compatible with most IV solutions. It also causes fewer cardiovascular complications than phenytoin and can be given in an IV dextrose solution. After administration, fosphenytoin converts to phenytoin in the body. Therefore the FDA requires the dosage to be written as a phenytoin equivalent (PE); 150 mg of fosphenytoin equals 100 mg of phenytoin. Give fosphenytoin at a rate of 100 to 150 mg/min IV piggyback.

    ??? No more than 50mg/min of phenytoin, and 150mg fosphenytoin = 100mg phenytoin, so 100-150 mg fosphenytoin = 66-100 mg phenytoin, which is 16-50 mg over the limit for phenytoin
  115. Do not administer AAA with phenytoin.
    A) warfarin
  116. Vagal nerve stimulation (VNS) may be performed for control of AAA seizures. Patients with BBB seizures are not candidates for surgery because VNS may result in severe neurologic deficits.
    • A) continuous simple or complex partial
    • B) generalized
  117. AAA meningitis is the most common fungal infection that affects the CNS of patients with acquired immune deficiency syndrome (AIDS). Fulminant invasive fungal sinusitis is also a recognized cause of fungal meningitis.
    A) Cryptococcus neoformans
  118. Bacterial meningitis is a medical emergency with a mortality rate of about AAA. It occurs most often in fall and winter when upper respiratory tract infections commonly occur. The most frequently involved organisms responsible for bacterial meningitis include BBB and CCC
    • A) 25%
    • B) Streptococcus pneumoniae (pneumococcal disease)
    • C) Neisseria meningitides
  119. Controversy exists as to whether steroids are helpful in the treatment of all adults with meningitis. They are, however, recommended for patients with AAA meningitis
    A) Streptococcus pneumoniae
  120. People who have been in close contact with a patient with AAA meningitides should have prophylaxis treatment with BBB, CCC, or DDD.
    • A) Neisseria
    • B) rifampin (Rifadin, Rofact)
    • C) ciprofloxacin (Cipro)
    • D) ceftriaxone (Rocephin).
  121. Preventive treatment with AAA may be prescribed for those in close contact with a patient with BBB meningitis
    • A) rifampin
    • B) Haemophilus influenzae
  122. Stages of Parkinson Disease:
    • STAGE 1: INITIAL STAGE
    • Unilateral limb involvement
    • Minimal weakness
    • Hand and arm trembling

    • STAGE 2: MILD STAGE
    • Bilateral limb involvement
    • Masklike faces
    • Slow, shuffling gait

    • STAGE 3: MODERATE DISEASE
    • Postural instability
    • Increased gait disturbances

    • STAGE 4: SEVERE DISABILITY
    • Akinesia
    • Rigidity

    STAGE 5: COMPLETE ADL DEPENDENCE
  123. The nurse is preparing a teaching plan for a client with migraine headaches who is receiving propranolol (Inderal) for migraine headaches. What health teaching by the nurse is important for the client?

    A. “Take this drug as prescribed every day, even when feeling well, to prevent a migraine.”
    B. “This drug is low dose, so you don’t have to worry about your heart rate or blood pressure.”
    C. “This drug will relieve the pain during the aura phase soon after a headache has started.”
    D. “Take this drug only when you have symptoms at the beginning of a migraine headache.”
    A. “Take this drug as prescribed every day, even when feeling well, to prevent a migraine.”

    Propranolol (Inderal) is a beta-blocker and is taken to prevent the development of a migraine headache. For prevention purposes, this drug should be taken daily, not intermittently. Abruptly stopping a beta-blocker may cause adverse symptoms. This drug can lower blood pressure and decrease pulse rate. Inderal is considered a preventive drug; efficacy as an abortive drug has not been substantiated by research.
    (this multiple choice question has been scrambled)
  124. A client with a history of seizures is placed on seizure precautions. What emergency equipment will the nurse provide at the bedside? Select all that apply.

    A. Padded tongue blade
    B. Oxygen setup
    C. Nasogastric tube
    D. Suction setup
    E. Artificial oral airway
    B, D, and E
  125. A client with Alzheimer’s disease asks the nurse to find her mother, who is decreased. What is the nurse’s best response?

    A. “I’ll ask your daughter to find your mother.”
    B. “I’ll find your mother as soon as I finish passing meds.”
    C. “What did your mother look like?”
    D. “Your mother died over 20 years ago.”
    C. “What did your mother look like?”

    The nurse should use validation therapy for the client with moderate or severe Alzheimer’s disease (AD). In validation therapy, the staff member recognizes and acknowledges the client’s feelings and concerns. This response is not argumentative but also does not reinforce the client’s belief that her mother is still living. For the client in the later stages of AD, reality orientation does not work and often increases agitation. Telling the client to wait until medications have been issued or that her daughter will find her mother is not consistent with validation therapy because it reinforces the client’s belief that her mother is still alive.
    (this multiple choice question has been scrambled)
  126. What medications will the physician most likely order for status epilepticus? Describe the nursing implications (administration, side effects, drug level monitoring) for these medications.
    Lorazepam (Ativan, Apo-Lorazepam) or diazepam (Valium, Meva, Vivol Diastat [rectal diazepam gel]). Lorazepam is usually given as 4 mg over a 2-minute period. This procedure may be repeated, if necessary, until a total of 8 mg is reached. Monitor the patient for respiratory distress and have endotracheal intubation equipment readily available. A loading dose of IV phenytoin (Dilantin) is given and oral doses are administered as a follow-up. Phenytoin is administered at no more than 50 mg/min using an infusion pump. Fosphenytoin (Cerebryx) is compatible with most IV solutions; it causes fewer cardiovascular complications than phenytoin. Fosphenytoin may be administered at a rate of 100 to 150 mg/min IV piggyback. Serum drug levels should be checked every 6 to 12 hours after the loading dose and then 2 weeks after oral phenytoin has started.
  127. The client newly diagnosed with Parkinson disease is being discharged. Which instruction is best for the nurse to provide to the client's spouse?

    A. Administer medications promptly on schedule to maintain therapeutic drug levels.
    B. Complete activities of daily living for the client.
    C. Provide high-calorie, high-carbohydrate foods to maintain the client's weight.
    D. Speak loudly for better understanding.
    A. Administer medications promptly on schedule to maintain therapeutic drug levels.

    Slow speech rather than loud speech is more effective for the client with Parkinson disease.

    Small, frequent meals are more effective for the client with Parkinson disease.
    (this multiple choice question has been scrambled)
  128. The client has Parkinson disease (PD). Which nursing intervention best protects the client from injury?

    A. Suggesting that the client obtain assistance in performing ADLs
    B. Discouraging the client from activity
    C. Monitoring the client's sleep patterns
    D. Encouraging the client to watch the feet when walking
    C. Monitoring the client's sleep patterns

    Clients with PD tend to not sleep well at night because of drug therapy and the disease itself. Some clients nap for short periods during the day and may not be aware that they have done so. This sleep misperception could put the client at risk for injury (e.g., falling asleep while driving).
    (this multiple choice question has been scrambled)
  129. The client with dementia and Alzheimer's disease is discharged to home. The client's daughter says, "He wanders so much, I am afraid he'll slip away from me." What resource does the nurse suggest?

    A. Alzheimer's Wandering Association
    B. National Alzheimer's Group
    C. Safe Return Program
    D. Lost Family Members Tracking Association
    C. Safe Return Program

    The family should enroll the client in the Safe Return Program, a national, government-funded program of the Alzheimer's Association that assists in the identification and safe, timely return of those with dementia who wander off and become lost.
    (this multiple choice question has been scrambled)
  130. T/F: At the beginning of a migraine attack, the client may be able to alleviate pain with analgesics and by lying down and darkening the room with a cool cloth on his or her forehead. If the client falls asleep, he or she should remain undisturbed until awakening.
    True
  131. Which is the most effective way for the college student to minimize the risk for bacterial meningitis?

    A. Getting the meningitis polysaccharide vaccine
    B. Avoiding large crowds
    C. Taking prophylactic antibiotics
    D. Taking a daily vitamin
    A. Getting the meningitis polysaccharide vaccine

    People who live in highly populated areas, such as a college dorm, should get the meningitis polysaccharide vaccine (Menomune) to prevent infection.
    (this multiple choice question has been scrambled)
  132. The nurse is teaching the client newly diagnosed with migraine about trigger control. Which statement made by the client demonstrates good understanding of the teaching plan?

    A. "I can still eat Chinese food."
    B. "It is okay to drink a few wine coolers."
    C. "I need to use fake sugar in my coffee."
    D. "I must not miss meals."
    D. "I must not miss meals."

    (Chinese) Monosodium glutamate (MSG)-containing foods are a trigger for many people suffering from migraines and should be eliminated until the triggers are identified.

    Missing meals is a trigger for many people suffering from migraines. The client should not skip any meals until the triggers are identified.

    Alcohol is a trigger for many people suffering from migraines and should be eliminated until the triggers are identified.

    Artificial sweeteners are a trigger for many people suffering from migraines and should be eliminated until the triggers are identified.
    (this multiple choice question has been scrambled)
  133. The nurse is caring for the client with advanced Alzheimer's disease. Which communication technique is best to use with this client?

    A. Assuming that the client is not totally confused
    B. Writing down instructions for the client
    C. Providing the client with several choices to choose from
    D. Waiting for the client to express a need
    A. Assuming that the client is not totally confused

    with several choices - Choices should be limited. Too many choices causes frustration and increased confusion in the client.

    Never assume that the client is totally confused and cannot understand what is being communicated.

    Rather than waiting for the client to express a need, try to anticipate the client's needs and interpret nonverbal communication.

    Rather than writing down instructions, provide the client instructions with pictures, and put them in a highly visible place.
    (this multiple choice question has been scrambled)
  134. The female client with newly diagnosed migraine is being discharged with a prescription for sumatriptan (Imitrex). Which comment by the client indicates an understanding of the nurse's discharge instructions?

    A. "Sumatriptan should be taken as a last resort."
    B. "I must report any chest pain right away."
    C. "Birth control is not needed while taking sumatriptan."
    D. "St. John's wort can also be taken to help my symptoms."
    B. "I must report any chest pain right away."

    Sumatriptan must be taken as soon as migraine symptoms appear.

    Chest pain must be reported immediately with the use of sumatriptan.

    Remind the client to use contraception (birth control) while taking the drug because it may not be safe for women who are pregnant.

    Triptans should not be taken with selective serotonin reuptake inhibitors (SSRIs) or St. John's wort, an herb used commonly for depression.
    (this multiple choice question has been scrambled)
  135. Absence seizures are ...
    more common in children and consist of brief (often just seconds) periods of loss of consciousness and blank staring, as though he or she is daydreaming.
  136. Myoclonic seizures are ...
    characterized by brief jerking or stiffening of the extremities, which may occur singly or in groups.
  137. Tonic seizures are ...
    characterized by an abrupt increase in muscle tone, loss of consciousness, and autonomic changes lasting from 30 seconds to several minutes.
  138. The client is admitted with bacterial meningitis. Which nursing intervention is the highest priority for this client?

    A. Decreasing environmental stimuli
    B. Assessing neurologic status at least every 2 to 4 hours
    C. Managing pain through drug and nondrug methods
    D. Strict monitoring of hourly intake and output
    B. Assessing neurologic status at least every 2 to 4 hours

    The most important nursing intervention for clients with meningitis is the accurate monitoring and recording of their neurologic status, vital signs, and vascular assessment. The client's neurologic status and vital signs should be assessed at least every 4 hours, or more often if clinically indicated. The priority for care is to monitor for early neurologic changes that may indicate increased intracranial pressure (ICP), such as decreased level of consciousness (LOC).

    Clients with bacterial meningitis report severe headaches requiring pain management, but this is the second-highest priority.
    (this multiple choice question has been scrambled)
  139. The client is being discharged to home with progressing stage I Alzheimer's disease. The family expresses concern to the nurse about caring for their parent. What is the priority for best continuity of care?

    A. Providing a safe environment
    B. Referring the family to the Alzheimer's Association
    C. Ensuring that all family questions are answered before discharge
    D. Assigning a case manager
    D. Assigning a case manager

    The root question is about "continuity of care".
    (this multiple choice question has been scrambled)
  140. The spouse of the client with Alzheimer's disease (AD) is listening to the hospice nurse explaining the client's drug regimen. Which statement by the spouse indicates an understanding of the nurse's instruction?

    A. "Memantine (Namenda)is indicated for treatment of early symptoms of Alzheimer's disease.
    B. "Sertraline (Zoloft) will treat the symptoms of Alzheimer's disease.''
    C. "Rivastigmine (Excelon) is used to treat depression."
    D. "Donepezil (Aricept) will treat the symptoms of Alzheimer's disease."
    D. "Donepezil (Aricept) will treat the symptoms of Alzheimer's disease."

    Cholinesterase inhibitors (e.g., donepezil) are approved for the symptomatic treatment of Alzheimer's disease.

    Memantine (Namenda) is indicated for advanced Alzheimer's disease.

    Rivastigmine (Excelon) is a cholinesterase inhibitor that is used to treat Alzheimer's symptoms. Selective serotonin reuptake inhibitors (SSRIs) are antidepressants and may be used in Alzheimer's clients who develop depression.

    Some clients with Alzheimer's disease experience depression and may be treated with antidepressants such as sertraline.
    (this multiple choice question has been scrambled)
  141. The client with early-stage Alzheimer's disease is admitted to the surgical unit for a biopsy. Which client problem is the priority?

    A. Risk for reduced mobility related to progression of disability
    B. Potential for skin breakdown related to immobility and/or impaired nutritional status
    C. Potential for injury related to chronic confusion and physical deficits
    D. Lack of social contact related to personality and behavior changes
    C. Potential for injury related to chronic confusion and physical deficits

    The priority for interdisciplinary care is safety. Chronic confusion and physical deficits place the client with Alzheimer's disease at high risk for injury.

    The other issues are usually the result of long-term care.
    (this multiple choice question has been scrambled)
  142. The client has been diagnosed with Huntington disease. The nurse is teaching the client and her parents about the genetic aspects of the disease. Which statement made by the parents demonstrates a good understanding of the nurse's teaching?

    A. "Because she got the gene from her father, she'll live longer than other people with the disease."
    B. "More testing should definitely be done to see if she's really got the gene."
    C. "She could only have gotten the disease from both of us."
    D. "If she has children, she'll pass the gene on to her kids."
    D. "If she has children, she'll pass the gene on to her kids."

    An autosomal dominant trait with high penetrance, such as Huntington disease, means that a person who inherits just one mutated allele has an almost 100% chance of developing the disease.

    If the client inherited the gene from her mother, she would live a longer life than other people with the disease. If she inherited the gene from her father, her life would be shorter.
    (this multiple choice question has been scrambled)
  143. The nursing instructor asks the student nurse caring for a client with Alzheimer's disease who has been prescribed donepezil (Aricept) how the drug works. Which response by the nursing student best explains the action of donepezil?

    A. "Donepezil prevents the increase in the protein beta amyloid."
    B."Dopamine levels are increased."
    C. "It delays the destruction of acetylcholine by acetylcholinesterase."
    D. "The reuptake of serotonin is blocked."
    C. "It delays the destruction of acetylcholine by acetylcholinesterase."
    (this multiple choice question has been scrambled)
  144. donepezil (Aricept) works to treat the symptoms of AAA by BBB.
    • A) Alzheimer's disease
    • B) delaying the destruction of acetylcholine by acetylcholinesterase.
  145. Alopecia?
    baldness
  146. The nurse is caring for a client diagnosed with partial seizures after encephalitis, who is to receive carbamazepine (Tegretol). The nurse plans to monitor the client for which adverse effects? Select all that apply.

    A. Alopecia
    B. Headaches
    C. Dizziness
    D. Diplopia
    E. Increased blood glucose
    B, C, and D

    Adverse effects of carbamazepine because this drug affects the central nervous system.
  147. The nurse has received report on a group of clients. Which client requires the nurse's attention first?

    A. Young adult who has experienced four tonic-clonic seizures within the past 30 minutes
    B. Adult who is lethargic after a generalized tonic-clonic seizure
    C. Middle-aged adult with absence seizures who is staring at a wall and does not respond to questions
    D. Older adult with a seizure disorder who has a temperature of 101.9° F (38.8° C)
    A. Young adult who has experienced four tonic-clonic seizures within the past 30 minutes

    This client is experiencing status epilepticus, which is a medical emergency and requires immediate intervention.
    (this multiple choice question has been scrambled)
  148. A client receiving sumatriptan (Imitrex) for migraine headaches is experiencing adverse effects after taking the drug. Which adverse effect is of greatest concern to the nurse?

    A. Skin flushing
    B. Chest tightness
    C. Warm sensation
    D. Tingling feelings
    B. Chest tightness

    Triptan drugs are contraindicated in clients with coronary artery disease because they can cause arterial narrowing; the nurse should instruct the client to not take the medication until the nurse can talk with the prescribing health care provider.

    All others are common adverse effects with triptan medications but are not an indication to avoid using this group of drugs.
    (this multiple choice question has been scrambled)
  149. sumatriptan (Imitrex) is a AAA type drug that can be used to treat BBB. It is contraindicated for pts with CCC because it can cause DDD resulting in EEE.
    • A) triptan
    • B) migraine headaches
    • C) coronary artery disease
    • D) arterial narrowing
    • E) chest tighness
  150. Signs of bacterial meningitis...
    • Cloudy, turbid cerebrospinal fluid
    • Increased white blood
    • Increased protein
    • Decreased glucose
  151. The nurse is reviewing the history of a client who has been prescribed topiramate (Topamax) for treatment of intractable partial seizures. The nurse plans to contact the health care provider if the client has which condition?

    A. Glaucoma
    B. Hypothyroidism
    C. Bipolar disorder
    D. Diabetes mellitus
    C. Bipolar disorder

    Cases of suicide have been reported with pts on Topamax, most often in clients with bipolar disorder
    (this multiple choice question has been scrambled)
  152. The nurse is providing medication instructions for a client for whom phenytoin (Dilantin) has been requested for treatment of epilepsy. The nurse plans to instruct the client to avoid which beverage?

    A. Grape juice
    B. Grapefruit juice
    C. Milk
    D. Apple juice
    B. Grapefruit juice

    Grapefruit (any citric acid) juice can interfere with the metabolism of phenytoin
    (this multiple choice question has been scrambled)
  153. neurotransmitters...
    • acetylcholine [ACh]
    • norepinephrine
    • dopamine
    • serotonin
  154. apraxia
    inability to use words or objects correctly
  155. aphasia
    inability to speak or understand
  156. anomia
    inability to find words
  157. agnosia
    loss of sensory comprehension
  158. prosopagnosia
    an inability to recognize oneself and other familiar faces.
  159. Tricyclic antidepressants, such as amitriptyline (Elavil, Levate), should not be used because of their anticholinergic effect, especially for older adults. (more)
    Anticholinergic drugs frequently cause serious side effects, including increased confusion, urinary retention, and constipation
  160. Complementary and alternative therapies for AD...
    Vitamin E, music, dance, massage
  161. Antipsychotic agents or monoamine-depleting agents used to manage movement abnormalities that are disabling or interfere with ADLs for (which disease?)
    HD
  162. Some patients with Alzheimer’s disease develop depression and can be treated with antidepressant drugs such as ...
    SSRIs: paroxetine (Paxil) and sertraline (Zoloft)

    But NOT tricyclics such as Elavil and Levate because of their anticholinergic effect, especially for older adults which frequently cause serious side effects, including increased confusion, urinary retention, and constipation.
  163. The patient’s wife calls the physician’s office to report that she is concerned, because the last time her husband took a walk in the neighborhood where they have lived for 35 years, he got lost and a neighbor brought him back home.What measures should the nurse recommend for patient safety? (Select all that apply.)

    A. “Have him wear an ID bracelet or badge at all times.”
    B. “Enroll him in the Safe Return program.”
    C. “Place him in a geri-chair when you can’t be with him.”
    D. “Take him for a walk two or three times a day.”
    E. “Ask your doctor to prescribe a sedative drug to keep him calm.”
    A, B, and C

    Positive interventions for coping with restlessness and wandering include having the patient wear an ID bracelet, enrolling him in a Safe Return program, and the use of a geri-chair. Physical and chemical restraints such a sedatives should only be used as a last resort.
  164. What is the priority nursing intervention for a 53-year-old woman with new onset of migraine headaches with photophobia?

    A. Evaluation and education of cardiovascular and stroke signs and symptoms
    B. Management of associated nausea and vomiting
    C. Effective pain management
    D. Identification of triggers that cause headaches
    A. Evaluation and education of cardiovascular and stroke signs and symptoms

    It is important to teach women older than 50 years who have migraines about the risk factors for cardiovascular disease. Encourage them to notify their health care provider if they experience symptoms such as facial drooping, arm weakness, or difficulties with speech. Other priority interventions include education on the three R’s: Recognize migraine symptoms, Respond and see the health care provider, and Relieve pain and associated symptoms.
    (this multiple choice question has been scrambled)
  165. Estimates vary, but experts suggest that as many as AAA Americans may have Alzheimer’s.(Source: Accessed August 11, 2011)
    A) 5.1 million
  166. Proprioception?
    Awareness of position and movements of parts of the body
  167. In addition to CNS problems when can a Babinski's sign occur? And what is it?
    • Drug or alcohol intoxication
    • After a seizure
    • Pts with miltiple sclerosis or liver disease

    Dorsiflexion of the great toe and fanning of all others. Normal: flexion of all toes.
  168. DIC?
    Disseminated intravascular coagulation, a pathological activation of coagulation (blood clotting) mechanisms that happens in response to a variety of diseases

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