neuro part 2

The newly admitted patient to the emergency room 30 minutes ago after a fall off a ladder has gradually decreased in consciousness and has slowly reacting pupils, a widening pulse pressure, and verbal responses that are slow and unintelligible. What is the most appropriate position for the patient?

• Neck placed in a neutral position

• Head raised slightly with hips flexed

• Supine in gravity neutral position

• Turn on right right side with head elevated

Which question is likely to elicit the most valid response from the patient who is being interviewed about a neurologic problem?

• “Do you have any sensations of pins and needles in your feet?”

• 1. “Does the pain radiate from your back into your legs?

• 1. “Can you describe the sensations you are having?”

• 1. “Do you ever have any nausea or dizziness?”

As the result of a stroke, a patient has difficulty discerning the position of his body without looking at it. In the nurse’s documentation, which would best describe the patient’s inability to assess spatial position of his body?

• 1. Agnosia

• 1. Proprioception

• Apraxia

• 1. Sensation

The nurse assures an anxious family member of a 92-year-old patient who is demonstrating signs of dementia that many causes of dementia are reversible and preventable. What is one example?

• Hypotension

• Alzheimer disease

• Diabetes

• Parkinson disease

What is the nurse assessing when asking the patient, “Who is the president of the United States?” during a level of consciousness assessment?

• Orientation

• Memory

• Calculation

• Fund of knowledge

What is the nurse aware of when assessing a person with a craniocerebral injury?

• Most injuries of this type are irreversible

• Open injuries are always more serious than closed injuries

• Signs and symptoms may not occur until several days after the trauma

• Trauma to the frontal lobe is more significant than to any other area

The nurse is caring for a home health patient who had a spinal cord injury at C5 three years ago. The nurse bases the plan of care on the knowledge that the patient will be able to

• feed self with setup and adaptive equipment

• transfer self to wheelchair

• stand erect with full leg braces

• sit with good balance

A frantic family member is distressed about the flaccid paralysis of her son following a spinal cord injury several hours ago. What does the nurse know about this condition?

• It is an ominous indicator of permanent paralysis

• It is possibly a temporary condition and will clear

• It degenerates into a spastic paralysis

• It will progress up the cord to cause seizures

A patient with a spinal cord injury at T1 complains of stuffiness of the nose and a headache. The nurse notes a flushing of the neck and “goose flesh.” What should be the primary nursing intervention based on these assessments

• 1. Place patient in flat position and check temperature

• 1. Administer oxygen and check oxygen saturation

• 1. Place on side and check for leg swelling

• 1. Sit upright and check blood pressure

The nurse is aware that the drug t-PA (Activase), a tissue plasminogen activator, must be given in____hours of the onset of symptoms to have maximum benefit.

• 3 hours

• 4 hours

• 6 hours

• 8 hours