Question 1

At each vertebral level is a pair of spinal nerves,each consisting of an anterior and a posterior root.Select the statement that represents true information about motor or sensory distribution.&#10;A) The posterior root is the sensory root.&#10;B) Skin dermatomes represent motor innervations.&#10;C) The anterior root is the sensory root.&#10;D) Spinal ganglia exit the spinal cord through the cauda equina.

Accepted Answer

The posterior,or sensory,root contains cell bodies that lie in the spinal ganglia located in the intervertebral foramina,the opening through which the nerves exit from the spinal canal and emerge from the cord.In the lumbar region,the course of the nerves is nearly vertical,forming the cauda equina.The normal segmental sensory distribution is valuable in the anatomic localization of sensory disorders.Dermatomes are bands of skin innervated by a sensory root of a single spinal nerve.

Question 2

Achieving hemostasis in delicate areas can be a challenge for the neurosurgeon.In addition to using meticulous technique to prevent bleeding,topical agents are routinely used as an adjunct to hemostasis.Some hemostatic products form a composite clot that seals a bleeding site by using a thrombin component that converts fibrinogen in the patient's blood to fibrin.Select the diad (2)of hemostatic products that provide hemostasis by topical application,essentially acting as a patch rather than a clotting factor.

A) Oxidized cellulose (Surgicel) and topical thrombin
B) Bone wax and topical thrombin
C) Bone wax and oxidized cellulose (Surgicel)
D) Gelatin matrix (FloSeal) and collagen hemostat (Avitene)

Accepted Answer

Bone wax is a hemostatic material that should be available for all cranial and spinal cord operations.Bone wax may be applied with the surgeon's fingertip or with the tip of an instrument such as a Freer or Penfield elevator.The surgeon firmly rubs or packs the wax into the bleeding surfaces of bone.Regenerated cellulose (Surgicel)allows platelets and aggregates of thrombin and particulate blood elements to cling and form a coagulum that can act as a patch.Collagen hemostatic agents (Avitene,Helistat,Instat)attract platelets that aggregate into thrombi,initiating formation of a physiologic platelet plug.An absorbable gelatin sponge (Gelfoam)absorbs and holds blood and fluid within its interstices,exerting a physical hemostatic effect.The granules in a gelatin matrix (FloSeal)form a composite clot that seals a bleeding site.

Question 3

Trigeminal neuralgia is an extremely painful and debilitating condition characterized by unilateral intense pain in the ear,eye,lips,nose,scalp,forehead,teeth,or jaw.A variety of treatments,including microvascular surgical decompression,are available.Select a minimally invasive targeted therapy that has demonstrated significant success in ablation of the entry of the trigeminal nerve.

A) Endovascular ablation
B) Stereotactic alcohol injections
C) Gamma knife radiosurgery
D) Cavitron ultrasonic surgical ablation

Accepted Answer

Gamma knife radiosurgery creates a lesion at the root entry of the trigeminal nerve,resulting in degeneration of the axons and their ability to transmit impulses.Analysis of the data in Little's study (Little et al,2009)showed that at 5 years,20% of patients were pain free and 50% had pain relief;41% of the group studied required a subsequent procedure.

Question 4

Twelve pairs of cranial nerves arise within the cranial cavity.Although they are part of the peripheral nervous system,from a surgical standpoint they are considered part of the anatomy of the head.Which three pairs of nerves,conveniently considered together because of their motor influence on the eye,are subject to toxic,inflammatory,vascular,and neoplastic lesions?

A) Ninth,tenth,and eleventh cranial nerves
B) Second,third,and fourth cranial nerves
C) Third,fourth,and sixth cranial nerves
D) First,second,and third cranial nerves

Accepted Answer

The third,fourth,and sixth cranial nerves are the oculomotor,trochlear,and abducens,respectively.They are conveniently considered together because they are the motor nerves to the muscles of the eyes.They are affected by many toxic,inflammatory,vascular,and neoplastic lesions.The third cranial nerve may be affected by aneurysms of the posterior communicating artery,and pressure against this nerve accounts for pupillary dilation when temporal lobe herniation,resulting from increased ICP,is present.

Question 5

Jordan Gribbins,a 69-year-old pipe smoker with a history of cardiac disease and atrial rhythm disturbance,is scheduled for a supratentorial craniotomy and is securely positioned in a semisitting position.The perioperative nurse and anesthesia provider have discussed the anesthesia plan and Mr.Gribbin's surgical and anesthesia risks,and agree that he is at risk for venous air embolism (VAE).Sequential compression devices have been placed on both legs.Pulmonary lines have been placed and the nurse has prepared an area for preparation of TEE (transesophageal electrocardiography),if needed.During the procedure,Mr.Gribbins reacted with decreases in arterial pressure and end-tidal CO₂.Precordial "washing machine" sounds emanated from the Doppler.What should the perioperative nurse anticipate as a possible next response?

A) Increase the pressure to 60 mm Hg on the SCD pump.
B) Cover the surgical wound with antibiotic-soaked sponges.
C) Reposition the patient in left lateral decubitus position to entrap air in the right atrium.
D) Aspirate air bubbles from the arterial line and give dobutamine.

Accepted Answer

A repositioning to the left lateral decubitus position (right side up)may be indicated to prevent the air in the atrium from moving to the ventricle and causing an air lock.If the patient's position cannot be changed because of the positioning apparatus,the tilt of the OR bed can be adjusted to lower the source of air entry and decrease the negative air pressure gradient.The perioperative nurse partners with the anesthesia provider,neurosurgeon,and scrub person to provide safety for patients during seated neurosurgical procedures.
Once VAE has been diagnosed,a critical component of treatment is to prevent further air entrainment.The nurse should ensure saline-soaked sponges are available on the sterile field so the surgeon can immediately cover the surgical site.The surgeon should then assess and eliminate any entry site to prevent additional air entry.The anesthesia provider is responsible for attempting to aspirate the air by way of the multiorifice right atrial catheter and may administer ephedrine,dobutamine,or norepinephrine to provide inotropic support to the right ventricle.

Question 6

What is the term for the bloodless plane that contains loose areolar tissue and permits mobility of the scalp?&#10;A) Pericranial plane&#10;B) Galea&#10;C) Subgaleal space&#10;D) Outer skull periosteum

Accepted Answer

The subgaleal space contains loose areolar tissue that permits mobility of the scalp.It is in this bloodless plane that the standard craniotomy scalp flap is created.The subcutaneous tissue,which is exceptionally dense,tough,and vascular,is firmly attached to the galea.Most of the blood vessels lie superficial to the galea.The pericranium,or outer periosteum of the skull,separates the galea from the cranium.

Question 7

The most frequently occurring tumors of the spine are metastatic,and the spine is the most common site for skeletal metastasis.From what organs or disease processes do most secondary spinal tumors originate?

A) Lung,breast,lymphoma,and myeloma
B) Intestines,thyroid,soft tissue sarcoma,and breast
C) Osteosarcoma,meningioma,lymphoma,and pancreas
D) Myeloma,gastric,biliary,and lung

Accepted Answer

Secondary spinal tumors most often originate from carcinomas of the lung and breast,and lymphoma and myeloma.Pain is the earliest and most prominent symptom,followed by weakness.

Question 8

Tracey,the neurosurgical perioperative nurse,is the circulating nurse on a cranial procedure with a new surgical resident on his first day on the neurosurgical surgery service.She has observed and coached him carefully as he removes the patient's hair from the intended incision site with the clippers and then combs the remaining hair away from the incision,holding it back with prepping solution.When the resident asked the scrub person for methylene blue and a sterile cotton-tipped applicator on a wood stick,Tracey intervened and offered him an indigo carmine surgical skin marker.What was Tracey's rationale for not using methylene blue as a skin marker?

A) Methylene blue produces an inflammatory reaction in CNS tissue.
B) Methylene blue markings tend to wash off during the prep.
C) Methylene blue will not be able to be seen through the povidone-iodine.
D) Methylene blue is not compatible with povidone-iodine.

Accepted Answer

Methylene blue should never be found in a neurosurgical OR because it produces an inflammatory reaction in CNS tissue.Many neurosurgeons mark the incision line with a sterile marking pen or a sterile marking solution and wooden stick.If a marking solution is used,indigo carmine,gentian violet,or brilliant green is recommended.Because the markings tend to wash off during the prep,some surgeons may scratch the scalp along the planned incision with a sharp sterile needle.

Question 9

An important area of the brain that is critical for learning and memory is the ___,while emotion and social behavior are regulated by the .&#10;A) parahippocampal gyri;limbic system&#10;B) amygdal;cingulate&#10;C) hypothalamus;septum&#10;D) hippocampus;amygdala

Accepted Answer

The hippocampus is critical for learning and memory.The amygdala regulates the perceptive and expressive aspects of emotional and social behavior.The limbic system consists of large parts of the cortex near the medial wall of the cerebral hemisphere (cingulate and parahippocampal gyri)along with the hippocampus,amygdala,and septum.It is closely and significantly connected with the hypothalamus.The limbic system affects endocrine and autonomic functions of the body,recent memory,emotions,behaviors,and motivational and mood states.

Question 10

Brain tumors are either malignant or benign,depending on the cell type.Primary tumors generally do not resemble the carcinomas and sarcomas found elsewhere in the body and rarely metastasize outside the CNS.Select the tumor that has been identified as an extremely rare and very malignant neoplasm.

A) Germinoma
B) Teratoma
C) Meningioma
D) Choriocarcinoma

Accepted Answer

Choriocarcinoma is an extremely rare,very malignant neoplasm.Multiple factors are suspected of playing a role in the pathogenesis of intracranial neoplasms.Early diagnosis simplifies surgical treatment because increased ICP and severe neurologic changes are not usually present.Meningiomas are usually benign,circumscribed,slow-growing tumors.A teratoma is a congenital tumor containing embryonic elements.It occurs most frequently in children and is likely to arise in or near the ventricular walls.The 5-year survival rate is 73%.Germinoma is a neoplasm arising from germ cells.Survival with germinomas is much better than with nongerminomatous tumors (teratoma,embryonal cell carcinoma,choriocarcinoma).

Question 11

The brainstem is located in the posterior fossa and forms the floor of the fourth ventricle.It is the site of many ascending and descending fiber tracts that allow for communication among the structures of the brain and between the brain and spinal cord.The brainstem consists of what three structures?

A) Dura,epidura,and subdura
B) Midbrain,pons,and medulla oblongata
C) Mesencephalon,cephalon,and cerebrum
D) Pons,medulla,and foramen magnum

Accepted Answer

The answer of The brainstem is located in the posterior...

Question 12

Microsurgical techniques have been applied to cranial,spinal,and peripheral nerve operations.Some procedures in which microsurgery is of value are explorations of the posterior fossa,especially for tumors of the fourth ventricle or cerebellopontine angle,and removal of small acoustic neuromas,with resulting preservation of the facial nerve.Each time the surgeon must look away and then back to the surgical field,open wound time and anesthesia time are increased while the surgeon becomes reoriented to the field.A nursing action,in the scrub person role,directed toward assisting the surgeon in efficiency and expediting the microsurgical procedure would be:

A) have the patient prepped and draped before the time out.
B) place the instruments and accessories within the surgeon's peripheral vision.
C) hand instruments proficiently,in direction of use,without delay.
D) transfer micro-wiped instruments and accessories via the first assistant.

Accepted Answer

The answer of Microsurgical techniques have been applied to cranial,spinal,and...

Question 13

A familiarity with basic neurologic assessment tools gives the nurse the ability to perform a standardized neurologic exam that can be used preoperatively to establish a baseline assessment and postoperatively to establish a return to baseline or assess postoperative neurologic stability.The Glasgow Coma Scale (GCS)is commonly used to assess patients with brain injury using three indicators of cerebral function:eye opening,verbal communication,and motor response to verbal and noxious stimuli.Within the scoring range for the GCS,the best possible score is _ and the worst possible score is __.

A) 15;3
B) 12;0
C) 3;15
D) 0;12

Accepted Answer

The answer of A familiarity with basic neurologic assessment tools...

Question 14

Transsphenoidal hypophysectomy (TSH)is performed with the patient administered a general endotracheal anesthetic,combined with a local anesthetic.The surgical team places the patient in a semisitting position,with the head against the headrest.A transnasal or a sublabial incision can be used for rapid access to the sella turcica.Select the diad (2)of conditions that would be appropriate indications for TSH.

A) Acromegaly and hyperpituitarism
B) Advanced uncontrollable diabetes and retinal detachment
C) Endophthalmos and malignant exophthalmos
D) Hypopituitarism and small pituitary tumors

Accepted Answer

The answer of Transsphenoidal hypophysectomy (TSH)is performed with the patient...

Question 15

Interventional neuroradiology uses fluoroscopy to gain access to the intracranial circulation by way of a percutaneous transfemoral catheter.The endovascular approach to the treatment of both ruptured and unruptured cerebral aneurysms is endosaccular occlusion.This is an excellent technique for aneurysms that are complex,have a neck that is too short for clipping,or are difficult to reach via traditional craniotomy.This approach is less invasive than the traditional open craniotomy with identification and clipping of the aneurysm followed by cranial closure and extended recovery.Select the true endovascular procedure that has been designed as an alternative to its open surgical option.

A) Endovascular coil occlusion of an aneurysm
B) Endovascular approach for VP shunt insertion
C) Endovascular evacuation of intracranial hemorrhage
D) Endovascular ultrasound

Accepted Answer

The answer of Interventional neuroradiology uses fluoroscopy to gain access...

Question 16

Metastases to the spine occur most often in the thoracic spine,followed by the lumbar and cervical areas.Treatment goals for metastatic tumors of the spine are pain relief and preservation or restoration of neurologic function.Therapeutic options include radiation,surgery,or a combination of these.Select the statement that best reflects a therapeutic spinal procedure goal for a secondary metastatic tumor.

A) Spinal cord tumors produce spinal fluid blockage and can be found with MRI.
B) Surgery is directed toward decompressing and stabilizing the spine.
C) Metastatic spinal tumors are usually extradural.
D) A standard laminectomy is used for exposure and removal.

Accepted Answer

The answer of Metastases to the spine occur most often...

Question 17

Identify the dura fold that separates the right and left cerebral hemispheres.&#10;A) Falx cerebri&#10;B) Tentorium cerebelli&#10;C) Falx cerebelli&#10;D) Tentorium cerebri

Accepted Answer

The answer of Identify the dura fold that separates the...

Question 18

Brain tumors are either malignant or benign,depending on the cell type.Primary tumors generally do not resemble the carcinomas and sarcomas found elsewhere in the body and rarely metastasize outside the CNS.Both primary and metastatic tumors of the brain and its membranes are included in the term intracranial tumors.What three tumor types are the most frequently seen CNS tumors in adults?

A) Meningioma,oligodendroglioma,and glioblastoma
B) Glioblastoma,meningioma,and astrocytoma
C) Medulloblastoma,meningioma,and neurilemmoma
D) Astrocytoma,hemangioma,and sarcoma

Accepted Answer

The answer of Brain tumors are either malignant or benign,depending...

Question 19

Select the name of the procedure for which this patient is positioned.&#10; &#10;A) Transsphenoidal hypophysectomy&#10;B) Sagittal computed tomography&#10;C) Stereotactic brain biopsy&#10;D) Occipital craniotomy with evacuation of subdural hematoma

Accepted Answer

The answer of Select the name of the procedure for...

Question 20

Sara Gardiner is the perioperative nurse in the circulating role in OR 2,and is planning for her three neurosurgical procedures for the day.She is explaining the basic processes of the three procedures to the scrub person and double-scrubbed surgical technology student:(1)a VP shunt insertion(2)a reconstructive craniosynostosis for an infant with severe deformity,and (3)exploration of a severe head injury with increased intracranial pressure (ICP)to evacuate a hematoma and possible brain tissue.To give the brain room to swell in the third procedure,the bone flap may need to be sterile-wrapped and stored,for later replacement.Sara asks the student to name the appropriate surgical approach to the brain for each of the procedures.She expects the correct sequence to be:

A) craniectomy,craniotomy,and craniotomy.
B) burr hole,craniectomy,and craniotomy.
C) craniotomy,craniotomy,and craniectomy.
D) Burr hole,craniectomy,and burr hole.

Accepted Answer

The answer of Sara Gardiner is the perioperative nurse in...

Question 21

The surfaces of the hemispheres form convolutions called gyri and intervening furrows called sulci,which serve as anatomic landmarks.Two sulci of particular anatomic importance during surgery are the lateral sulcus,or sylvian fissure,which separates the temporal lobe from the frontal and parietal lobes,and the central sulcus,or fissure of Rolando,which separates the frontal lobe from the parietal lobe.The central sulcus also separates the motor cortex from the sensory cortex.Both the motor and sensory cortices are represented by a map called a homunculus that proportionately shows each body part at the area of the gyri that controls it and illustrates how the number of neurons corresponds to the degree of motor and sensory control required.Select all the true statements about sensory and motor function.

A) Another name for the homunculus is the dermatome grid.
B) Areas of fine motor and sensory control have more neurons.
C) The right motor and sensory cortices control the right side of the body.
D) The left motor and sensory cortices control the right side of the body.

Accepted Answer

The answer of The surfaces of the hemispheres form convolutions...

Question 22

Gina,the perioperative circulating nurse,has prepared the OR for a craniotomy for tumor and has assembled the primary bed base attachments for the head fixation positioning system.She has verified with the surgeon and anesthesia provider that the bed attachment is properly secured before the start of patient positioning and is prepared for positioning and securing the patient's head with the skull clamp.After the skull pins are secured,Gina will step back to view the head placement and symmetry,ensuring that (select all that apply):

A) the pins in the rocker arm are equidistant from the centerline of the patient's head.
B) the single pin in the extension arm is exactly at the centerline.
C) and the rocker arm is in the "CLOSED" position.
D) the pins are at an angle of 90 degrees.
E) the necessary pounds of clamping force are applied.
F)the pins avoid the areas of the frontal sinus,temporal fossa,blood vessels,and nerves.

Accepted Answer

The answer of Gina,the perioperative circulating nurse,has prepared the OR...

Question 23

Most patients will have undergone diagnostic procedures before arriving in the OR.Radiologic and other diagnostic studies are of great significance to the surgical team for determining a surgical diagnosis and developing a plan for treatment.MRI is the gold standard imaging scan for the diagnosis of tumors,abscesses,tissue/ligamentous injury,and disk herniation.Which three diagnostic tests of neurologic activity can be performed before surgery and also concurrently during the procedure?

A) Stereotactic CT scan
B) Electroencephalogram
C) Stereotactic MRI
D) Ultrasound
E) Evoked potentials f.Myelogram

Accepted Answer

The answer of Most patients will have undergone diagnostic procedures...

Deck 20: Neurosurgery