Question 1

The nurse instructs a patient on actions to help reduce the onset of migraine headaches. Which patient statement indicates that additional teaching is required?

Accepted Answer

Red wine contains tyramine, which is a trigger for migraines. Therefore, switching to red wine would not be a helpful action to reduce the onset of migraines. The patient should be educated on avoiding all forms of wine.

Question 2

The nurse is instructing a patient with a brain tumor about a scheduled craniotomy. What should the nurse include in this teaching?

Accepted Answer

A craniotomy involves excising the tumor (A), cutting the bone between burr holes (B), returning the bone flap to the opening (C), and making a series of burr holes in the skull (D). Plastic material is not typically placed over the opening in a standard craniotomy (E).

Question 3

The nurse is caring for a patient with migraine headaches. Which medication should the nurse expect to be prescribed prophylactically for this patient?

Accepted Answer

Propranolol hydrochloride is a beta-blocker that is often prescribed prophylactically to prevent migraine headaches from occurring. Acetaminophen, zolmitriptan, and sumatriptan are all medications used to treat acute migraine headache symptoms, not to prevent them.

Question 4

The nurse is caring for a patient with hemiplegia after experiencing a stroke. Which body areas should the nurse expect to be affected by the stroke? Mark an "X" on the body diagram below that depicts hemiplegia.

Accepted Answer

The answer of The nurse is caring for a patient...

Question 5

The nurse is planning a seminar about headaches for a local civic group. What type of headache should the nurse describe as having a strong familial connection, affects females three to one over males, and results in lost productivity?

Accepted Answer

Migraines have a strong familial connection, affect females three to one over males, and can result in lost productivity. Cluster headaches are more common in males and stress headaches are often related to tension and anxiety, while sinus headaches are related to pressure and congestion in the sinuses.

Question 6

A patient is diagnosed with doll's-eye movements. What should the nurse expect to assess in this patient?

Accepted Answer

Doll's-eye movements, also known as oculocephalic reflex, is a test to check for brainstem function. In a patient with doll's-eye movements, the eyes appear to move in the direction opposite to the motion of the head, when the head is gently rotated. This reflex is absent in some neurological conditions.

Question 7

The nurse is caring for a patient who is experiencing a tonic‒clonic seizure. Which diagram depicts the tonic phase of this seizure disorder?

Accepted Answer

The answer of The nurse is caring for a patient...

Question 8

A patient with increased intracranial pressure is prescribed mannitol (Osmitrol). What should the nurse do when providing this medication?

Accepted Answer

Mannitol can crystallize, so an in-line filter is used to prevent crystal infusion. Crystals in the solution indicate it should not be administered. Monitoring CVP and PAP is important to assess fluid status and prevent complications.

Question 9

A patient recovering from a stroke has agnosia. What should the nurse do when caring for this patient?

Accepted Answer

Agnosia is a condition where the patient has difficulty recognizing familiar objects, persons, sounds, shapes, or smells, while the specific sensory modality is not defective nor is there any significant memory loss. Repeatedly naming familiar persons and objects can help reinforce recognition and memory, aiding in the patient's recovery.

Question 10

The nurse is caring for a patient with transient ischemic attack (TIA). Which medication should the nurse expect to be prescribed for this patient?

Accepted Answer

Antiplatelet agents, such as aspirin, are the medication of choice for preventing further TIAs or strokes. Fibrinolytic therapy is used for acute ischemic strokes, while anticoagulant therapy may be used in certain cases, such as for atrial fibrillation. Corticosteroids are not typically used for TIA treatment.

Question 11

The nurse is caring for a patient in the postoperative unit following carotid endarterectomy. How should the nurse position the patient?

Accepted Answer

The patient should be positioned on the unoperated side, either in a flat position or with the head of the bed elevated 30 degrees. This helps to promote blood flow to the operative site and reduce the risk of bleeding or clot formation. Placing a small towel directly against the operative site or using a pressure dressing over the site is not recommended, as it can increase the risk of bleeding or obstruct blood flow.

Question 12

The nurse notes on the surgical schedule that a patient is scheduled for cranial burr holes. For which health problems does the nurse realize this type of surgical approach is indicated?

Accepted Answer

Cranial burr holes are typically used in cases of acute subdural hematoma or epidural hematoma to relieve pressure on the brain by allowing excess blood or fluid to drain. It is not typically used for ischemic stroke, migraine headache, or hemorrhagic stroke.

Question 13

The nurse is caring for a patient with a seizure disorder who is scheduled for surgery to remove the epileptogenic focus within the cerebral cortex. The nurse realizes that this patient must have met which criteria to have this type of surgery planned?

Accepted Answer

The answer of The nurse is caring for a patient...

Question 14

The nurse is teaching a community education class on warning signs of stroke and transient ischemic attacks (TIAs). What should be included in this presentation?

Accepted Answer

These are all warning signs of stroke or TIA.

Question 15

A patient with a brain tumor is scheduled for a chest x-ray and says "I don't understand why I'm having a chest x-ray when my problem is in my head!" What is the nurse's most appropriate response?

Accepted Answer

The nurse should explain the rationale behind the chest x-ray and provide some education on the potential relationship between brain tumors and lung cancer. This can help to alleviate the patient's confusion and anxiety. Option B may not provide enough information and could lead to further questions or concerns from the patient. Options C and D are dismissive and do not address the patient's concerns.

Question 16

The nurse is caring for a patient with a head injury involving cerebral edema and increased intracranial pressure (IICP). To prevent further transient increases from occurring, the nurse should implement what intervention?

Accepted Answer

Coughing and straining can cause transient increases in IICP, so implementing measures to help the patient avoid these actions can prevent further increases. Positioning the patient in the supine position with the head of the bed at 30 degrees and initiating oxygen administration are interventions that can help decrease IICP, but they do not prevent transient increases from occurring. Initiating and monitoring an IV with normal saline is a standard intervention to maintain hydration, but it does not specifically address preventing transient increases in IICP.

Question 17

The nurse is completing discharge teaching to a patient following hospitalization for a seizure disorder who is being prescribed phenytoin (Dilantin). What should the nurse include in these instructions?

Accepted Answer

The answer of The nurse is completing discharge teaching to...

Question 18

The nurse is caring for a patient with an intracranial pressure monitoring device. For which priority problem should the nurse plan care for this patient?

Accepted Answer

With an intracranial pressure monitoring device, the priority problem would be the risk for infection at the insertion site. Any signs of infection should be reported immediately to the healthcare provider. Confusion, changes in skin integrity, and changes in mobility status may also be important to monitor, but infection prevention takes priority.

Question 19

The nurse completes an assessment of a patient on the neurology unit. After reviewing the results listed in the table, what coma state does the nurse realize this patient is experiencing? $$\begin{array} { | l | l | } 
\hline \text { Physical Assessment } & \
\hline \text { Eyes } & \begin{array} { l } 
\text { Wandering eye movements present; does not focus on objects or } \
\text { faces }
\end{array} \
\hline \text { Head and neck } & \text { Able to chew and swallow } \
\hline \text { Respiratory } & \text { Coughs at intervals but not on command } \
\hline \text { Musculo-skeletal } & \text { Grasps objects but not on command } \
\hline \text { LOC (level of } & \text { Blinks or smiles when physically stimulated but not on command; } \
\text { consciousness) }&\text { does not respond to verbal stimuli; sleep-wake cycles present }
\
\hline
\end{array}$$

Accepted Answer

The patient's physical assessment findings are consistent with a persistent vegetative state. The patient has sleep-wake cycles, but does not respond to verbal stimuli, and only responds to physical stimulation with blinking or smiling. The wandering eye movements and lack of focus on objects or faces also support this diagnosis. The patient does not demonstrate enough responsiveness to be classified as minimally conscious, locked-in, or stuporous.

Question 20

The nurse is caring for a patient who had a craniotomy for a brain tumor and has developed postoperative leakage of cerebrospinal fluid (CSF) from the nose. What are appropriate nursing interventions for this patient?

Accepted Answer

The answer of The nurse is caring for a patient...

Quiz 42: Nursing Care of Patients With Intracranial Disorders

The nurse instructs a patient on actions to help reduce the onset of migraine headaches. Which patient statement indicates that additional teaching is required?

The nurse is instructing a patient with a brain tumor about a scheduled craniotomy. What should the nurse include in this teaching?

The nurse is caring for a patient with migraine headaches. Which medication should the nurse expect to be prescribed prophylactically for this patient?

The nurse is caring for a patient with hemiplegia after experiencing a stroke. Which body areas should the nurse expect to be affected by the stroke? Mark an "X" on the body diagram below that depicts hemiplegia.

The nurse is planning a seminar about headaches for a local civic group. What type of headache should the nurse describe as having a strong familial connection, affects females three to one over males, and results in lost productivity?

A patient is diagnosed with doll's-eye movements. What should the nurse expect to assess in this patient?

The nurse is caring for a patient who is experiencing a tonic‒clonic seizure. Which diagram depicts the tonic phase of this seizure disorder?

A patient with increased intracranial pressure is prescribed mannitol (Osmitrol) . What should the nurse do when providing this medication?

A patient recovering from a stroke has agnosia. What should the nurse do when caring for this patient?

The nurse is caring for a patient with transient ischemic attack (TIA) . Which medication should the nurse expect to be prescribed for this patient?

The nurse is caring for a patient in the postoperative unit following carotid endarterectomy. How should the nurse position the patient?

The nurse notes on the surgical schedule that a patient is scheduled for cranial burr holes. For which health problems does the nurse realize this type of surgical approach is indicated?

The nurse is caring for a patient with a seizure disorder who is scheduled for surgery to remove the epileptogenic focus within the cerebral cortex. The nurse realizes that this patient must have met which criteria to have this type of surgery planned?

The nurse is teaching a community education class on warning signs of stroke and transient ischemic attacks (TIAs) . What should be included in this presentation?

A patient with a brain tumor is scheduled for a chest x-ray and says "I don't understand why I'm having a chest x-ray when my problem is in my head!" What is the nurse's most appropriate response?

The nurse is caring for a patient with a head injury involving cerebral edema and increased intracranial pressure (IICP) . To prevent further transient increases from occurring, the nurse should implement what intervention?

The nurse is completing discharge teaching to a patient following hospitalization for a seizure disorder who is being prescribed phenytoin (Dilantin) . What should the nurse include in these instructions?

The nurse is caring for a patient with an intracranial pressure monitoring device. For which priority problem should the nurse plan care for this patient?

The nurse is caring for a patient who had a craniotomy for a brain tumor and has developed postoperative leakage of cerebrospinal fluid (CSF) from the nose. What are appropriate nursing interventions for this patient?