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NCLEX Related Questions for Neurologic Disorders

Terms in this set (106)

What things should you question for a patient with increased ICP if ordered? Head of bed elevated 30-45 degrees, suctioning every 2 hours, lateral positioning, group activities to allow downtime and ice mattress for comfort?
No suctioning every 2 hours just as needed, no grouping of activities because patient needs rest periods, and no ice mattress because shivering can cause increase ICP. Keep Head and neck straight to allow for CSF movement.
What is an aura?
It is a foreknowledge that a seizure is going to occur
What occurs in the post-ictal period?
Patient sleeps for several hours after seizure. Do not call physician because this is expected.
What should you do if a pregnant woman starts thrashing in bed?
Make sure the patient is side lying and not handrails up first because she may aspirate first
What should you document for a seizure occurrence?
The time it occurred and lasted and what parts of the body were affected.
How can you keep your patient safe during seizure?
Have airway open, clear harmful objects, assess respirations and then pulse. Do not restrain patient during seizure. Do not try to open clenched jaw. Do not move unless it is unsafe not to move. Do not suction until motor activity stops.
What treatment is done for seizure patients?
1) Anticonvulsants: Phebobarbital, Carbamazepine (Tegretol) or Phenytoin (Dilantin).
2) Evaluate consciousness, safety, avoid alcohol.
3) Reduce activities that stimulate and reduce stimuli; no strobe lights because it is repetitive.
4) Reorient client after seizure.
What should you watch for with TEGETROL?
Used as an anticonvulsant for seizure prevention. Monitor CBC d/t bone marrow suppression and watch for infection
What is the therapeutic level of DILANTIN?
"Dial at Ten" 10-20 = therapeutic level
What is DILANTIN used for?
Seizure prevention
What are the adverse reactions from medication?
Gingival hyperplasia, GI disturbances, heptoxicity, ataxia, hypocalcemia, and decrease in vitamin D absorption
What is important to teach pregnant women about DILANTIN?
DO NOT TAKE, because it causes birth defects.
What is the proper way to give DILANTIN?
IV Push: (not compatible with IV solutions), give closest insertion site, flush/push/flush
What should you teach a patient on DILANTIN?
Good oral hygiene and nutrition are important
What is characteristic of a left hemisphere CVA?
Right sided weakness and aphasia
What is characteristic of a right hemisphere CVA?
Left sided weakness and perceptual deficits (vulnerable to accidents)
What are CVA risk factors that are reversible?
Smoking, obesity, increased salt intake, sedentary lifestyle, increased stress, and birth control pills.
What are the non-reversible risk factors for CVA?
Sex, age, race and heredity
What population has the highest risk for stroke?
Black males (most risk), white males, black females, then white females (least risk).
What is HOMONYMOUS HEMIANOPSIA?
A pupillary abnormality associated with CVA where vision is lost on the same side of each eye so when driving must turn head to see (CN II is affected)
What are the causes of CVA?
1) Atherosclerosis
2) Thrombosis
3) Embolism
4) Cerebral hemorrhage (due to trauma or tissue damage)
What are the nursing goals related to CVA care?
1) Airway and oxygenation
2) Decreased ICP
3) Nutrition
4) Preserve function
5) Safety
6) Rehabilitation
7) Education
What are symptoms of stroke?
1) Sudden weakness or numbness of the face, arm and leg, usually on one side of the body.
2) Difficulty talking or understanding speech
3) Dimness or loss of vision on one eye
4) Unexplained dizziness and unsteadiness
5) Falls
6) Sudden severe headache
What are the three types of abnormal posturing?
1) Flexor (Decorticate - toward core)
2) Extenser (Decerebrate) and
3) Flaccid
What is an appropriate intervention to provide safety in someone with decorticate posturing?
Since flexed, roll washcloth and place between hands to prevent fingernails from embedding into palms because tension is so tight.
What are the symptoms of subarachnoid hemorrhage?
1. Exploding headache
2. Loss of consciousness
3. Seizure
4. Sluggish pupil reaction
5. Photophobia
6. Elevated blood pressure, heart rate, respiration
7. One sided weakness
8. Lethargic
What is the cause of subarachnoid hemorrhage?
Rupture of a blood vessel or an intracranial aneurysm, typically at circle of Willis or major cranial artery branches and commonly after head trauma
What is the mortality rate associated with subarachnoid hemorrhage?
40% mortality rate
What are the risk factors for a subarachnoid hemorrhage?
HTN, smoking, alcohol, or cocaine use and pregnancy
What is the hallmark symptom of subarachnoid hemorrhage?
SEVERE HEADACHE THAT COMES SUDDENLY
What should you do immediately for someone suspected of subarachnoid hemorrhage?
Administer oxygen, place IV line, do an EKG, once preliminary diagnosis is made: prepare patient for cerebral angiogram to locate site.
What are the goals of treatment for a subarachnoid hemorrhage?
Locate site of bleeding and repair the damage. Also manage complications (hydrocephalus, hyponatremia, seizures, and increased ICP)
What is the correct way to help someone with a CVA get out of bed?
Functioning vs. affected side CVA. Place wheel chair on the patient's strong side, lock the wheels, elevate the head of bed, and stand on the patient's strong side to assist
If a patient with CVA is getting dressed which side should they address first?
Dress the weak side first
What should someone with a CVA do to prevent contractures?
Keep joints fully extended without bends.
What 3 kinds of therapy will someone with a post CVA receive?
1) Occupational therapy, activities of daily living
2) Physical therapy, ambulation
3) Speech therapy, speech and swallowing
What kind of diet should someone with a post CVA be on?
High protein and high Vitamin C, e.g. custard and strawberries, to assist with pressure ulcer prevention or healing.
What is sensory aphasia?
Also known as RECEPTIVE APHASIA, a patient cannot understand oral or written forms of communication.
What is motor aphasia?
Also known as EXPRESSIVE APHASIA, Broca's area, it is the inability to speak or write. However, patient can comprehend the spoken or written form of communication.
Is someone with aphasia still considered competent?
YES
What nursing interventions should be implemented for someone with aphasia?
1) Stand in front of client
2) Speak clearly, slowly.
3) Do not shout or speak loudly. They can hear.
4) Be patient and give client time to respond
5) Use nonverbal communication, e.g. touche, smile
6) Assist client with motor aphasia to practice simple words,
7) Listen carefully
8) Provide simple directions
9) Involve family in practice
10) Show picture cards to help convey a message
How many cervical spinal nerves are there? What do they control?
Eat breakfast at 8 in the morning = 8 spinal nerves
Controls: diaphragm C1-4, chest, wall muscles, arms and shoulders.
How many thoracic spinal nerves are there? What do they control?
Eat lunch at noon = 12 thoracic spinal nerves
Controls: upper body and gastrointestinal function
How many lumbar and sacral spinal nerves are there? What do they control?
Eat dinner at 5 in the afternoon = 5 lumbar spinal nerves and 5 sacral spinal nerves.
Controls: lower body, bowel and bladder
What does quadriplegia mean? What are the considerations?
Paralysis from shoulders down. Broken cervical area, C2-4. Need vent because diaphragm innervation is lost. Bowel care by RN is necessary.
What does paraplegia mean? What are the considerations?
Paralysis from waist down. Patient can insert own suppository and roll hands over bladder to facilitate.
What does hemiplegia mean? What are the considerations?
One half of the body is paralyzed. Cranial nerves are involved so at risk for aspiration.
What is autonomic dysreflexia? What is the cause? What are the signs and symptoms?
Also known as hyperreflexia, it is a potentially life threatening condition involving exaggeration of the sympathetic response to stimulation. The condition occurs in people with spinal cord injuries at T-6 or higher. It is triggered by a sustained stimuli such as restrictive clothing, pressure areas, FULL BLADDER, UTI or FECAL IMPACTION.

Signs and symptoms above the level of injury:
1) flushed face
2) increased blood pressure 200/100
3) headache
4) distended neck veins
5) decreased heart rate
6) increased sweating, vasodilation

Signs and symptoms below level of injury:
1. Pale
2. Cool
3. No sweating, vasoconstriction
What drug is used by someone experiencing autonomic dysreflexia symptoms at home?
PROCARDIA to decrease BP. Prick and squeeze under tongue. Works quickly and raise head of bed.
On patients with spinal cord injuries, what areas must be placed on vents?
C1-C4 because the diaphragm is paralyzed.
Who does ALL the care of patients with spinal cord injuries
RN or LPN
How can someone with a C1-C4 injury maintain some independence?
Blow stick/mouth stick on wheelchair that allows them to control the chair.
What is multiple sclerosis?
It is a progressive neurological disease with an onset among those who are at their 20's through 40's. It has a hereditary link and occurs most commonly among women. It involves the hardening of multiple nerves, and is aggravated by stress. It limits changes.
What are the signs and symptoms of multiple sclerosis?
1. tinnitus
2. decreased hearing
3. urinary retention
4. spastic bladder
5. constipation
6. nystagmus
7. diplopia
8. blurred vision
9. dysarthria
10. dysphagia
11. numbness
12. tingling
13. weakness
14. paralysis
15. muscle spasticity
16. ataxia
17. vertigo
What kind of death does a person with multiple sclerosis normally die from?
Respiratory. Watch for hypoxia, restlessness, and agitation.
How is multiple sclerosis treated?
With steroids when active. Patient then becomes immunocompromised.
What should you make sure to discuss with someone who has multiple sclerosis?
Advanced directives because patient will eventually end up on vent and the use of a peak flow meter.
What is myasthenia gravis?
It is an autoimmune neuromuscular disease that affects the motor cranial nerves. It is the GRAVE MUSCLE WEAKNESS. Exacerbation and remissions are parts of the disease which tend to be progressive over time.
What are the signs and symptoms of MYASTHENIA GRAVIS?
1. bobblehead
2. ptosis
3. diplopia
4. slow speech
5. frowning
6. decreased tongue movement
7. drooling
8. pupils slowly react
9. increased frowning
10. decreased chewing
What are the people with myasthenia gravis always at risk for?
Respiratory Distress
How is the diagnosis of myasthenia gravis made versus cholinergic crisis?
Since both are present with the same symptoms, administer TENSILON to differentiate one from the other. If the symptoms improve, then it is myasthenia gravis. A lack of medication, PROSTIGMIN, would then be the problem. So, increase medication. If the symptoms get worse, then it is a cholinergic crisis. Too much medication is the problem with increased Prostigmin. So provide an antidote which is ATROPIN.
What is the short term treatment for diagnosis of myasthenia gravis? And for long term?
Short term is TENSILON. Long term treatment is PROSTIGMIN, an airway medication and MESTINON.
What makes someone with myasthenia gravis worse?
Exercise and Infection
What is PARKINSON'S DISEASE?
It is a progressive neurological disease with a slow onset that usually occurs after age 50, rarely occurring in the black population, and leading to a respiratory death. The motor symptoms of Parkinson's disease result from the death of dopamine-generating cells in the substantia nigra, a region of the midbrain; the cause of this cell death is unknown.
What are the signs and symptoms of Parkinson's Disease?
1. Mask like blank expression
2. pill rolling
3. Shuffling gait
4. propulsive gait
5. tremors
6. bradykinesia
7. loss of ability to swallow
8. decreased blinking
9. muscle rigidity
What kinds of food or vitamins should someone with Parkinson's avoid? Why?
Spinach, bananas, fish and pepper. Also, Vitamin B6, because they all deactivate LEVODOPA, the precursor to the neurotransmitters dopamine, norepinephrine (noradrenaline), and epinephrine (adrenaline) collectively known as catecholamines
What drug is commonly taken to help Parkinson's symptoms? What are the Considerations?
LEVODOPA. Watch for hypotension and place TED hose on your patient to prevent further complications.
What kind of shoes should you recommend for a patient with Parkinson's Disease?
Shoes with 1 thread so they can slide through lie. No tennis shoes or leather bottom shoes. Slippers are good.
What is Guillain Barre Syndrome?
An autoimmune disease of the nervous system due to damage of myelin sheath around the nerves., progresses rapidly or over 2-3 weeks, characterized by muscle weakness or symmetrical paralysis. Pig Head. Also, Landry's paralysis, an acute polyneuropathy affecting the PNS. The most typical symptoms cause change in sensation or pain, as well as dysfunction of the ANS. It can cause complications, in particularly in the respiratory muscles if the ANS is involved. It is usually triggered by an infection.
What are the risk factors for Guillain Barre Syndrome?
More common among the 20-50 age group, associated with swine flu immunizations, frequently preceded by mild respiratory or intestinal infection.
If someone with GBS has voiding problems, what should you be concerned about?
Get a vent in place because diaphragm is going to be affected next.
How does GBS progress?
Begins in lower extremities and ascends bilaterally starting with weakness, then ataxia, then bilateral paresthesia progressing in paralysis.
What is AMYOTROPHIC LATERAL SCLEROSIS? What is important to know about it?
Also known as Lou Gehrig's Disease, it is a progressive neurological disease characterized by neuron death resulting in muscle weakness and eventually paralysis. The patient will die when respiratory paralysis reaches diaphragm so discuss advance directives and make sure to check gag reflex before feeding this patient.
What is TRIGEMINAL NEURALGIA? What are the considerations?
A cranial nerve disorder affecting sensory branches of the trigeminal nerve (CN V). Lukewarm food, chew on unaffected side, eye care, tearing, blinking, oral hygiene, increased protein, calories, room temperature and avoid touching client.
Why should the patient with trigeminal neuralgia chew on the unaffected side? What is the outcome?
Because the unaffected side is painful. Patient would lose weight. The outcome should be weight gain as a result of chewing on unaffected side and eating a high calorie, high protein diet like custard, milk and eggs.
What is the medical treatment for TRIGEMINAL NEURALGIA? What is the surgical treatment?
DILANTIN or TEGRETOL. For surgical, local nerve blocks or slow nerve transmission to decrease pain.
What is BELLS PALSY? What are the considerations?
Bell's palsy is a form of facial paralysis resulting from a dysfunction of the cranial nerve VII (the facial nerve) causing an inability to control facial muscles on the affected side. The biggest complications are pain and an eyelid that won't shut. To protect the eyes from corneal abrasions, use drops and eye patches at night or tape shut to protect.
What lid is the correct way to administer Eyedrops? What is the sequential order?
1. Offer tissue paper. Make sure patient has no contact lenses.
2. Do hand hygiene, wear gloves.
3. Clean eyes with gauze or moistened cotton balls
4. Ask patient to tilt head back
5. Turn head slightly to treated side
6. Pull lower lid down with thumb.
7. Place bottle 1/2 to 3/4 inches from above the conjunctival sac
8. Administer dose, ask to gently close eyes and move them while closed to help distribute medication.
9. Do not squeeze, shut or rub eyes.
10. Press on inner canthus for about 30 seconds to slow drainage of medication.
11. Use tissue paper to remove excess medication.
12. Give water drops before oil and leave for 5 minutes between eyedrop administration.
What is retinal detachment?
A small horseshoe shaped tear that allows sub retinal fluid to leak between the retinal pigment epithelium and the layer of rods and cones. This leakage splits the retinas outer layer, pulling it away from its blood supply.
What are the signs and symptoms of risk factors for retinal detachment?
Myopia, nearsightedness, seeing flashing spots, recent intraocular eye surgery, direct eye trauma, peripheral retinal holes, or history of retinal degeneration.
Who is retinal detachment more common in?
Myopic, nearsighted whites and men who suffered traumatic injuries.
What should be done on a post retinal detachment surgery?
1. Position face down because gas was placed in eye
2. Apply ice compresses and provide analgesics as needed
3. No lifting of anything heavier than 20 lbs.
4. No rubbing of eyes
5. No coughing or suctioning
6. Needs 2 eye patches at night. 2 words = 2 patches
What is a cataract?
A condition in which the lens of the eye becomes opaque or cloudy and making vision difficult. It is usually a slow gradual loss of vision in the affected eye. They are common in elderly but may also be caused by some drugs like corticosteroids.
What is the only treatment for cataracts?
Surgical removal
What should you teach your patient for post op care after cataract surgery?
They should wear sunglasses when in the sun and avoid sneezing or vomiting. If they have pain in the eye, they should call the physician and they should wear 1 eye patch over the affected eye at night. One word = one patch.
Should everyone young and old wear sunglasses when in the sun?
YES
What if you end up with a foreign body in your eye? And what if it were a chemical?
Put a dressing over both eyes and go to the ER. If chemical, then you should flush eyes first then head to the ER.
What is GLAUCOMA?
A condition characterized by increased intraocular pressure and progressive vision loss.
What are the risk factors for GLAUCOMA?
Familial over age 40, diabetes, and history of ocular problems.
What are the two types of GLAUCOMA?
1. Primary open-angle = chronic
2. Closed angle = acute and painful
What is characteristic of open angle glaucoma?
Gradual loss of peripheral vision - tunnel. Generally, PAINLESS, and blindness can result if not treated
What drugs help decrease the fluid in the eyeball and therefore the intraocular pressure?
1. DIAMOX - decreases production of fluid
2. MANNITOL - draws fluid out of the eyeball
Is periorbital edema present with glaucoma?
NO
What drug should never be given to someone with Glaucoma?
ATROPINE
What should you teach a patient about managing GLAUCOMA?
No straining for bowel movement, no vomiting or sneezing
What is a normal eye pressure? What device is used?
22 mm Hg, measured by TONOMETRY
How do you describe a GLAUCOMA vision?
Described as a halo or tunnel vision. It never returns to normal
How do you describe a CATARACT vision?
Blurred, but vision can return to normal.
How do you describe a RETINAL DETACHMENT vision?
A curtain in front of or partially over your eye.
How do you describe a MACULAR DEGENERATION vision?
A blind spot / black spot in the center of the vision field. Peripheral vision is retained.
What is the correct way to help a patient who is visually impaired?
1. Tell the patient each time you enter the room and say your name. 2. Always explain what you are going to do
3. When walking, ask which side they prefer you on, then offer your arm for them to grasp
4. Position self on half step beside and ahead of them
What is MENIERE's Disease?
It is called 'my ears disease'. An idiopathic chronic condition associated with water in the ear.
What are the signs and symptoms of MENIERE's disease?
1. vertigo
2. tinnitus
3. unilateral nerve deafness
What is the treatment for Meniere's disease?
1. Decreased sodium in diet
2. Stop smoking
3. Benadryl, atropine, Dramamine and
4. Lasix to decrease water in ear.
Is someone with Meniere's disease a priority disease?
NO, they can be discharged because they won't die from the condition.
What is the proper way to converse with hearing impaired patients?
1. Get your patient's attention
2. Ask permission to turn off television and reduce noise
3. Face patient at eye level
4. Make sure light is on face
5. If patient has hearing aid, make sure it is in and turned on and functioning properly.
6. Use simple sentences, speak slowly and avoid shouting.
7. Supplement with gestures
8. Avoid jokes, slang and ask for oral feedback to assess understanding.
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