Podcast
Questions and Answers
A patient reports a loss of smell following a head trauma. Which cranial nerve should the nurse assess?
A patient reports a loss of smell following a head trauma. Which cranial nerve should the nurse assess?
- Trochlear Nerve
- Oculomotor Nerve
- Olfactory Nerve (correct)
- Optic Nerve
Which cranial nerve is primarily responsible for pupillary constriction and opening of the eyelid?
Which cranial nerve is primarily responsible for pupillary constriction and opening of the eyelid?
- Abducens
- Trochlear
- Oculomotor (correct)
- Trigeminal
A patient is unable to move their eye medially and downward. Dysfunction of which cranial nerve is suspected?
A patient is unable to move their eye medially and downward. Dysfunction of which cranial nerve is suspected?
- Hypoglossal
- Oculomotor
- Trochlear (correct)
- Abducens
When assessing a patient's ability to feel light touch on their face, which cranial nerve is being evaluated?
When assessing a patient's ability to feel light touch on their face, which cranial nerve is being evaluated?
A patient cannot move their eye laterally. Which cranial nerve is most likely affected?
A patient cannot move their eye laterally. Which cranial nerve is most likely affected?
Before administering medication, a nurse assesses a patient's gag reflex. Which cranial nerve is being assessed?
Before administering medication, a nurse assesses a patient's gag reflex. Which cranial nerve is being assessed?
When assessing a patient's motor function, the nurse asks the patient to shrug their shoulders against resistance. Which cranial nerve is the nurse testing?
When assessing a patient's motor function, the nurse asks the patient to shrug their shoulders against resistance. Which cranial nerve is the nurse testing?
A patient is assessed for tongue movement. Which cranial nerve is the nurse evaluating?
A patient is assessed for tongue movement. Which cranial nerve is the nurse evaluating?
Which of the following cranial nerves are associated with the medulla oblongata?
Which of the following cranial nerves are associated with the medulla oblongata?
A patient's chart reveals a diagnosis of damage to the brainstem. What is the primary concern related to this diagnosis?
A patient's chart reveals a diagnosis of damage to the brainstem. What is the primary concern related to this diagnosis?
Which set of cranial nerves originates from the pons?
Which set of cranial nerves originates from the pons?
What is the primary function of the sympathetic nervous system?
What is the primary function of the sympathetic nervous system?
Which neurotransmitter is primarily associated with the sympathetic nervous system?
Which neurotransmitter is primarily associated with the sympathetic nervous system?
Stimulation of alpha-adrenergic receptors typically results in which physiological effect?
Stimulation of alpha-adrenergic receptors typically results in which physiological effect?
Which of the following is a typical effect of beta receptor activation in the sympathetic nervous system?
Which of the following is a typical effect of beta receptor activation in the sympathetic nervous system?
Which neurotransmitter is most associated with the parasympathetic nervous system?
Which neurotransmitter is most associated with the parasympathetic nervous system?
Stimulation of muscarinic receptors in the parasympathetic nervous system can result in:
Stimulation of muscarinic receptors in the parasympathetic nervous system can result in:
Activation of nicotinic receptors in the parasympathetic nervous system results in:
Activation of nicotinic receptors in the parasympathetic nervous system results in:
The nurse is assessing a patient with increased intracranial pressure (ICP). What intervention is crucial for maintaining venous outflow from the brain?
The nurse is assessing a patient with increased intracranial pressure (ICP). What intervention is crucial for maintaining venous outflow from the brain?
A nurse assesses a patient who requires strong stimulation to elicit minimal movement, and the patient quickly returns to an unresponsive state. How should the nurse document the patient's level of consciousness?
A nurse assesses a patient who requires strong stimulation to elicit minimal movement, and the patient quickly returns to an unresponsive state. How should the nurse document the patient's level of consciousness?
Which Glasgow Coma Scale (GCS) score indicates that a patient opens their eyes only to painful stimuli?
Which Glasgow Coma Scale (GCS) score indicates that a patient opens their eyes only to painful stimuli?
A patient is able to move their arm with full range of motion against gravity but only with moderate resistance from the nurse. What is the appropriate muscle strength score to document?
A patient is able to move their arm with full range of motion against gravity but only with moderate resistance from the nurse. What is the appropriate muscle strength score to document?
While assessing a patient, the nurse elicits an extension of the toes in response to stimulation of the plantar surface of the foot. How should this finding be documented?
While assessing a patient, the nurse elicits an extension of the toes in response to stimulation of the plantar surface of the foot. How should this finding be documented?
Prior to a cerebral angiography, what assessment is essential for the nurse to complete?
Prior to a cerebral angiography, what assessment is essential for the nurse to complete?
A nurse is providing post-procedure care for a patient who underwent cerebral angiography. Which intervention is most important?
A nurse is providing post-procedure care for a patient who underwent cerebral angiography. Which intervention is most important?
Following a lumbar puncture, a patient reports a severe headache that worsens when sitting upright. What intervention is most appropriate?
Following a lumbar puncture, a patient reports a severe headache that worsens when sitting upright. What intervention is most appropriate?
A patient has been treated for a migraine with medication that targets the reduction of vasoconstriction and vasodilation. Which class of migraine medication are they most likely taking?
A patient has been treated for a migraine with medication that targets the reduction of vasoconstriction and vasodilation. Which class of migraine medication are they most likely taking?
What is the primary pathological change in the brain associated with Parkinson's disease?
What is the primary pathological change in the brain associated with Parkinson's disease?
Which of the following class of symptoms is a cardinal sign associated with Parkinson's disease?
Which of the following class of symptoms is a cardinal sign associated with Parkinson's disease?
Which of the following is a common potential complication associated with Parkinson's Disease?
Which of the following is a common potential complication associated with Parkinson's Disease?
What is the underlying cause of tremors, rigidity, and bradykinesia in Parkinson's disease?
What is the underlying cause of tremors, rigidity, and bradykinesia in Parkinson's disease?
What is the definitive method for diagnosing Alzheimer's Disease after death?
What is the definitive method for diagnosing Alzheimer's Disease after death?
Which of the following is the action of medications used to treat Alzheimer's Disease that increase levels of AcH?
Which of the following is the action of medications used to treat Alzheimer's Disease that increase levels of AcH?
What is the primary goal of disaster triage?
What is the primary goal of disaster triage?
What statement refers to the action of radiation 'exposing' something or someone to it?
What statement refers to the action of radiation 'exposing' something or someone to it?
Which form of radiation is composed of positively charged particles, effectively stopped by clothing or paper, yet damaging if ingested or inhaled?
Which form of radiation is composed of positively charged particles, effectively stopped by clothing or paper, yet damaging if ingested or inhaled?
Which principle is a key element of maximizing safety for all participants in disaster preparedness drills?
Which principle is a key element of maximizing safety for all participants in disaster preparedness drills?
Which statement made by the caregiver of a patient with dementia demonstrates an accurate understanding of providing a safe environment?
Which statement made by the caregiver of a patient with dementia demonstrates an accurate understanding of providing a safe environment?
Which statement made by a patient's family member would indicate a higher likelihood of delirium than dementia in the patient?
Which statement made by a patient's family member would indicate a higher likelihood of delirium than dementia in the patient?
In managing a patient who has both delirium and dementia, which intervention is beneficial for delirium specifically?
In managing a patient who has both delirium and dementia, which intervention is beneficial for delirium specifically?
What potential deficit should the nurse practitioner be aware of involving a patient with social recognition difficulties?
What potential deficit should the nurse practitioner be aware of involving a patient with social recognition difficulties?
What is the most likely origin of a patient who presents with a sudden onset of nonsensical speech?
What is the most likely origin of a patient who presents with a sudden onset of nonsensical speech?
What is the most appropriate action when caring for a 90 year old patient who is unable to sleep, has difficulty, and is distracted, has a loss of energy?
What is the most appropriate action when caring for a 90 year old patient who is unable to sleep, has difficulty, and is distracted, has a loss of energy?
Which patient statement indicates the usefulness of a current nurse-patient relationship?
Which patient statement indicates the usefulness of a current nurse-patient relationship?
Which belief would be least helpful for a nurse working in crisis intervention?
Which belief would be least helpful for a nurse working in crisis intervention?
Following a stroke affecting the midbrain, a patient exhibits deficits in upward and downward eye movements. Which cranial nerve(s) is/are most likely affected?
Following a stroke affecting the midbrain, a patient exhibits deficits in upward and downward eye movements. Which cranial nerve(s) is/are most likely affected?
A patient with a traumatic brain injury exhibits difficulty with balance and coordination. Which area of the CNS should the nurse suspect has been affected?
A patient with a traumatic brain injury exhibits difficulty with balance and coordination. Which area of the CNS should the nurse suspect has been affected?
A patient is diagnosed with damage to the medulla oblongata following a motor vehicle accident. Which of the following symptoms would the nurse most likely observe?
A patient is diagnosed with damage to the medulla oblongata following a motor vehicle accident. Which of the following symptoms would the nurse most likely observe?
A patient is being assessed after a head injury. When shining a light into the patient's right eye, the nurse notes that the right pupil constricts, but the left pupil does not. This finding suggests damage to which cranial nerve?
A patient is being assessed after a head injury. When shining a light into the patient's right eye, the nurse notes that the right pupil constricts, but the left pupil does not. This finding suggests damage to which cranial nerve?
A patient displaying signs of increased sympathetic nervous system activity also has a history of cardiovascular disease. Which assessment finding would warrant immediate intervention?
A patient displaying signs of increased sympathetic nervous system activity also has a history of cardiovascular disease. Which assessment finding would warrant immediate intervention?
Which cranial nerve is responsible for taste sensation on the posterior third of the tongue, as well as regulating blood pressure and respiration?
Which cranial nerve is responsible for taste sensation on the posterior third of the tongue, as well as regulating blood pressure and respiration?
A patient presents with difficulty swallowing, a weak gag reflex, and hoarseness. Which cranial nerve is most likely affected?
A patient presents with difficulty swallowing, a weak gag reflex, and hoarseness. Which cranial nerve is most likely affected?
A nurse notes that a patient has an asymmetrical smile and difficulty closing one eye. Which cranial nerve is most likely affected?
A nurse notes that a patient has an asymmetrical smile and difficulty closing one eye. Which cranial nerve is most likely affected?
Following a stroke, a patient has difficulty sticking out their tongue and moving it from side to side. Which cranial nerve is most likely affected?
Following a stroke, a patient has difficulty sticking out their tongue and moving it from side to side. Which cranial nerve is most likely affected?
After a head injury, a patient has double vision when trying to look downward and medially. Which cranial nerve is most likely affected?
After a head injury, a patient has double vision when trying to look downward and medially. Which cranial nerve is most likely affected?
A patient reports numbness and tingling in the cheek and jaw following dental surgery. Which cranial nerve is most likely affected?
A patient reports numbness and tingling in the cheek and jaw following dental surgery. Which cranial nerve is most likely affected?
What is the most likely result from stimulating alpha-adrenergic receptors in the sympathetic nervous system?
What is the most likely result from stimulating alpha-adrenergic receptors in the sympathetic nervous system?
A patient has increased heart rate and bronchodilation. Activation of which receptor is most likely causing these changes?
A patient has increased heart rate and bronchodilation. Activation of which receptor is most likely causing these changes?
A patient is experiencing dry mouth, blurred vision, and urinary retention. These findings are most likely due to the blockade of which receptors?
A patient is experiencing dry mouth, blurred vision, and urinary retention. These findings are most likely due to the blockade of which receptors?
Which finding would most likely be observed in a patient with increased parasympathetic nervous system activity?
Which finding would most likely be observed in a patient with increased parasympathetic nervous system activity?
Following a traumatic brain injury, a patient demonstrates signs of both sympathetic and parasympathetic dysfunction. Where is the injury most likely located?
Following a traumatic brain injury, a patient demonstrates signs of both sympathetic and parasympathetic dysfunction. Where is the injury most likely located?
A patient with a brainstem injury exhibits irregular breathing, changes in heart rate, and fluctuating blood pressure. Which area of the brainstem is most likely affected?
A patient with a brainstem injury exhibits irregular breathing, changes in heart rate, and fluctuating blood pressure. Which area of the brainstem is most likely affected?
A patient opens their eyes to verbal commands, is disoriented, and withdraws from pain. What is their Glasgow Coma Scale (GCS) score?
A patient opens their eyes to verbal commands, is disoriented, and withdraws from pain. What is their Glasgow Coma Scale (GCS) score?
A nurse assesses a patient's muscle strength and notes that the patient can move their arm against gravity but cannot overcome any resistance. What muscle strength score should the nurse document?
A nurse assesses a patient's muscle strength and notes that the patient can move their arm against gravity but cannot overcome any resistance. What muscle strength score should the nurse document?
During a neurological assessment, a nurse finds that a patient is drowsy but easily aroused, though sometimes confused. How should the nurse document this?
During a neurological assessment, a nurse finds that a patient is drowsy but easily aroused, though sometimes confused. How should the nurse document this?
What is the most important nursing intervention following a lumbar puncture to prevent complications?
What is the most important nursing intervention following a lumbar puncture to prevent complications?
Which assessment finding post-cerebral angiography requires urgent intervention?
Which assessment finding post-cerebral angiography requires urgent intervention?
A patient is scheduled for a cerebral angiogram. Which pre-procedure assessment is most important for the nurse to perform?
A patient is scheduled for a cerebral angiogram. Which pre-procedure assessment is most important for the nurse to perform?
A patient taking beta blockers for hypertension is newly diagnosed with migraines. Why would the beta blocker medication be helpful for both conditions?
A patient taking beta blockers for hypertension is newly diagnosed with migraines. Why would the beta blocker medication be helpful for both conditions?
What is the most important consideration in the nursing management of a patient with Parkinson's disease to prevent?
What is the most important consideration in the nursing management of a patient with Parkinson's disease to prevent?
Which nursing assessment is most important focusing on a patient who has Parkinson's disease?
Which nursing assessment is most important focusing on a patient who has Parkinson's disease?
A patient with Parkinson's disease is prescribed medication that increases dopamine levels in the brain. What assessment should the nurse prioritize to determine if this medication is working?
A patient with Parkinson's disease is prescribed medication that increases dopamine levels in the brain. What assessment should the nurse prioritize to determine if this medication is working?
A patient's family reports that the patient is showing progressive memory loss, language difficulties, and changes in personality. Which is the priority nursing intervention?
A patient's family reports that the patient is showing progressive memory loss, language difficulties, and changes in personality. Which is the priority nursing intervention?
The family of a patient with Alzheimer's disease asks about medications to improve cognitive function. Which of these medication actions is the way to achieve improvement?
The family of a patient with Alzheimer's disease asks about medications to improve cognitive function. Which of these medication actions is the way to achieve improvement?
A patient with Alzheimer's disease is prescribed a medication that is meant to inhibit acetylcholinesterase. What is the goal of this medication?
A patient with Alzheimer's disease is prescribed a medication that is meant to inhibit acetylcholinesterase. What is the goal of this medication?
What is the first action that must be done for the START triage method?
What is the first action that must be done for the START triage method?
In a disaster response, a patient is tagged as "expectant" using the SALT triage method. What does this indicate about the patient's condition?
In a disaster response, a patient is tagged as "expectant" using the SALT triage method. What does this indicate about the patient's condition?
During a mass casualty incident, a triage nurse uses the START triage system. Which finding in an adult patient would require immediate intervention and a red tag?
During a mass casualty incident, a triage nurse uses the START triage system. Which finding in an adult patient would require immediate intervention and a red tag?
Emergency personnel arrive on the scene. Some are labeled "walking wounded" using the SALT triage methodology. What is the proper action for such a casualty?
Emergency personnel arrive on the scene. Some are labeled "walking wounded" using the SALT triage methodology. What is the proper action for such a casualty?
During a radiation event, a nurse learns that the act of 'exposing' something or someone to radiation is called what?
During a radiation event, a nurse learns that the act of 'exposing' something or someone to radiation is called what?
A construction worker is working in an environment that contains radiation. Which action is the most appropriate for this person to take?
A construction worker is working in an environment that contains radiation. Which action is the most appropriate for this person to take?
A patient involved in a radiation accident requires decontamination. What describes external contamination for a patient involved in an accident?
A patient involved in a radiation accident requires decontamination. What describes external contamination for a patient involved in an accident?
A nurse is teaching a community group about the different types of radiation. What accurately describes alpha radiation?
A nurse is teaching a community group about the different types of radiation. What accurately describes alpha radiation?
A man presents with symptoms of forgetfulness, difficulty finding words, and personality changes. Based on this, which is the best diagnosis?
A man presents with symptoms of forgetfulness, difficulty finding words, and personality changes. Based on this, which is the best diagnosis?
The community nurse is asked to present information regarding safety for caregivers of dementia patients. Which of the following statements is most appropriate?
The community nurse is asked to present information regarding safety for caregivers of dementia patients. Which of the following statements is most appropriate?
What statement from a patient indicates that they are suffering from delirium as opposed to dementia?
What statement from a patient indicates that they are suffering from delirium as opposed to dementia?
What statement made by a patient's caregiver suggests social recognition difficulties?
What statement made by a patient's caregiver suggests social recognition difficulties?
The crisis nurse finds a patient incapable of responding to instruction. How is the counselor-patient relationship?
The crisis nurse finds a patient incapable of responding to instruction. How is the counselor-patient relationship?
What is the highest-priority goal of crisis intervention?
What is the highest-priority goal of crisis intervention?
A patient presents with a loss of sensation on the anterior two-thirds of the tongue, but maintains taste function. While conducting a cranial nerve assessment, which nerve would the nurse focus on based on these findings?
A patient presents with a loss of sensation on the anterior two-thirds of the tongue, but maintains taste function. While conducting a cranial nerve assessment, which nerve would the nurse focus on based on these findings?
A patient with a known brainstem lesion is exhibiting signs of both sympathetic and parasympathetic nervous system dysfunction. Which clinical manifestation would be most indicative of the brainstem's involvement in autonomic regulation?
A patient with a known brainstem lesion is exhibiting signs of both sympathetic and parasympathetic nervous system dysfunction. Which clinical manifestation would be most indicative of the brainstem's involvement in autonomic regulation?
A patient who has suffered a traumatic brain injury is being assessed using the Glasgow Coma Scale (GCS). They open their eyes when pain is applied, moan incomprehensibly, and withdraw their hand to pain. What GCS score should the nurse document?
A patient who has suffered a traumatic brain injury is being assessed using the Glasgow Coma Scale (GCS). They open their eyes when pain is applied, moan incomprehensibly, and withdraw their hand to pain. What GCS score should the nurse document?
To ensure adequate venous outflow in a patient with increased intracranial pressure (ICP), which nursing intervention is most important to implement?
To ensure adequate venous outflow in a patient with increased intracranial pressure (ICP), which nursing intervention is most important to implement?
For a patient experiencing migraine headaches, what intended effect do selective serotonin reuptake inhibitors (SSRIs) have for treatment?
For a patient experiencing migraine headaches, what intended effect do selective serotonin reuptake inhibitors (SSRIs) have for treatment?
Flashcards
Olfactory Nerve
Olfactory Nerve
Cranial nerve I; Responsible for the sense of smell.
Optic Nerve
Optic Nerve
Cranial Nerve II; Responsible for vision.
Oculomotor Nerve
Oculomotor Nerve
Cranial Nerve III; controls eye movement up, down, laterally; eyelid opening; pupil constriction.
Trochlear Nerve
Trochlear Nerve
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Trigeminal Nerve
Trigeminal Nerve
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Abducens Nerve
Abducens Nerve
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Facial Nerve
Facial Nerve
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Vestibulocochlear Nerve
Vestibulocochlear Nerve
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Glossopharyngeal Nerve
Glossopharyngeal Nerve
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Vagus Nerve
Vagus Nerve
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Spinal Accessory Nerve
Spinal Accessory Nerve
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Hypoglossal Nerve
Hypoglossal Nerve
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Brainstem
Brainstem
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Medulla Oblongata
Medulla Oblongata
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Pons
Pons
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Midbrain
Midbrain
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Jugular Vein Alignment
Jugular Vein Alignment
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Sympathetic Nervous System
Sympathetic Nervous System
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Parasympathetic Nervous System
Parasympathetic Nervous System
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Norepinephrine
Norepinephrine
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Acetylcholine
Acetylcholine
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Alpha Adrenergic Receptors
Alpha Adrenergic Receptors
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Beta Adrenergic Receptors
Beta Adrenergic Receptors
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Conscious
Conscious
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Confusion
Confusion
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Lethargic
Lethargic
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Obtundation
Obtundation
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Stupor
Stupor
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Coma
Coma
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Autonomic Nervous System
Autonomic Nervous System
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Cranial Nerve Assessment
Cranial Nerve Assessment
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Atrophy
Atrophy
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Paresis
Paresis
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Plegia
Plegia
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Contraction
Contraction
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Involuntary Movements
Involuntary Movements
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Spasm
Spasm
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Spasticity
Spasticity
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Olfactory Testing
Olfactory Testing
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Optic Testing
Optic Testing
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Oculomotor Testing
Oculomotor Testing
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Trochlear Testing
Trochlear Testing
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Abducens Testing
Abducens Testing
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Facial Testing
Facial Testing
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Vestibulocochlear (acoustic) Testing
Vestibulocochlear (acoustic) Testing
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Pupillary Dilation (Sympathetic)
Pupillary Dilation (Sympathetic)
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Pupillary Constriction (Parasympathetic)
Pupillary Constriction (Parasympathetic)
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Glasgow Coma Scale (GCS)
Glasgow Coma Scale (GCS)
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Abnormal Flexion to Pain
Abnormal Flexion to Pain
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Abnormal Extension to Pain
Abnormal Extension to Pain
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Romberg Test
Romberg Test
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Proprioception
Proprioception
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Agnosia
Agnosia
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Parkinson's Disease (PD)
Parkinson's Disease (PD)
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Bradykinesia
Bradykinesia
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Akinesia
Akinesia
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Medication Overuse Headaches
Medication Overuse Headaches
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Status Migrainosus
Status Migrainosus
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Alpha Radiation
Alpha Radiation
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Beta Radiation
Beta Radiation
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Gamma Radiation
Gamma Radiation
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Irradiation
Irradiation
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External Contamination
External Contamination
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Internal Contamination
Internal Contamination
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Cushing's Triad
Cushing's Triad
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Cerebral Angiography
Cerebral Angiography
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Lumbar Puncture
Lumbar Puncture
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Cushing's Triad
Cushing's Triad
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Aspiration Risk with PD
Aspiration Risk with PD
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Alzheimer's Disease
Alzheimer's Disease
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Cerebellar Assessment
Cerebellar Assessment
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Spontaneous Eye Opening
Spontaneous Eye Opening
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Eye Opening to Speech
Eye Opening to Speech
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Eye Opening to Pain
Eye Opening to Pain
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Following Commands
Following Commands
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Response to Pain
Response to Pain
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Withdrawal from Pain
Withdrawal from Pain
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Oriented
Oriented
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Confused
Confused
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Inappropriate Words
Inappropriate Words
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Incomprehensible sounds
Incomprehensible sounds
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Study Notes
Case Study Questions - More Possible Answers
- Confusion, elevated blood pressure, and incontinence can be clinical manifestations of increased ICP
- Speech therapist should conduct the swallowing evaluation
- The rationale for administering dexamethasone is to decrease cerebral edema
- For Mr. Johnson's seizure activity, the nurse needs to get suction equipment
- The statement showing a need for more teaching will be: “I will not drink any alcoholic beverages.”
Clinical Judgement
- Recognizing cues and assessing findings are important to the assessment process, and there are solutions and courses of action that need to be performed
Disaster Assessment
Principles for minimizing exposure to radiation
- Stay as far away from the source as is practical
- Use appropriate shielding
- Limit exposure time.
Emergency Preparedness
- Maximizing realness in practice injection
- Volunteer moulage patients
- Ensure all practice devices are working
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