Nursing Assessment Quiz

Assessing Level of Consciousness

• The primary purpose of assessing a patient's level of consciousness is to evaluate their mental status and neurological function.
• A higher score on the Glasgow Coma Scale (GCS) indicates a higher level of consciousness.
• The highest possible score on the GCS is 15, indicating the highest level of consciousness.

Neurological Conditions and Assessment

• Hemiparesis is characterized by weakness or paralysis of one side of the body.
• An abnormal finding during a mental status examination could include confusion, disorientation, or memory impairment.
• An abnormal finding during a posture and gait assessment could include an unsteady gait, difficulty maintaining balance, or abnormal movements.
• The maximum score achievable on the Glasgow Coma Scale (GCS) for motor response is 6.
• The Glasgow Coma Scale does not assess pupil response.
• A score of 3 on the Glasgow Coma Scale indicates that the patient does not respond to any stimuli.

Neurological Signs and Symptoms

• The mnemonic F.A.S.T. helps someone recognize the signs of a stroke: Face drooping, Arm weakness, Speech difficulty, Time to call 911.
• The Mini-Mental State Examination (MMSE) assesses the ability to remember information through tasks like recalling a list of words.
• The best eye response score a patient can achieve on the GCS is 4.
• A patient displaying hypertonia, an increased muscle tone, would most likely exhibit stiffness and resistance to movement.
• A verbal response score of 4 on the GCS indicates a person who is disoriented but can still converse, meaning they can speak but their answers may not be accurate or appropriate.

Neurological Anatomy and Function

• Broca's area, located in the frontal lobe, is primarily responsible for speech production.
• The cerebellum is the part of the brain primarily involved with coordinating movement and balance.
• An electroencephalogram (EEG) is the diagnostic tool used to provide a graphic recording of the brain's electrical activity.
• Receptive aphasia, also known as Wernicke's aphasia, is associated with damage to Wernicke's area in the brain, impacting comprehension of language.

Neurological Diagnostic Procedures

• A lumbar puncture, also known as a spinal tap, is used to collect cerebrospinal fluid (CSF) for analysis, which can help diagnose conditions like meningitis or encephalitis.
• Cerebral angiography is a diagnostic procedure that uses a special dye to examine blood vessels in the brain, helping to identify blockages or aneurysms.
• Magnetic resonance imaging (MRI) is particularly useful in assessing brain tumors and bleeding, as it provides detailed images of the brain's soft tissues.

Glasgow Coma Scale and Neurological Assessment

• The Glasgow Coma Scale primarily assesses a patient's level of consciousness by evaluating their eye opening, verbal response, and motor response.