NEURO

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Questions and Answers

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?

  • Abducens
  • Trochlear
  • Oculomotor (correct)
  • Trigeminal

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?

<p>Trigeminal (C)</p>
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A patient cannot move their eye laterally. Which cranial nerve is most likely affected?

<p>Abducens (A)</p>
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Before administering medication, a nurse assesses a patient's gag reflex. Which cranial nerve is being assessed?

<p>Glossopharyngeal (A)</p>
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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?

<p>Spinal Accessory (D)</p>
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A patient is assessed for tongue movement. Which cranial nerve is the nurse evaluating?

<p>Hypoglossal (A)</p>
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Which of the following cranial nerves are associated with the medulla oblongata?

<p>Glossopharyngeal, Vagus, Spinal Accessory, and Hypoglossal (A)</p>
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A patient's chart reveals a diagnosis of damage to the brainstem. What is the primary concern related to this diagnosis?

<p>Life-threatening complications (B)</p>
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Which set of cranial nerves originates from the pons?

<p>V, VI, VII, VIII (B)</p>
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What is the primary function of the sympathetic nervous system?

<p>Preparing the body for 'fight or flight' (A)</p>
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Which neurotransmitter is primarily associated with the sympathetic nervous system?

<p>Norepinephrine (B)</p>
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Stimulation of alpha-adrenergic receptors typically results in which physiological effect?

<p>Vasoconstriction (C)</p>
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Which of the following is a typical effect of beta receptor activation in the sympathetic nervous system?

<p>Increased heart rate (B)</p>
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Which neurotransmitter is most associated with the parasympathetic nervous system?

<p>Acetylcholine (A)</p>
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Stimulation of muscarinic receptors in the parasympathetic nervous system can result in:

<p>Pupillary constriction (D)</p>
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Activation of nicotinic receptors in the parasympathetic nervous system results in:

<p>Excitatory effect on skeletal muscle (C)</p>
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The nurse is assessing a patient with increased intracranial pressure (ICP). What intervention is crucial for maintaining venous outflow from the brain?

<p>Keeping the head in proper alignment (C)</p>
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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?

<p>Stuporous (C)</p>
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Which Glasgow Coma Scale (GCS) score indicates that a patient opens their eyes only to painful stimuli?

<p>2 (D)</p>
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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?

<p>4 (A)</p>
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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?

<p>Positive Babinski Sign (B)</p>
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Prior to a cerebral angiography, what assessment is essential for the nurse to complete?

<p>Assess patient's peripheral pulses (B)</p>
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A nurse is providing post-procedure care for a patient who underwent cerebral angiography. Which intervention is most important?

<p>Monitoring vital signs every 15 minutes for the first hour (D)</p>
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Following a lumbar puncture, a patient reports a severe headache that worsens when sitting upright. What intervention is most appropriate?

<p>Maintaining flat bedrest (C)</p>
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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?

<p>Beta Blockers (B)</p>
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What is the primary pathological change in the brain associated with Parkinson's disease?

<p>Decreased dopamine production in the substantia nigra (C)</p>
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Which of the following class of symptoms is a cardinal sign associated with Parkinson's disease?

<p>Resting Tremors (B)</p>
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Which of the following is a common potential complication associated with Parkinson's Disease?

<p>Risk of aspiration (B)</p>
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What is the underlying cause of tremors, rigidity, and bradykinesia in Parkinson's disease?

<p>Imbalance between acetylcholine and dopamine (D)</p>
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What is the definitive method for diagnosing Alzheimer's Disease after death?

<p>Microscopic Examination of Brain Tissue (D)</p>
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Which of the following is the action of medications used to treat Alzheimer's Disease that increase levels of AcH?

<p>Inhibit the enzymes acetylcholinesterase and butyrylcholinesterase (C)</p>
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What is the primary goal of disaster triage?

<p>To do the most good for the greatest number of people (D)</p>
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What statement refers to the action of radiation 'exposing' something or someone to it?

<p>Irradiation (D)</p>
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Which form of radiation is composed of positively charged particles, effectively stopped by clothing or paper, yet damaging if ingested or inhaled?

<p>Alpha Radiation (C)</p>
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Which principle is a key element of maximizing safety for all participants in disaster preparedness drills?

<p>All communications during a drill should start and end with &quot;This is a drill&quot; (D)</p>
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Which statement made by the caregiver of a patient with dementia demonstrates an accurate understanding of providing a safe environment?

<p>&quot;We've installed locks on all the outside doors.&quot; (A)</p>
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Which statement made by a patient's family member would indicate a higher likelihood of delirium than dementia in the patient?

<p>&quot;Dad doesn't seem to recognize us anymore.&quot; (A)</p>
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In managing a patient who has both delirium and dementia, which intervention is beneficial for delirium specifically?

<p>Assisting with needs related to nutrition, elimination, hydration, and personal hygiene (C)</p>
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What potential deficit should the nurse practitioner be aware of involving a patient with social recognition difficulties?

<p>Social cognition ability (A)</p>
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What is the most likely origin of a patient who presents with a sudden onset of nonsensical speech?

<p>A urinary tract infection (B)</p>
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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?

<p>Arrange for an appointment with a mental health professional for the evaluation and treatment of suspected major depressive disorder. (D)</p>
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Which patient statement indicates the usefulness of a current nurse-patient relationship?

<p>“I appreciate the time you spent with me. I have a better understanding of what I can do to manage my problem.&quot; (C)</p>
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Which belief would be least helpful for a nurse working in crisis intervention?

<p>A person in crisis is incapable of responding to instruction. (D)</p>
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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?

<p>Oculomotor (III) and Trochlear nerve (IV) (A)</p>
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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?

<p>Cerebellum (A)</p>
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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?

<p>Difficulty swallowing and changes in voice quality (B)</p>
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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?

<p>Oculomotor (III) on the left side (A)</p>
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A patient displaying signs of increased sympathetic nervous system activity also has a history of cardiovascular disease. Which assessment finding would warrant immediate intervention?

<p>Increased heart rate and elevated blood pressure (C)</p>
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Which cranial nerve is responsible for taste sensation on the posterior third of the tongue, as well as regulating blood pressure and respiration?

<p>Glossopharyngeal (IX) (B)</p>
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A patient presents with difficulty swallowing, a weak gag reflex, and hoarseness. Which cranial nerve is most likely affected?

<p>Glossopharyngeal (IX) (A)</p>
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A nurse notes that a patient has an asymmetrical smile and difficulty closing one eye. Which cranial nerve is most likely affected?

<p>Facial (VII) (C)</p>
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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?

<p>Hypoglossal (XII) (C)</p>
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After a head injury, a patient has double vision when trying to look downward and medially. Which cranial nerve is most likely affected?

<p>Trochlear (IV) (D)</p>
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A patient reports numbness and tingling in the cheek and jaw following dental surgery. Which cranial nerve is most likely affected?

<p>Trigeminal (V) (B)</p>
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What is the most likely result from stimulating alpha-adrenergic receptors in the sympathetic nervous system?

<p>Vasoconstriction (D)</p>
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A patient has increased heart rate and bronchodilation. Activation of which receptor is most likely causing these changes?

<p>Beta-adrenergic (B)</p>
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A patient is experiencing dry mouth, blurred vision, and urinary retention. These findings are most likely due to the blockade of which receptors?

<p>Muscarinic receptors (B)</p>
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Which finding would most likely be observed in a patient with increased parasympathetic nervous system activity?

<p>Increased gastrointestinal motility (C)</p>
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Following a traumatic brain injury, a patient demonstrates signs of both sympathetic and parasympathetic dysfunction. Where is the injury most likely located?

<p>Brainstem (B)</p>
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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?

<p>Medulla Oblongata (A)</p>
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A patient opens their eyes to verbal commands, is disoriented, and withdraws from pain. What is their Glasgow Coma Scale (GCS) score?

<p>12 (D)</p>
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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?

<p>3 (A)</p>
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During a neurological assessment, a nurse finds that a patient is drowsy but easily aroused, though sometimes confused. How should the nurse document this?

<p>Lethargic (C)</p>
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What is the most important nursing intervention following a lumbar puncture to prevent complications?

<p>Maintaining flat bedrest (D)</p>
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Which assessment finding post-cerebral angiography requires urgent intervention?

<p>Decreased peripheral pulses distal to the insertion site (A)</p>
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A patient is scheduled for a cerebral angiogram. Which pre-procedure assessment is most important for the nurse to perform?

<p>Assessing for allergies to iodine or shellfish (B)</p>
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A patient taking beta blockers for hypertension is newly diagnosed with migraines. Why would the beta blocker medication be helpful for both conditions?

<p>Beta blockers prevent vasoconstriction and vasodilation in cerebral blood vessels. (D)</p>
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What is the most important consideration in the nursing management of a patient with Parkinson's disease to prevent?

<p>Risk for aspiration (C)</p>
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Which nursing assessment is most important focusing on a patient who has Parkinson's disease?

<p>Gag and swallow (D)</p>
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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?

<p>Coordination and movement (B)</p>
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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?

<p>Ensure physical and emotional support for the patient and family. (A)</p>
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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?

<p>Inhibiting acetylcholinesterase to increase acetylcholine levels (A)</p>
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A patient with Alzheimer's disease is prescribed a medication that is meant to inhibit acetylcholinesterase. What is the goal of this medication?

<p>Improve memory and cognitive function (B)</p>
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What is the first action that must be done for the START triage method?

<p>Ask the walking wounded to a specific location (D)</p>
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In a disaster response, a patient is tagged as "expectant" using the SALT triage method. What does this indicate about the patient's condition?

<p>The patient may have life-threatening injuries, but resources are not available to treat them. (D)</p>
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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?

<p>Respirations greater than 30 per minute (C)</p>
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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?

<p>Should be given a lower treatment priority (D)</p>
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During a radiation event, a nurse learns that the act of 'exposing' something or someone to radiation is called what?

<p>Irradiation (C)</p>
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A construction worker is working in an environment that contains radiation. Which action is the most appropriate for this person to take?

<p>Limit exposure time (D)</p>
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A patient involved in a radiation accident requires decontamination. What describes external contamination for a patient involved in an accident?

<p>A radioactive material deposit on the skin. (D)</p>
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A nurse is teaching a community group about the different types of radiation. What accurately describes alpha radiation?

<p>Is easily stopped by clothing or paper. (B)</p>
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A man presents with symptoms of forgetfulness, difficulty finding words, and personality changes. Based on this, which is the best diagnosis?

<p>Alzheimer's Disease (C)</p>
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The community nurse is asked to present information regarding safety for caregivers of dementia patients. Which of the following statements is most appropriate?

<p>&quot;Installing locks on all outside doors greatly decreases the risk of wandering.&quot; (A)</p>
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What statement from a patient indicates that they are suffering from delirium as opposed to dementia?

<p>&quot;I was perfectly fine last night, but this morning I'm very confused.&quot; (B)</p>
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What statement made by a patient's caregiver suggests social recognition difficulties?

<p>&quot;She doesn't recognize familiar faces anymore.&quot; (A)</p>
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The crisis nurse finds a patient incapable of responding to instruction. How is the counselor-patient relationship?

<p>One where it is unhelpful to use counseling (D)</p>
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What is the highest-priority goal of crisis intervention?

<p>Safety (A)</p>
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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?

<p>The trigeminal nerve (V) because it carries general sensation from the anterior tongue. (D)</p>
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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?

<p>Unstable blood pressure, erratic heart rate, and irregular breathing patterns. (C)</p>
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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?

<p>8 (C)</p>
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To ensure adequate venous outflow in a patient with increased intracranial pressure (ICP), which nursing intervention is most important to implement?

<p>Elevating the head of the bed and maintaining proper head alignment. (A)</p>
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For a patient experiencing migraine headaches, what intended effect do selective serotonin reuptake inhibitors (SSRIs) have for treatment?

<p>Increasing serotonin levels in the brain. (C)</p>
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Flashcards

Olfactory Nerve

Cranial nerve I; Responsible for the sense of smell.

Optic Nerve

Cranial Nerve II; Responsible for vision.

Oculomotor Nerve

Cranial Nerve III; controls eye movement up, down, laterally; eyelid opening; pupil constriction.

Trochlear Nerve

Cranial Nerve IV; responsible for medial and downward eye movement.

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Trigeminal Nerve

Cranial Nerve V; responsible for touch, temperature, and sensations from upper and lower face, and chewing.

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Abducens Nerve

Cranial Nerve VI; Responsible for lateral eye movements

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Facial Nerve

Cranial Nerve VII; Responsible for taste and facial expressions.

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Vestibulocochlear Nerve

Cranial Nerve VIII; responsible for hearing and balance.

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Glossopharyngeal Nerve

Cranial Nerve IX; responsible for Taste, touch, pressure, pain, temperature; sensations from tongue and outer ear; regulates blood pressure and respiration, salivation, swallow, and gag.

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Vagus Nerve

Cranial Nerve X; responsible for taste; sensations of fullness, and gastrointestinal discomfort; bronchoconstriction; gastrointestinal secretion, and motility

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Spinal Accessory Nerve

Cranial Nerve XI; responsible for swallowing, head, neck, and shoulder movements

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Hypoglossal Nerve

Cranial Nerve XII; responsible for tongue movement and food manipulation and swallowing

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Brainstem

The medulla, pons, and midbrain. Most cranial nerves originate here and Any injury or trauma to this area can be life-threatening.

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Medulla Oblongata

Part of the brainstem, associated with glossopharyngeal (IX), vagus (X), spinal accessory (XI), and hypoglossal (XII).

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Pons

Part of the brainstem, associated with trigeminal (V), abducens (VI), facial (VII), and acoustic (VIII).

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Midbrain

Part of the brainstem, cranial nerves III and IV (oculomotor and trochlear, respectively), originate here.

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Jugular Vein Alignment

Increased intracranial pressure (ICP) due to bleeding or edema

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Sympathetic Nervous System

Prepares the body for physical activity; elicits the “fight-or-flight” response.

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Parasympathetic Nervous System

Has a calming/relaxing effect on the body.

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Norepinephrine

The “fight-or-flight” neurotransmitter. Fibers that secrete this are adrenergic.

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Acetylcholine

The primary neurotransmitter that is released. Fibers that secrete this are cholinergic.

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Alpha Adrenergic Receptors

Receptors that typically have an excitatory effect, producing vasoconstriction that increases blood pressure.

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Beta Adrenergic Receptors

Receptors that are usually inhibitory and dilate the bronchioles, which enhances airflow.

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Conscious

Awake with appropriate speech and behavior

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Confusion

Disorientation, bewilderment, difficulty following commands

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Lethargic

Sleepiness; slow and delayed response to stimulus

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Obtundation

Somnolence with drowsiness between sleep states, lessened interest in environment, slowed responses to stimulation

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Stupor

Minimal movement without stimulus; requires strong vigorous stimulus and then drifts back to unresponsiveness

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Coma

Not arousable and unresponsive

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Autonomic Nervous System

Regulates the activity of cardiac muscle, smooth muscle, and glands.

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Cranial Nerve Assessment

Tests for expressive aphasia.

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Atrophy

Decrease in muscle mass.

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Paresis

Slight or incomplete paralysis.

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Plegia

Complete loss of muscle function

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Contraction

Shortening or tightening of the muscles

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Involuntary Movements

Uncontrolled movements

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Spasm

Involuntary muscle contraction.

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Spasticity

Increased muscle tone that creates stiff movement.

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Olfactory Testing

Using aromatic items such as coffee, oragnes, vanilla, or chocolate to test Cranial Nerve I.

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Optic Testing

Visual acuity—use a Snellen's chart, or ask the patient to read from a book or a newspaper. Assess for peripheral vision (visual fields)

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Oculomotor Testing

Using a flashlight shine it from the lateral position and shine it directly into the eye to assess constriction.

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Trochlear Testing

Patient follows the examiner's finger as it is moved toward the patient's nose.

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Abducens Testing

The examiner asks the patient to follow the examiner's finger by moving the eyes laterally.

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Facial Testing

Patient to smile, frown, puff cheeks, raise eyebrows, and close eyes tightly.

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Vestibulocochlear (acoustic) Testing

Check for hearing by rubbing fingers close to the ear or by whispering.

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Pupillary Dilation (Sympathetic)

Pupillary dilation during sympathetic activation.

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Pupillary Constriction (Parasympathetic)

Pupillary constriction during parasympathetic activation.

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Glasgow Coma Scale (GCS)

An assessment tool grading eye-opening, motor, and verbal responses to stimuli.

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Abnormal Flexion to Pain

Abnormal motor response with flexion in response to pain.

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Abnormal Extension to Pain

Abnormal motor response with extension in response to pain.

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Romberg Test

A test to assess balance by observing the patient standing with eyes closed.

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Proprioception

Ability to perceive position

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Agnosia

Inability to recognize objects through sensory input (sight, sound, touch).

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Parkinson's Disease (PD)

Disorder with resting tremors, rigidity, bradykinesia, and postural instability.

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Bradykinesia

Slow movement

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Akinesia

No movement

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Medication Overuse Headaches

Medication overuse can cause chronic daily headache.

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Status Migrainosus

Severe headache with dehydration and emesis, requiring inpatient management.

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Alpha Radiation

A stream of positively charged particles stopped by skin or paper.

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Beta Radiation

A stream of electrons stopped by aluminum, penetrates a cm.

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Gamma Radiation

High-energy radiation penetrating the whole body.

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Irradiation

Applying something to radiation

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External Contamination

Radioactive material on the skin, in clothing or wound.

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Internal Contamination

Radioactive material inside the body via inhalation, ingestion, or wounds.

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Cushing's Triad

Decreased blood pressure, bradycardia, and irregular respirations related to increased ICP.

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Cerebral Angiography

A radiologic procedure visualizing cerebral circulation via catheter and dye.

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Lumbar Puncture

Obtaining CSF for analysis; spinal needle inserted below spinal cord.

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Cushing's Triad

Elevated blood pressure with a widening pulse pressure, and bradycardia related to increased ICP.

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Aspiration Risk with PD

Motor deficits may cause difficulty swallowing

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Alzheimer's Disease

Cognitive decline affecting memory, thinking, and behavior.

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Cerebellar Assessment

Involves balance, coordination, gait and posture.

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Spontaneous Eye Opening

Spontaneous, Not necessarily to command.

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Eye Opening to Speech

Opens eyes only to verbal stimuli.

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Eye Opening to Pain

Opens eyes only to painful stimuli.

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Following Commands

Obeys commands.

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Response to Pain

Purposeful movement to pain.

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Withdrawal from Pain

Withdraws from painful stimuli.

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Oriented

Oriented to person, place, and time.

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Confused

Confused conversation.

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Inappropriate Words

Disorganized or random speech

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Incomprehensible sounds

Moans, mumbles

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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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