NEUROLOGICAL SYSTEM AND DISORDER

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CRISIS 5
Neurological system and disorders

1.        A patient arrived in the ER with a head injury. She is unconscious. You and a fellow nurse are the only staff members near the patient. He begins to criticize the attending physician and suggest that a different physician should care for this patient. What is the best response?
a.       Report the nurse to the attending physician.
b.      Call the nurse away from the patient and remind him that the patient can still hear even if unconscious.
c.       Ask the nurse why he has such feelings.
d.       Simply nod your head in agreement.
2.       Your patient has unilateral facial paralysis and is unable to close his right eye. He is diagnosed with Bell’s palsy. He asks you if there is any special care required for his eye. What is the best response?
a.       No, since the symptoms will go away in a few weeks.
b.       Wear sunglasses.
c.       Increase fluid intake to prevent dryness of the eye.
d.      Yes, you’ll need to instill artificial teardrops and use an eye patch.
3.       A new patient arrived in your unit. He has been diagnosed with a brain tumor. You are told that the patient is unable to speak. Based on this sign, where do you expect the tumor is located?
a.       Frontal lobe.
b.       Occipital lobe.
c.       Cerebellum.
d.       Parietal lobe.
4.       The wife of a patient who has a ruptured aneurysm asks how this could have happened considering that he passed a physical three months ago. What is the best response?
a.       Aneurysms are often asymptomatic.
b.       The physician must have misread the x-ray.
c.       The aneurysm must have developed since his physical.
d.       Don’t be too concerned because this happens all the time.
5.        A 49-year-old patient is diagnosed with Huntington’s disease. He thought he saw symptoms of the disease in his 15-year-old son. What is the best response?
a.       Your son probably has the early symptoms of the disease.
b.       Huntington’s disease is genetically transmitted.
c.       Symptoms usually appear between the ages of 30 and 50 years; however, you may want to ask your physician about genetic testing that can detect if your son has the gene that is associated with Huntington’s disease.
d.       Symptoms usually appear before the age of 30 years; however, you may want to ask your physician about genetic testing that can detect if your son has the gene that is associated with Huntington’s disease.
6.       A patient arrives in the ER with blurred and double vision, muscle weakness, and intolerance of temperature changes. The physician suspects multiple sclerosis. What test would you expect the physician to order to confirm her suspicions?
a.       CBC with a very low WBC count.
b.      CT scan showing plaque formation.
c.       Endocrine function study with a low growth hormone and high T3 and T4.
d.       Fasting glucose test with a result over 300 mg/dl.
7.       A patient who was in an automobile accident 30 minutes ago reports that she is unable to move her legs. What is the best response?
a.       Swelling due to the initial trauma may make the injury seem more severe than it actually is. A more accurate assessment will be made once the swelling goes down.
b.       Swelling due to the initial trauma prevents you from moving your legs.
c.       There are good rehabilitation centers that will help restore sensation to your legs.
d.       You should have been wearing your seatbelt.
8.       A husband visiting his wife in the hospital suddenly becomes confused and has difficulty with speech and starts slurring his words. The physician caring for his wife recognizes this as a cerebrovascular accident. What would you expect the physician to do?
a.       Administer TPA since this is within 3 hours of the CVS.
b.      Assess if the husband had an ischemic or hemorrhagic CVS.
c.       Tell the husband to go home, get rest and to call the physician in the morning if the symptoms continue.
d.       Admit the husband and place him on bed rest.
9.       A patient is admitted to your unit diagnosed with advanced ALS. Which is the priority intervention?
a.       Provide six small meals high in protein and assist with feeding.
b.       Don’t involve the patient in decisions about his health care because he does not have the mental status to respond.
c.       Develop a method of communication.
d.       Provide six normal meals high in protein and assist with feeding.
10.   Your patient diagnosed with Guillain-Barre syndrome has a burning, tickling feeling and asks what causes that feeling. What is the best response?
a.       The myelin cover of the nerve endings is absent.
b.       You are lying too long on the affected side.
c.       This is in response to your medication.
d.       This is secondary to dysphagia.


Assessment of Neurologic Function
MULTIPLE CHOICE
Read each question carefully. Circle your answer.
1.       A neurotransmitter that helps control mood and sleep is:
a.       acetylcholine.
b.       dopamine.
c.       enkephalin.
d.      Serotonin
2.       Parkinson’s disease is caused by an imbalance in the neurotransmitter known as:
a.       acetylcholine.
b.      dopamine.
c.       GABA.
d.       endorphin.
3.       A person’s personality and judgment are controlled by that area of the brain known as the:
a.       frontal lobe.
b.       occipital lobe.
c.       parietal lobe.
d.       temporal lobe.
4.       The lobe of the cerebral cortex that is responsible for the understanding of language and music is the:
a.       frontal lobe.
b.       occipital lobe.
c.       parietal lobe.
d.      temporal lobe.
5.       Voluntary muscle control is governed by a vertical band of “motor cortex” located in the:
a.       frontal lobe.
b.       occipital lobe.
c.       parietal lobe.
d.       temporal lobe.
6.       The sleep–wake cycle regulator and the site of the hunger center is known as the:
a.       hypothalamus.
b.       medulla oblongata.
c.       pituitary gland.
d.       thalamus.
7.       The overall regulation of the autonomic nervous system is the function of the:
a.       cerebellum.
b.      hypothalamus.
c.       pons.
d.       temporal lobe of the cerebral cortex.
8.       The “master gland” is also known as the:
a.       adrenal gland.
b.       thyroid gland.
c.       pineal gland.
d.      pituitary gland.
9.       The major receiving and communication center for afferent sensory nerves is the:
a.       medulla oblongata.
b.       pineal body.
c.       pituitary gland.
d.      thalamus.
10.   The normal adult produces about 150 mL of cerebrospinal fluid daily from the:
a.       ventricles.
b.       dura mater.
c.       circle of Willis.
d.       corpus callosum.
11.   The spinal cord tapers off to a fibrous band of tissue at the level of the:
a.       coccygeal nerve.
b.      first lumbar vertebra.
c.       lateral ventricle.
d.       medulla oblongata.
12.   The preganglionic fibers of the sympathetic neurons are located in those segments of the spinal cord identified as:
a.       C1 to T1.
b.       C3 to L1.
c.       C8 to L3.
d.       T1 to S5.
13.   The parasympathetic division of the autonomic nervous system yields impulses that are mediated by the secretion of:
a.       acetylcholine.
b.       epinephrine.
c.       norepinephrine.
d.       all of the above.
14.   Motor axons form pyramidal tracts that cross to the opposite side. This crossed pyramidal tract occurs in the brain in the area of the:
a.       frontal cerebrum.
b.       lateral portion of the cerebellum.
c.       medulla oblongata.
d.       pons.
15.   The brain center responsible for balancing and coordination is the:
a.       cerebellum.
b.       second lumbar vertebra.
c.       first sacral nerve.
d.       sacrum.
16.   The Romberg test is used to assess:
a.       balance and coordination.
b.       muscle strength.
c.       biceps reflex.
d.       muscle tone.
17.   The Babinski reflex is used to assess:
a.       muscle strength.
b.       coordination.
c.       central nervous system disease.
d.       optical nerve damage.
18. To reduce leakage of cerebrospinal fluid after myelography with an oil-based medium, the patient lies down for 12 to 24 hours in what position?
a.       In high-Fowler’s position
b.      In bed with head elevated 30 to 45 degrees
c.       Prone
d.       Recumbent
18.   Patient preparation for electroencephalography includes omitting, for 24 hours before the test, all of the following except:
a.       coffee and tea.
b.       solid foods.
c.       stimulants.
d.       Tranquilizers.
19.   For a lumbar puncture, the nurse should assist the patient to flex his or her head and thighs while lying on the side so that the needle can be inserted between the:
a.       fourth and fifth cervical vertebrae.
b.       fifth and sixth thoracic vertebrae.
c.       third and fourth lumbar vertebrae.
d.       first and second sacral vertebrae.
20.   After a lumbar puncture, the nurse knows to assess for the most common (30% occurrence) complication of a(an):
a.       epidural abscess.
b.       epidural hematoma.
c.       throbbing headache.
d.       meningitis.

Management of Patients With Neurologic Dysfunction
MULTIPLE CHOICE
Read each question carefully. Circle your answer.
1.       Unconsciousness may have what type of origin?
a.       Neurologic
b.       Metabolic
c.       Toxicologic
d.      Multisystem involvement
2.       The first priority of treatment for a patient with altered level of consciousness is:
a.       assessment of pupillary light reflexes.
b.       determination of the cause.
c.       positioning to prevent complications.
d.      maintenance of a patent airway.
3.       A nurse assesses the patient’s level of consciousness using the Glasgow Coma Scale. What score indicates severe impairment of neurologic function?
a.       3
b.       6
c.       9
d.       12
4.       The most severe neurologic impairments are evidenced by abnormal body posturing defined as:
a.       decerebrate.
b.       decorticate.
c.       flaccid.
d.       rigid.
5.       The normal range of intracranial pressure (ICP) is:
a.       5 to 8 mm Hg.
b.      0 to 10 mm Hg.
c.       20 to 30 mm Hg.
d.       25 to 40 mm Hg.
6.       ICP can be increased by a:
a.       decrease in venous outflow.
b.       dilation of the cerebral blood vessels.
c.       rise in PaCO2.
d.      change in all of the above.
7.       Initial compensatory vital sign changes with increased ICP include all of the following except:
a.       a slow, bounding pulse.
b.       an increased systemic blood pressure.
c.       a decreased temperature.
d.       respiratory rate irregularities.
8.       A patient is admitted to the hospital with an ICP reading of 20 mm Hg and a mean arterial pressure of 90 mm Hg. The nurse knows that the cerebral perfusion pressure (CPP) would be calculated at:
a.       50 mm Hg.
b.       60 mm Hg.
c.       70 mm Hg.
d.       80 mm Hg.
9.       Irreversible neurologic dysfunction occurs when the CPP is:
a.       less than 50 mm Hg.
b.       60 to 80 mm Hg.
c.       75 to 95 mm Hg.
d.       greater than 100 mm Hg.
10.   A nurse knows that a patient experiencing Cushing’s triad would not exhibit:
a.       bradycardia.
b.       bradypnea.
c.       hypertension.
d.      tachycardia.
11.   The earliest sign of serious impairment of brain circulation related to increasing ICP is:
a.       a bounding pulse.
b.       bradycardia.
c.       hypertension.
d.      lethargy and stupor.
12.   As ICP rises, the nurse knows that she may be asked to give a commonly used osmotic diuretic:
a.       glycerin.
b.       isosorbide.
c.       mannitol.
d.       urea.
13.   An indicator of compromised respiratory status significant enough to require mechanical ventilation for an average-weight adult patient with a neurologic dysfunction would be:
a.       an expiratory reserve volume of 1,300 mL.
b.       an inspiratory capacity of 3,000 mL.
c.       a residual volume of 1,400 mL.
d.      a vital capacity of 1,000 mL.
14.   Nursing care activities for a patient with increased ICP would not include:
a.       assisting the patient with isometric exercises.
b.       avoiding activities that interfere with venous drainage of blood from the head.
c.       use of a cervical collar.
d.       teaching the patient to exhale when being turned (to avoid the Valsalva maneuver).
15.   A nurse assessing urinary output as an indicator of diabetes insipidus knows that an hourly output of what volume over 2 hours may be a positive indicator?
a.       50 to 100 mL/h
b.       100 to 150 mL/h
c.       150 to 200 mL/h
d.      More than 200 mL/h
16.   Neurologic and neurosurgical approaches to pain relief would include:
a.       stimulation procedures.
b.       administration of intraspinal opiates.
c.       interruption of nerve tracts that conduct pain.
d.      all of the above mechanisms.
17.   Post craniotomy cerebral edema is at a maximum how long after brain surgery?
a.       6 hours
b.       12 to 20 hours
c.       24 to 72 hours
d.       3 to 5 days
18.   The majority of cases of epilepsy occur in those:
a.       younger than 20 years of age.
b.       25 to 35 years of age.
c.       approximately 45 years of age.
d.       older than 60 years of age.
19.   Long-term use of antiseizure medication in women leads to an increased incidence of:
a.       anemia.
b.       osteoarthritis.
c.       osteoporosis.
d.       obesity.
20.   Nursing care for a patient who is experiencing a convulsive seizure includes all of the following except:
a.       loosening constrictive clothing.
b.      opening the patient’s jaw and inserting a mouth gag.
c.       positioning the patient on his or her side with head flexed forward.
d.       providing for privacy.
21.   A seizure characterized by loss of consciousness and tonic spasms of the trunk and extremities, rapidly followed by repetitive generalized clonic jerking, is classified as a:
a.       focal seizure.
b.       generalized seizure.
c.       Jacksonian seizure.
d.       partial seizure.
22.   A nutritional approach for seizure management includes a diet that is:
a.       low in fat.
b.       restricts protein to 10% of daily caloric intake.
c.       high in protein and low in carbohydrate.
d.       at least 50% carbohydrate.
23.   Headaches classified as primary would include all of the following except:
a.       aneurysm.
b.       cluster.
c.       migraine.
d.       tension.
24.   A beta-blocking agent commonly used for the treatment of a migraine headache is:
a.       Amerge.
b.      Inderal.
c.       Maxalt.
d.       Zomig.


Read each statement carefully. Write your response in the space provided.
1. Potential collaborative problems for a patient with an altered level of consciousness would include:
___________________, ___________________, ___________________, ___________________, and
___________________.
2. List three major potential complications in a patient with a depressed level of consciousness:
_____________________, _____________________, and _____________________.
3. The earliest sign of increased ICP is: ______________________________________________________.
4. List three primary complications of increased ICP:
_____________________, _____________________, and _____________________.
5. List six treatment goals for the prompt management of increased ICP:
_____________________, _____________________, _____________________,
_____________________, _____________________, and _____________________.
6. The primary, lethal complication of ICP is: ____________________________________________________.
7. Nursing postoperative management includes: detecting and reducing _________________, relieving
______________, preventing _________________, and monitoring ________________ and
_______________________.
8. The leading cause of seizures in the elderly is: _____________________________________________.
9. A major potential complication of epilepsy is: ______________________________________________.
10. List six “triggers” known to cause migraine headaches:
_____________________, _____________________, _____________________,
_____________________, _____________________, and _____________________.

Management of Patients With
Neurologic Infections, Autoimmune
Disorders, and Neuropathies
MULTIPLE CHOICE
Read each question carefully. Circle your answer.
1. Identify the bacteria not associated with the cause of septic meningitis:
a.       Cryptococcus neoformans.
b.       Haemophilus influenza.
c.       Neisseria meningitides.
d.       Streptococcus pneumoniae.
2. The most severe form of meningitis is considered to be:
a.       bacterial.
b.       aseptic.
c.       septic.
d.       viral.
3. Bacterial meningitis alters intracranial physiology, causing:
a.       cerebral edema.
b.       increased permeability of the blood–brain barrier.
c.       raised intracranial pressure.
d.      all of the above changes.
4. A brain abscess is a collection of infectious material within the substance of the brain that is caused by:
a.       direct invasion of the brain.
b.       spread of infection from nearby sites.
c.       spread of infection by other organs.
d.      all of the above mechanisms.
5. During assessment, the nurse knows that the most frequently reported disabling symptom found in multiple sclerosis is:
a.       depression.
b.       double vision.
c.       fatigue.
d.       pain.
6. A positive diagnosis of myasthenia gravis can be reached using the following test:
a.       anticholinesterase levels.
b.       magnetic resonance imaging.
c.       computed tomography (CT) scan.
d.       electromyography.
7. A surgical intervention that can cause substantial remission of myasthenia gravis is:
a.       esophagostomy.
b.       myomectomy.
c.       thymectomy.
d.       splenectomy.
8. The initial neurologic symptom of Guillain-Barré syndrome is:
a.       absent tendon reflexes.
b.       dysrhythmias.
c.       paresthesia of the legs.
d.       transient hypertension.
9. Tic douloureux is characterized by paroxysms of pain and burning sensations. It is a disorder of which cranial nerve?
a.       Third
b.      Fifth
c.       Seventh
d.       Eighth
10. Bell’s palsy is characterized by weakness or paralysis of the facial muscles. It is a disorder of which cranial nerve?
a.       Third
b.       Fifth
c.       Seventh
d.       Eighth
11. Tinnitus and vertigo are clinical manifestations of damage to which cranial nerve.
a.       Fourth
b.       Sixth
c.       Eighth
d.       Tenth

SHORT ANSWER
Read each statement carefully. Write your response in the space provided.
1. Name the five infectious disorders of the nervous system: _____________________, ___________________,
___________________, _____________________, and ____________________________.
2. List six signs of bacterial meningitis that a nurse should assess:
_____________________, _____________________, _____________________,
_____________________, _____________________, and ______________________.
3. The most common cause of acute encephalitis in the United States is: _________________. The two
medications of choice for this disorder are: ___________________ and ___________________________.
4. The diagnosis of Creutzfeldt–Jakob disease can now be supported by the presence of: _________________ in the cerebrospinal fluid.
5. The primary pathology of multiple sclerosis is damage to the: _____________myelin material covering the brain and spinal cord nerve cells_________________________.
6. List the three forms of multiple sclerosis based on the frequency and progression of symptoms:
___relapse-remitting__________________, ______primary progressive_______________, and ___________secondary progressive___________.
7. Myasthenia gravis is considered an autoimmune disease in which antibodies are directed against
_________acetlycholine_____________.
8. The majority of patients with myasthenia gravis exhibit these two clinical signs: __double vision and _droppling of eyelids________ and
____________.
9. The most common cause of peripheral neuropathy is: _____________________.
SHORT ANSWER
1. Meningitis, brain abscesses, various types of encephalitis, Creutzfeldt-Jakob disease, and variant Creutzfeldt- Jacob disease
2. Severe headache, high fever, a stiff neck (nuchal rigidity), photophobia, a positive Kernig sign, and positive Brudzinski sign
3. Herpes simplex virus (HSV); acyclovir (Zovirax), and ganciclovir (Cytovene)
4. A protein kinase inhibitor (protein 14-3-3) in cerebrospinal fluid
5. Myelin material that surrounds the nerve fibers in the brain and the spinal cord
6. relapsing–remitting, secondary progressive, and primary progressive
7. Acetylcholine receptors
8. Double vision, and drooping of the eyelids
9. Diabetes with poor glycemic control

CASE STUDY: Multiple Sclerosis
Toni, a 32-year-old mother of two, has had multiple sclerosis for 5 years. She is currently enrolled in a school of nursing. Her husband is supportive and helps with the care of their preschool sons. Toni has been admitted to the clinical area for diagnostic studies related to symptoms of visual disturbances.
1. The nurse is aware that multiple sclerosis is a progressive disease of the central nervous system characterized by:
a.       Axon degeneration.
b.       Demyelination of the brain and the spinal cord.
c.       Sclerosed patches of neural tissue.
d.      All of the above.
2. During the physical assessment, the nurse recalls that the area’s most frequently affected by multiple sclerosis are the:
a.       lateral, third, and fourth ventricles.
b.       optic nerve and chiasm.
c.       pons, medulla, and cerebellar peduncles.
d.      above areas.
3. The nurse knows that the two most common clinical symptoms are: ____fatigue_________ and ________pain_________.
4. During the nursing interview, Toni minimizes her visual problems, talks about remaining in school to attempt advanced degrees, requests information about full-time jobs in nursing, and mentions her desire to have several more children. The nurse recognizes Toni’s emotional responses as being:
a.       an example of inappropriate euphoria characteristic of the disease process.
b.       a reflection of coping mechanisms used to deal with the exacerbation of her illness.
c.       indicative of the remission phase of her chronic illness.
d.       realistic for her current level of physical functioning.
5. Toni’s disease process involves a sacral plexus. Assessment should include:
a.       bladder problems or urinary tract infections.
b.       bowel management.
c.       sex.
d.      all of the above.
6. The nurse knows that disease-modifying pharmacologic therapy can reduce the frequency and duration of relapse. List five probable medications: ____________, ______________, _________________,
______________, and _________________.




1. To assess for Kernig sign, the nurse would ask the patient to extend one leg while the opposite thigh is flexed on the abdomen. Inability to do this is considered positive for bacterial meningitis.
To assess for Brudzinski sign, the nurse would ask the patient to flex his neck. If flexion of the knees and hips occurs at the same time, the test is considered positive for bacterial meningitis.
2. Demyelination refers to the destruction of myelin, the fatty and protein material that surrounds nerve fibers in the brain and spinal cord. This destruction results in impaired transmission of nerve impulses.


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ADVANCED PUBLIC HEALTH WEEK 1-COMPLIATION INTRODUCTION TO EPIDEMIOLOGY Exercise 1.1 Define epidemiology Answer: Epidemiology is defined as “the study of the distribution and determinants of health-related states or events in specified populations , and the application of this study to the prevention and control of health problems ” Term Explanation Study Includes: surveillance, observation, hypothesis testing, analytic research and experiments. Distribution Refers to analysis of: times, persons, places and classes of people affected Determinants Include factors that influence health: biological, chemical, physical, social, cultural, economic, genetic and behavioral Health-related states and events Refer to: diseases, causes of death, behaviors such as use of tobacco, positive health states, reactions to preventive regimes and provision and use of health...
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Nursing Administration and Management 2

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Exercise 1.1 What is Nursing Administration? Answer: It is both an art and science that engages leadership practice and values which influences the future and overseas health care delivery and inspires clinical practitioners and promotes health among individual, significant others, population and community. OR It is the blend of science and art that involves the application of leadership practice and values to influence the future, overseas health care delivery and inspire clinical practitioners and promote health among individual, significant others, population and community. Exercise 1.2 Explain Nursing administration as an art. Answer: Nursing Administration as an art refers to the operational part of nursing administration. Hence, it is basically what the nurse administrator does. OR Nursing administration as an art is the ability to sense a situation, to respond to its nature and demands in terms of the inner or intuitive senses, which are capable of handling in...
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Global REIT, the Best platform for Real Estate cryptocurrency investors, Assets holders and REITs

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In the light several barriers and challenges posed by the traditional real estate models to potential real estate investors, Global Real Estate Investment Trusts (Global REIT), an alternative reliable investment vehicle seeks to mitigate the risks associated with real estate investment and provide sustainable solutions to overcome the challenges encountered by potential investors who want to simultaneously invest in real estate and earn regular dividends or investors who seek to exit into a liquid market anchored by cryptocurrency. https://steemit.com/blockchain/@samcofy/global-reit-the-best-platform-for-real-estate-cryptocurrency-investors-assets-holders-and-reits Global Real Estate Investment Trusts (Global REIT) is the first ever Blockchain based Sharia-compliant REIT to be launched in the market that owns or finances income producing real estate. It is basically a platform for diversifying a long-term real estate investment portfolio. By intertwining REITs to the Block Chain ...
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