Deck 23: Neurologic Clinical Assessment and Diagnostic Procedures

Question 1

Which of the following statements best describes assessment of arousal?

A) It measures content of consciousness and is a higher level function.
B) It is an evaluation of the reticular activating system and its connection with the thalamus and the cerebral cortex.
C) It becomes a valid parameter when the patient is able to respond to verbal stimuli, such as squeezing the hands on command.
D) Noxious stimuli are not to be used as an assessment parameter.

Answer 1

It is an evaluation of the reticular activating system and its connection with the thalamus and the cerebral cortex.

Question 2

Decerebrate posturing (abnormal extension)indicates dysfunction in which area of the central nervous system?

A) Cerebral cortex
B) Thalamus
C) Cerebellum
D) Brainstem

Answer 2

Brainstem

Question 3

A score of 6 on the Glasgow Coma Scale (GCS)indicates

A) a vegetative state.
B) paraplegia.
C) coma.
D) obtundation.

Answer 3

coma.

Question 4

A patient is admitted to the critical care unit with a subdural hematoma.The GCS is used to assess his level of consciousness.Which statement is true concerning the GCS?

A) It provides data about level of consciousness only.
B) It is considered equivalent to a complete neurologic examination.
C) It is a sensitive tool for evaluation of an altered sensorium.
D) It is the most critical assessment parameter to account for possible aphasia.

Question 5

Which of the following denotes the most serious prognosis?

A) Decorticate posturing
B) Decerebrate posturing
C) Absence of Babinski reflex
D) GCS score of 14

Question 6

The respiratory pattern with rhythmic increase and decrease of rate and depth of respiration,then brief periods of apnea,is known as

A) central neurogenic hyperventilation.
B) apneustic breathing.
C) ataxic respirations.
D) Cheyne-Stokes respirations.

Question 7

The oculovestibular reflex,or cold caloric test,

A) should not be performed on an unconscious patient because of the risk of aspiration.
B) has an abnormal response of rapid nystagmus-like deviation to the side of the body that is tested.
C) is a routine test of the nursing neurologic examination.
D) is one of the final clinical assessments of brainstem function.

Question 8

The clinical manifestations of the Cushing reflex are

A) bradycardia, systolic hypertension, and widening pulse pressure.
B) tachycardia, systolic hypotension, and tachypnea.
C) headache, nuchal rigidity, and hyperthermia.
D) bradycardia, aphasia, and visual field disturbances.

Question 9

With an intact oculocephalic reflex,the

A) patient's eyes move in the same direction the head is turned.
B) patient's eyes move in the opposite direction to the movement of the patient's head.
C) patient's eyes remain midline.
D) doll's eye reflex is absent.

Question 10

Testing of extraocular eye movements assesses

A) pupillary response to light.
B) function of the three cranial nerves of the eye.
C) the ability of the eyes to accommodate to a closer moving object.
D) the oculocephalic reflex.

Question 11

The GCS is an invalid measure for the patient with

A) hemiplegia.
B) Parkinson disease.
C) mental retardation.
D) intoxication.

Question 12

While starting an intravenous line on the right hand of an unconscious patient,the patient reaches over with his left hand and tries to remove the noxious stimuli.This response is called

A) decorticate posturing.
B) decerebrate posturing.
C) withdrawal.
D) localization.

Question 13

Symptoms of late stages of intracranial hypertension include

A) decreased perfusion of cerebral tissue.
B) widening pulse pressure values.
C) increased perfusion pressure across the blood-brain barrier.
D) decreased intracranial pressure.

Question 14

An oval pupil is indicative of

A) cortical dysfunction.
B) intracranial hypertension.
C) hydrocephalus.
D) metabolic coma.

Question 15

A critically injured patient can be aroused only by vigorous and continuous external stimuli.The patient's level of consciousness is considered

A) lethargic.
B) obtunded.
C) stuporous.
D) comatose.

Question 16

Before performing the doll's eye or oculocephalic reflex,the nurse must verify

A) the absence of cervical injury.
B) the depth and rate of respiration.
C) a physician's order to perform the maneuver.
D) the patient's ability to follow a verbal command.

Question 17

Which of the following choices is an acceptable and recommended method of noxious stimulation?

A) Nipple pinch
B) Nail bed pressure
C) Supraorbital pressure
D) Sternal rub

Question 18

How much of a size difference between the two pupils is still considered normal?

A) 1 mm
B) 1.5 mm
C) 2 mm
D) 2.5 mm

Question 19

The initial history for the neurologically impaired patient needs to be

A) limited to the chief complaint.
B) comprehensive, including events preceding hospitalization.
C) directed to level of consciousness and pupillary reaction.
D) information that only the patient can provide.

Question 20

The most important aspect of the neurologic examination is

A) medical history.
B) physical examination.
C) level of consciousness.
D) pupillary responses.

Question 21

An important intervention before and after a cerebral angiogram is

A) ensuring that the patient is adequately hydrated.
B) maintaining the patient on an NPO status.
C) administering antibiotics to the patient.
D) keeping the patient flat in bed for 24 hours.

Question 22

Results from which two procedures complement each other in the preoperative evaluation of the carotid arteries?

A) Ultrasound and magnetic resonance angiography
B) Conventional angiography and evoked potential
C) CT and magnetic resonance angiography
D) Transcranial Doppler and extracranial Doppler

Question 23

The patient is ordered a CT scan with contrast.Which question should the nurse ask the conscious patient before the procedure?

A) Are you allergic to penicillin?
B) Are you allergic to iodine-based dye?
C) Are you allergic to latex?
D) Are you allergic to eggs?

Question 24

The difference between electroencephalography and evoked potentials is that evoked potentials

A) record electrical and muscle activity.
B) monitor cerebral blood flow velocity.
C) record impulses generated by sensory stimuli.
D) cannot be used in the assessment of spinal cord injury.

Question 25

Considering anatomic location,which cranial nerve will be affected first by downward pressure onto the infratentorial structures?

A) III
B) VI
C) IX
D) X

Question 26

Which of the following procedures is the diagnostic study of choice for acute head injury?

A) Magnetic resonance imaging
B) Computed tomography
C) Transcranial Doppler
D) Electroencephalography

Question 27

The most serious complication of lumbar puncture in a critically ill patient is

A) bacterial meningitis.
B) dural tear.
C) brainstem herniation.
D) spinal cord trauma.

Question 28

Successful completion of digital subtraction angiography requires what participation on the part of the patient?

A) Responding appropriately to various commands
B) Repositioning at appropriate intervals
C) Remaining motionless
D) Holding inspiration during imaging

Question 29

Which of the following patients may need sedation before having an MRI scan?

A) Claustrophobic patient
B) Comatose patient
C) Elderly patient
D) Patient with a spinal cord injury

Question 30

Postprocedural care of a patient undergoing a water-based contrast myelogram should include which of the following interventions?

A) Maintain the patient flat in bed for 4 to 6 hours.
B) Observe the puncture sight every 15 minutes for 2 hours for signs of bleeding.
C) Keep the patient's head elevated 30 to 45 degrees for 8 hours.
D) Administer a sedative to keep the patient from moving around.

Question 31

Which of the following is an abnormal finding in the analysis of the cerebrospinal fluid?

A) Clear and colorless
B) Glucose of 60 mg/dL
C) Protein of 20 mg/dL
D) 30 red blood cells

Question 32

Which type of ICP monitoring device has the most accurate ICP measurement and provides access to CSF for sampling?

A) Subarachnoid bolt or screw
B) Subdural or epidural catheter
C) Intraventricular catheter
D) Fiberoptic transducer tipped catheter

Question 33

Which diagnostic study provides the best evaluation of the functional integrity of cerebral motor pathways?

A) Electroencephalography
B) Xenon CT
C) Motor-evoked potentials
D) Emission tomography

Question 34

MRI is superior to CT for which of the following?

A) Brain death determination
B) Detection of central nervous system infection
C) Estimation of intracranial pressure
D) Identification of subarachnoid hemorrhage

Question 35

A patient is admitted to the critical care unit with a subdural hematoma.The GCS is used to assess his level of consciousness.In assessing the patient's best motor response,the movement that receives the lowest score is

A) decerebrate posturing.
B) localizing pain.
C) withdrawing from pain.
D) decorticate posturing.

Question 36

Carotid Doppler studies are used to monitor

A) blood flow in the anterior, middle, or posterior cerebral arteries.
B) blood flow in the common and internal carotid arteries.
C) arteriovenous circulation in the intracranial space.
D) global cerebral blood flow.

Question 37

Presence of the grasp reflex in an adult indicates what type of damage?

A) Brainstem
B) Spinal cord
C) CN III
D) Cortical

Question 38

Cerebral infarction is a serious complication of which procedure?

A) Extracranial Doppler
B) Evoked potential testing
C) Myelography
D) Conventional angiography

Question 39

The difference between cerebral angiography and digital subtraction angiography is that digital subtraction angiography

A) has more complications.
B) uses arterial injection of dye.
C) uses significantly less dye.
D) allows the patient more mobility during the procedure.

Question 40

Which nuclear medicine studies are used to detect cerebrovascular disease,seizures,and tumors?

A) PET
B) MRI
C) MRA
D) SPECT

Question 41

Studies have shown that the intraparenchymal catheter has a better result than the intraventricular catheter.Identify the answer that supports this statement.

A) The intraparenchymal catheter allows for CSF drainage.
B) The intraparenchymal catheter has increased monitoring time.
C) The intraparenchymal catheter has a longer insertion time for monitoring ICP.
D) The intraparenchymal catheter has decreased device-related complications.

Question 42

The most clinically significant ICP waveform is

A) A waves.
B) B waves.
C) C waves.
D) D waves.

Question 43

The patient's ICP reading has gradually climbed from 15 to 23 mm Hg.The nurse's primary action is to:

A) drain off 7 mm of CSF from the catheter.
B) notify the physician.
C) place the patient in a high Fowler position to decrease the pressure.
D) check level of consciousness.

Question 44

Identify the drawbacks to using continuous electroencephalography (cEEG)in a critical care unit.

A) Size of machine
B) Expensive
C) Labor-intensive program
D) Requires expertise for interpretation
E) Artifacts from ICU environment

Question 45

A critical care patient is diagnosed with massive head trauma.The patient is receiving brain tissue oxygen pressure (PbtO?)monitoring.The nurse recognized that the goal of this treatment is to maintain PbtO?

A) greater than 20 mm Hg.
B) less than 15 mm Hg.
C) between 15 and 20 mm Hg.
D) between 10 and 20 mm Hg.

Question 46

According to the 2007 Brain Trauma Foundation guidelines,the recommended CPP range is

A) 10 to 30 mm Hg.
B) 30 to 50 mm Hg.
C) 50 to 70 mm Hg.
D) 70 to 85 mm Hg.

Question 47

A patient is being prepared for a neurologic work-up.Examinations include a CT scan,cerebral angiography,and lumbar puncture.The best position to place the patient in for a lumbar puncture is

A) supine.
B) reverse Trendelenburg.
C) high Fowler.
D) lateral recumbent position with her knees and head slightly tucked.

Question 48

Indications for the use of EEG include

A) cerebral infarct.
B) metabolic encephalopathy.
C) confirmation of brain death.
D) altered consciousness.
E) all head injuries.

Question 49

When assessing motor function,which of the following are correct?

A) The presence of a Babinski reflex is an abnormal finding in an adult.
B) Lower extremity muscle tone is assessed by asking the patient to push or pull his or her foot against resistance.
C) When using noxious stimuli to elicit a motor response, each limb is tested separately.
D) Abnormal extension, or decerebrate posturing, indicates a less positive outcome than abnormal flexion.
E) Evaluation of deep tendon reflexes is an essential part of the nursing assessment.

Question 50

Identify the sites for monitoring ICP.

A) Intraventricular space
B) Epidural space
C) Jugular veins
D) Subdural space
E) Parenchyma