Question 1

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

Accepted Answer

With the location of the oculomotor nerve (cranial nerve [CN] III)at the notch of the tentorium,pupil size and reactivity play a key role in the physical assessment of intracranial pressure changes and herniation syndromes.In addition to CN III compression,changes in pupil size occur for other reasons.Large pupils can result from the instillation of cycloplegic agents,such as atropine or scopolamine,or can indicate extreme stress.Extremely small pupils can indicate narcotic overdose,lower brainstem compression,or bilateral damage to the pons.

Question 2

The nursing is caring for a comatose patient with a brain tumor.When the nurse touches the palm of the patient's hand,the patient grasps the nurse's hand.What is this sign indicative of?

Accepted Answer

The grasp reflex is present when tactile stimulation of the palm of the hand produces a grasp response that is not a conscious voluntary act.The grasp reflex is a primitive reflex that normally disappears with maturational development; thus,the presence of the grasp reflex in the adult indicates cortical damage.

Question 3

The nurse is precepting a new graduate nurse.The new graduate asks about the difference between electroencephalography and evoked potentials.What should the nurse tell the new graduate?

Accepted Answer

Evoked potentials involve the recording of electrical impulses generated by a sensory stimulus as it travels through the brainstem and into the cerebral cortex.Electroencephalography (EEG)records electric impulses,commonly called brain waves,generated by the brain.

Question 4

A patient is admitted to the critical care unit with a subdural hematoma.The nurse is assessing the patient's Glasgow Coma Scale (GCS)score.When assessing the patient's best motor response,which movement would receive the lowest score?

Accepted Answer

Abnormal extension (decerebrate posturing)receives a score of 2 on the Glasgow Coma Scale (GCS).The only lower score is 1,which is for a flaccid response.

Question 5

The nursing management plan for a patient undergoing a water-based contrast myelogram should include intervention?

Accepted Answer

Postprocedure care includes keeping the patient's head elevated 30 to 45 degrees for 8 hours,monitoring neurologic status,and encouraging oral fluids.

Question 6

A patient has been admitted with acute confusion and other focal neurologic signs.The practitioner orders magnetic resonance imaging (MRI).The nurse knows in certain situations an MRI is superior to computed tomography (CT).What is one those situations?

Accepted Answer

Magnetic resonance imaging (MRI)produces images with greater detail than computed tomography (CT)and provides views of several planes (sagittal,coronal,axial,and oblique)that are not possible with CT.MRI with contrast is the preferred study for detection of infectious and inflammatory processes of the central nervous system (CNS).MRI can detect areas of cerebral infarct within a few hours of the incident and can identify small areas of plaque in patients with multiple sclerosis.MRI with contrast is the preferred study for detection of infectious and inflammatory processes of the CNS,malignancy,and metastatic lesions; cervical spine imaging; and postoperative evaluation of tumor recurrence.MRI also is the diagnostic study of choice in the evaluation of spinal cord injury.

Question 7

A patient is undergoing a preoperative evaluation for carotid arteries.What two test should the nurse expect to see ordered for the patient?

Accepted Answer

Magnetic resonance angiography of the carotid arteries has become an established complement to preoperative ultrasound evaluation.It helps determine the area of salvageable tissue (or penumbra)after acute stroke and head injury.

Question 8

A patient has been admitted with acute confusion and other focal neurologic signs.The practitioner is going to perform a lumbar puncture.What is an abnormal finding in the cerebrospinal fluid?

Accepted Answer

Cerebrospinal fluid is normally a clear,colorless,odorless solution that contains 50 to 75 mg/dL of glucose,5 to 25 mg/dL of protein,and no red blood cells.

Question 9

Which patient may need sedation before having a magnetic resonance imaging (MRI)scan?

Accepted Answer

The magnetic resonance imaging procedure is lengthy and requires the patient to lie motionless in a tight,enclosed space.Mild sedation,a blindfold,or both may be necessary for claustrophobic patients.

Question 10

A patient is going for digital subtraction angiography.The patient education plan to prepare the patient for the procedure should include which instruction?

Accepted Answer

The major disadvantage of digital subtraction angiography involves the patient's ability to remain motionless during the entire procedure.Even swallowing significantly interferes with the imaging process.

Question 11

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

Accepted Answer

If the patient is scheduled to receive contrast for computed tomography (CT)scanning,questions about possible sensitivity to iodine-based dye must be asked beforehand,if possible.During infusion of the dye and for 10 to 30 minutes afterward,the patient is observed closely for an anaphylactic reaction.Fewer than 1% of all patients undergoing contrast-enhanced CT have severe anaphylactic reactions,shock,or cardiac arrest.

Question 12

The nurse is caring for a patient with an intracranial pressure-monitoring device that provides access to cerebrospinal fluid (CSF)for sampling.What type of device does the patient have?

Accepted Answer

An intraventricular catheter allows accurate intracranial pressure (ICP)measurement and provides access to cerebrospinal fluid (CSF)for drainage or sampling.A subarachnoid bolt,epidural catheter,and fiber-optic catheter provide no access for CSF sampling.

Question 13

The nurse is caring for a patient who is going to have digital subtraction angiography.The patient asks what is the difference between conventional and digital subtraction angiography.What should the nurse tell the patient?

Accepted Answer

Digital subtraction angiography uses significantly less dye than arterial angiography.Dye is injected in the venous or arterial system.The patient must remain motionless during the procedure.Complications are the same as those for cerebral angiography.

Question 14

Which nuclear medicine study should the nurse anticipate a practitioner's order for in a patient who is being evaluated for a brain tumor?

Accepted Answer

The single-photon emission computed tomography (SPECT)test differs from positron emission tomography (PET)in that tracer stays in the bloodstream rather than being absorbed by surrounding tissue,thereby limiting the images to areas where blood flows.SPECT is cheaper and more readily available than higher resolution PET.The major clinical uses of SPECT are to detect cerebrovascular disease,seizures,and tumors.Magnetic resonance imaging and magnetic resonance angiography are radiographic imaging examinations.

Question 15

A patient has been admitted with acute confusion and other focal neurologic signs.The practitioner is going to perform a lumbar puncture.What is the most serious complication of lumbar puncture?

Accepted Answer

Two life-threatening risks associated with lumbar puncture include possible brainstem herniation,if intracranial pressure is elevated,and respiratory arrest associated with neurologic deterioration.

Question 16

The practitioner has ordered a carotid Doppler study for a patient.The patient asks the nurse what the test is for.How should the nurse respond?

Accepted Answer

Ultrasound technology,although not an absolute measure of cerebral blood flow,uses a noninvasive technique to provide information about the flow velocity of blood through carotid vessels.Carotid duplex studies are used as a routine screening procedure for intraluminal narrowing of the common and internal carotid arteries as a result of atherosclerotic plaques.

Question 17

Cerebral infarction is a serious complication of which procedure?

Accepted Answer

Complications associated with cerebral angiography include cerebral embolus caused by the catheter dislodging a segment of atherosclerotic plaque in the vessel,hemorrhage or hematoma formation at the insertion site,vasospasm caused by the irritation of catheter placement,thrombosis of the extremity distal to the injection site,and allergic or adverse reaction to the contrast medium.

Question 18

The practitioner wishes to evaluate the functional integrity of cerebral motor pathways in a brain-injured patient.Which test should the nurse anticipate the practitioner will order?

Accepted Answer

Motor-evoked potentials assess the functional integrity of descending motor pathways.The motor cortex is stimulated via direct high-voltage electric stimulation through the scalp or use of a magnetic field to induce an electrical current within the brain.

Question 19

The nurse is caring for a patient who has just had a cerebral angiogram.Which intervention should be part of the nursing management plan?

Accepted Answer

After the cerebral angiogram,adequate hydration is necessary to assist the kidneys in clearing the heavy dye load.Inadequate hydration may lead to renal dysfunction and renal shutdown.

Question 20

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

Accepted Answer

Computed tomography offers rapid,convenient,noninvasive visualization of structures and is the diagnostic study of choice for an acute head injury.

Quiz 22: Neurologic Clinical Assessment and Diagnostic Procedures