CH 54 \Neurologic Disorder

Which divisions are the two divisions of the nervous system?

• Somatic and the autonomic

• Cerebellum and the brainstem

• Medulla oblongata and the diencephalon

• Central and the peripheral

Answer explanation

The central and the peripheral are the two divisions of the nervous system. The autonomic and the somatic are the division of the peripheral nervous system.

Which cranial nerve supplies most of the organs in the thoracic and abdominal cavities and carries motor fibers to glands that produce digestive juices and other secretions?

• Somatic motor nerve

• Visceral sensory nerve

• Abducens nerve

• Vagus nerve

Answer explanation

The vagus nerve extends from the throat, larynx, and organs in the thoracic and abdominal cavities. It is responsible for sensations and will accelerate peristalsis when stimulated.

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. Which position is most appropriate for the patient?

• Neck placed in a neutral position.

• Head raised slightly with hips flexed.

• Supine in gravity neutral position.

• Turn on right side with head elevated.

Answer explanation

The patient is experiencing increased intracranial pressure. To assist with reducing the intracranial pressure, place the patient’s neck in a neutral position (not flexed or extended) to promote venous drainage.

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?

• Does the pain radiate from your back into your legs?

• Can you describe the sensations you are having?

• Do you ever have any nausea or dizziness?

Answer explanation

For patients with suspected neurologic conditions, the presence of many symptoms or subjective data may be significant. Offering leading questions is not beneficial and may allow the patient to give misinformation. Questions should be specific about symptoms.

Which sign is the cardinal sign of increased intracranial pressure in a patient who has sustained a brain injury?

• Pupil changes

• Ipsilateral paralysis

• Vomiting

• Decrease in the level of consciousness

Answer explanation

Collection of objective data includes a change in level of consciousness. A change in the level of consciousness is the earliest sign of increased intracranial pressure.

The nurse is aware that when assessing a patient by the FOUR score coma scale, the patient is assessed in four categories: eye response, brainstem reflexes, motor response, and respiration. In which manner are these results reported?

• As a sum of the scores of the four categories

• As part of the Glasgow Coma Scale

• As individual scores in each category

• As progressive scores during a 24-hour period

Answer explanation

The FOUR score coma scale assesses the patient in four categories: eye response, brainstem reflexes, motor response, and respiration. The scores are reported as individual scores in each category. It is frequently done in conjunction with or as an alternative to the Glasgow Coma Scale, not part of it.

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 term would best describe the patient’s inability to assess spatial position of his body?

• Agnosia

• Loss of proprioception

• Apraxia

• Sensation

Answer explanation

Patients may experience a loss of proprioception with a stroke. This may include apraxia and agnosia (a total or partial loss of the ability to recognize familiar objects or people).

A patient is to have a myelogram to confirm the presence of a herniated intervertebral disk. Which nursing action will be planned with respect to this diagnostic test?

• Obtain an allergy history before the test.

• Ambulate the patient when returned to the room after the test.

• Use heated blanket to keep patient warm after procedure.

• Keep NPO for 6 to 8 hours after the test.

Answer explanation

Before the dye is injected, patients must be asked whether they have any allergies, specifically whether they have had any anaphylactic or hypotensive episodes from other dyes.

A patient has recently experienced a stroke with left-sided weakness and has problems with choking, especially when drinking thin liquids. Which nursing interventions would be most helpful in assisting this patient to swallow safely?

• Use a straw.

• Tuck chin when swallowing.

• Take a sip of liquid with each bite.

• Turn head to the left.

Answer explanation

The patient should sit at a 90-degree angle with the head up and chin slightly tucked.

What are surgical navigational systems?

• Computerized devices that guide the surgeon

• A set of detailed anatomic maps pinpointing specific areas of the brain

• A written set of progressive processes for the resection of small brain tumors

• The use of radioactive materials to pinpoint small tumors of the brain

Answer explanation

Surgical navigational systems are computerized devices that guide the surgeon and make possible the resection of tumors that were once thought to be inoperable.