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WorksheetsNursing Process Brain: Injury, Seizures, Migraines
Total questions: 26
Worksheet time: 14mins
Which definition relates to a myoclonic seizure?
Loss of consciousness or blackout for 1-3 minutes
Activity beginning in a part of one cerebral hemisphere
Sudden loss of muscle tone followed by postictal confusion
Brief jerking or stiffening of extremities lasting a few seconds
Which substance is prevented from crossing the blood brain barrier?
Alcohol
Glucose
Antibiotic
Anesthesia
Which patient condition is associated with a lower thoracic spinal cord injury?
Paraplegia
Tetraplegia
Hemiplegia
Quadriplegia
Which goal would the nurse associate with abortive therapy for patients with migraine headaches?
Identify triggers
Prevent recurrence of migraines
Alleviate pain during the aura phase
Decrease pain during the second phase
Which phrase describes traumatic brain injury (TBI)?
Injury to the brain from a congenital condition
Damage to the brain from an external mechanical force
Impairment of the brain caused by neurodegeneration
Diminishing functionality of the brain due to internal forces
Which statement about Multiple Sclerosis (MS) is accurate?
MS affects more men than women
MS usually occurs in people over 50 years old
MS is often seen in warmer climates
MS occurs more frequently among whites than other races
Which term describes a patient who experiences continuous seizures for more than 6 minutes per episode?
Acute seizure
Chronic seizure
Status epilepticus
Tonic-clonic seizure
Which clinical manifestation would the nurse associate with an absence seizure? SATA
Rigidity of the muscles
Sudden loss of muscle tone
Brief, blank staring episodes
Involuntary picking at clothes
Jerky movements of the extremities
The Glasgow Coma Scale (GCS) assesses what areas of response to stimuli? Select all that apply:
Auditory response
Verbal response
Tactile response
Eye-opening response
Motor response
What Glasgow Coma Scale score usually requires intubation because the airway reflexes are affected?
10 or less
9 or greater
8 or less
10 or greater
You’re assessing your patient load for the patients who are at MOST risk for seizures. Select all the patients below that are at risk:
A 32-year-old with a blood glucose of 20 mg/dL.
A 63-year-old whose CT scan shows an ischemic stroke.
A 72-year-old who is post opt day 5 from open heart surgery.
A 16-year-old with bacterial meningitis.
A 58-year-old experiencing ETOH withdrawal.
A patient with a history of epilepsy is taking Phenytoin. The patient’s morning labs are back, and the patient’s Phenytoin level is 7 mcg/mL. Based on this finding, the nurse will?
Assess the patient for a rash
Initiate seizure precautions
Hold the next dose of Phenytoin
Continue to monitor the patient
True or False: A patient who is experiencing a tonic-clonic seizure is experiencing a focal (partial) seizure.
TRUE
FALSE
Your patient has a history of epilepsy. While helping the patient to the restroom, the patient reports having this feeling of déjà vu and seeing spots in their visual field. Your next nursing action is to?
Continue assisting the patient to the restroom and let them sit down.
Initiate the emergency response system.
Lay the patient down on their side with a pillow underneath the head.
Assess the patient’s medication history.
A patient is being treated for increased intracranial pressure. Which activities below should the patient avoid performing? SATA
Coughing
Sneezing
Valsalva maneuver
Vomiting
Keeping the head of the bed between 30- 35 degrees
A patient is experiencing hyperventilation and has a PaCO2 level of 52. The patient has an ICP of 20 mmHg. As the nurse you know that the PaCO2 level will?
cause vasoconstriction and decrease the ICP
promote diuresis and decrease the ICP
cause vasodilation and increase the ICP
cause vasodilation and decrease the ICP
Which patient below is at MOST risk for increased intracranial pressure?
A patient who is experiencing severe hypotension.
A patient who is admitted with a traumatic brain injury.
A patient who recently experienced a myocardial infarction.
A patient post-op from eye surgery.
A patient who experienced a cerebral hemorrhage is at risk for developing increased ICP. Which sign and symptom below is the EARLIEST indicator the patient is having this complication?
Bradycardia
Decerebrate posturing
Restlessness
Unequal pupil size
During the assessment of a patient with increased ICP, you note that the patient’s arms are extended straight out and toes pointed downward. You will document this as:
Decorticate posturing
Decerebrate posturing
Flaccid posturing
Zombie pose
You’re caring for a patient with Parkinson’s Disease that has tremors. Select the option that is INCORRECT about tremors experienced in this disease:
The tremors are most likely to occur with purposeful movements.
A common term used to describe the tremors in the hands and fingers is called “pill-rolling”.
Tremors are one of the most common signs and symptoms in Parkinson’s Disease.
Tremors in this disease can occur in the hands, fingers, arms, legs and even the lips and tongue.
A patient with Parkinson’s Disease has slow movements that affects their swallowing, facial expressions, and ability to coordinate movements. As the nurse you will document the patient has:
Akinesia
“Freeze up” tremors
Bradykinesia
Pill-rolling
A patient is prescribed to take Carbidopa/Levodopa (Sinemet). As the nurse you know that which statement is incorrect about this medication:
It can take up to 3 weeks for the patient to notice a decrease in signs and symptoms when beginning treatment with this medication.
Body fluids can turn a dark color and stain clothes.
This medication is most commonly prescribed with a vitamin B6 supplement.
Carbidopa helps to prevent Levodopa from being broken down in the blood before it enters the brain. Hence, levodopa is able to enter the brain.
A patient is admitted with uncontrolled atrial fibrillation. The patient’s medication history includes vitamin D supplements and calcium. What type of stroke is this patient at MOST risk for?
Ischemic thrombosis
Ischemic embolism
Hemorrhagic
Ischemic stenosis
Which patient below is at most risk for a hemorrhagic stroke?
A 65 year old male patient with carotid stenosis.
A 89 year old female with atherosclerosis.
A 88 year old male with uncontrolled hypertension and a history of brain aneurysm repair 2 years ago.
A 55 year old female with atrial flutter.
Your patient who had a stroke has issues with understanding speech. What type of aphasia is this patient experiencing and what area of the brain is affected?
Expressive; Wernicke’s area
Receptive, Broca’s area
Expressive; hippocampus
Receptive; Wernicke’s area
A patient has experienced right side brain damage. You note the patient is experiencing neglect syndrome. What nursing intervention will you include in the patient’s plan of care?
Remind the patient to use and touch both sides of the body daily.
Offer the patient a soft mechanical diet with honey thick liquids.
Ask direct questions that require one word responses.
Offer the bedpan and bedside commode every 2 hours.
