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NEURO TEST QUESTIONS

1. Know parts to a neuron and each function.

Neurons are the primary functional unit of the nervous system, Although neurons come in
many shapes and sizes, they share three characteristics: excitability, or the ability to
generate a nerve impulse; conductivity, or the ability to transmit an impulse; and
influence, or the ability to influence other neurons, muscle cells, or glandular cells by
transmitting nerve impulses to them.
A typical neuron consists of a cell body, multiple dendrites, and an axon . The cell body
containing the nucleus and cytoplasm is the metabolic center of the neuron. Dendrites
are short processes extending from the cell body that receive impulses from the axons of
other neurons and conduct impulses toward the cell body. The axon projects varying
distances from the cell body, ranging from several micrometers to more than a meter. The
axon carries nerve impulses to other neurons or to end organs. The end organs are smooth
and striated muscles and glands.
Many axons in the CNS and PNS are covered by a myelin sheath, a white, lipid substance
that acts as an insulator for the conduction of impulses. Axons may be myelinated or
unmyelinated. Generally, the smaller fibers are unmyelinated.
Neurons have long been thought to be non-mitotic. That is, after being damaged neurons

NEURO TEST QUESTIONS


could not be replaced. The discovery of neuronal stem cells now demonstrates that
neurogenesis occurs in adult brains after cerebral injury. 1
Glial Cells.
Glial cells (glia or neuroglia) provide support, nourishment, and protection to neurons.
Glial cells constitute almost half of the brain and spinal cord mass and are 5 to 10 times
more numerous than neurons.
Glial cells are divided into microglia and macroglia. Microglia, specialized macrophages
capable of phagocytosis, protect the neurons. These cells are mobile within the brain and
multiply when the brain is damaged.
Different types of macroglial cells include the astrocytes (most abundant),
oligodendrocytes, and ependymal cells. 2 Astrocytes are found primarily in gray matter and
provide structural support to neurons. Their delicate processes form the blood-brain
barrier with the endothelium of the blood vessels. They also play a role in synaptic
transmission (conduction of impulses between neurons). When the brain is injured,
astrocytes act as phagocytes for neuronal debris. They help restore the neurochemical
milieu and provide support for repair. Proliferation of astrocytes contributes to the
formation of scar tissue (gliosis) in the CNS.
Oligodendrocytes are specialized cells that produce the myelin sheath of nerve fibers in
the CNS and are primarily found in the white matter of the CNS. (Schwann cells myelinate
the nerve fibers in the periphery.) Ependymal cells line the brain ventricles and aid in the
secretion of cerebrospinal fluid (CSF).
Neuroglia are mitotic and can replicate. In general, when neurons are destroyed, the tissue
is replaced by the proliferation of neuroglial cells. Most primary CNS tumors involve glial
cells. Primary malignancies involving neurons are rare.
strates that neurogenesis occurs in adult brains after cerebral injury. 1

NEURO TEST QUESTIONS

2. Know GLASCOW SCALE score and what the ranges are what they mean.

3. Know each one of the GCS number and what each mean eg. 5 local reactions to pain
4. ANS Sympathetic Nervous System Flight
5.
6. PNS/CNS parts
a. Central Nervous System The components of the CNS include the cerebrum
(cerebral hemispheres), brainstem, cerebellum, and spinal cord

NEURO TEST QUESTIONS


b. Peripheral Nervous System The PNS includes all the neuronal structures that
lie outside the CNS. It consists of the spinal and cranial nerves, their associated
ganglia (groupings of cell bodies), and portions of the ANS.

7. How to check for patients orientation situation is particularly important


8. When checked for eye opening check with least painful stimuli first
9. CRANIAL NERVES
10.Lumbar puncturePOSITION IMPORTANT BACK HUNCHED OVER, L2-5 so they can
aspirate inside vertebrae
a. POST OP-> VS, BED REST, SITE LEAKAGE, ICP
*The client is having a lumbar puncture performed. The nurse would plan to place the
client in which position for the procedure?
1. Side-lying, with legs pulled up and head bent down onto the chest
2. Side-lying, with a pillow under the hip
3. Prone, in a slight Trendelenburgs position
4. Prone, with a pillow under the abdomen.

NEURO TEST QUESTIONS


*The nurse is caring for the client with increased intracranial pressure. The nurse
would note which of the following trends in vital signs if the ICP is rising?
A. Increasing temperature, increasing pulse, increasing respirations, decreasing
blood pressure.
B. Increasing temperature, decreasing pulse, decreasing respirations, increasing
blood pressure.
C. Decreasing temperature, decreasing pulse, increasing respirations, decreasing
blood pressure.
D. Decreasing temperature, increasing pulse, decreasing respirations, increasing
blood pressure.
* A client admitted to the hospital with a subarachnoid hemorrhage has complaints of
severe headache, nuchal rigidity, and projectile vomiting. The nurse knows lumbar
puncture (LP) would be contraindicated in this client in which of the following
circumstances?
1 Vomiting continues
2 Intracranial pressure (ICP) is increased
3 The client needs mechanical ventilation
4 Blood is anticipated in the cerebralspinal fluid (CSF)
*

A client with subdural hematoma was given mannitol to decrease intracranial


pressure (ICP). Which of the following results would best show the mannitol was
effective?
A. Urine output increases
B.. Pupils are 8 mm and nonreactive
C. Systolic blood pressure remains at 150 mm Hg
D. BUN and creatinine levels return to normal
A lumbar puncture is performed on a child suspected of having bacterial
meningitis. CSF is obtained for analysis. A nurse reviews the results of the CSF
analysis and determines that which of the following results would verify the
diagnosis?
1 1. Cloudy CSF, decreased protein, and decreased glucose
2 2. Cloudy CSF, elevated protein, and decreased glucose
3 3. Clear CSF, elevated protein, and decreased glucose
4. Clear CSF, decreased pressure, and elevated protein

A nurse is reviewing the record of a child with increased ICP and notes that the
child has exhibited signs of decerebrate posturing. On assessment of the child,
the nurse would expect to note which of the following if this type of posturing
was present?
a.
b.
c.
d.

Abnormal flexion of the upper extremities and extension of the lower extremities
Rigid extension and pronation of the arms and legs
Rigid pronation of all extremities
Flaccid paralysis of all extremities

*An 18-year-old client is admitted with a closed head injury sustained in a MVA.
His intracranial pressure (ICP) shows an upward trend. Which intervention
should the nurse perform first?
A. Reposition the client to avoid neck flexion
B. Administer 1 g Mannitol IV as ordered

NEURO TEST QUESTIONS


C. Increase the ventilators respiratory rate to 20 breaths/minute
D. Administer 100mg of pentobarbital IV as ordered.

A client with head trauma develops a urine output of 300 ml/hr, dry skin, and
dry mucous membranes. Which of the following nursing interventions is the
most appropriate to perform initially?
A. Evaluate urine specific gravity
B. Anticipate treatment for renal failure
C. Provide emollients to the skin to prevent breakdown
D. Slow down the IV fluids and notify the physician
A 23-year-old client has been hit on the head with a baseball bat. The nurse
notes clear fluid draining from his ears and nose. Which of the following nursing
interventions should be done first?
A.
B.
C.
D.

Position the client flat in bed


Check the fluid for dextrose with a dipstick
Suction the nose to maintain airway patency
Insert nasal and ear packing with sterile gauze

When discharging a client from the ER after a head trauma, the nurse teaches the
guardian to observe for a lucid interval. Which of the following statements best
described a lucid interval?
A. An interval when the clients speech is garbled
B. An interval when the client is alert but cant recall recent events
C. An interval when the client is oriented but then becomes somnolent
D. An interval when the client has a warning symptom, such as an odor or visual
disturbance.
* A 30-year-old was admitted to the progressive care unit with a C5 fracture from a
motorcycle accident. Which of the following assessments would take priority?
A. Bladder distension
B. Neurological deficit
C. Pulse ox readings
D. The clients feelings about the injury
* A client arrives at the ER after slipping on a patch of ice and hitting her head. A CT
scan of the head shows a collection of blood between the skull and dura mater. Which
type of head injury does this finding suggest?
A. Subdural hematoma
B. Subarachnoid hemorrhage
C. Epidural hematoma
D. Contusion
An epidural hematoma occurs when blood collects between the skull and the dura
mater. In a subdural hematoma, venous blood collects between the dura mater and the
arachnoid mater. In a subarachnoid hemorrhage, blood collects between the pia mater
and arachnoid membrane. A contusion is a bruise on the brains surface.
The nurse is caring for the client in the ER following a head injury. The client
momentarily lost consciousness at the time of the injury and then regained it.
The client now has lost consciousness again. The nurse takes quick action,
knowing this is compatible with:
4 A. Skull fracture
5 B. Concussion
6 C. Subdural hematoma

NEURO TEST QUESTIONS


D Epidural hematoma
* Which of the following describes decerebrate posturing?
a. Internal rotation and adduction of arms with flexion of elbows, wrists, and fingers
b. Back hunched over, rigid flexion of all four extremities with supination of arms
and plantar flexion of the feet
c. Supination of arms, dorsiflexion of feet
d. Back arched; rigid extension of all four extremities.
* In planning the care for a client who has had a posterior fossa (infratentorial)
craniotomy, which of the following is contraindicates when positioning the client?
a. Keeping the client flat on one side or the other
b. Elevating the head of the bed to 30 degrees
c. Log rolling or turning as a unit when turning
d. Keeping the head in neutral position
* A client who is regaining consciousness after a craniotomy becomes restless and
attempts to pull out her IV line. Which nursing intervention protects the client without
increasing her ICP?
a. Place her in a jacket restraint
b. Wrap her hands in soft mitten restraints
c. Tuck her arms and hands under the draw sheet
d .Apply a wrist restraint to each arm
A client has signs of increased ICP. Which of the following is an early indicator of
deterioration in the clients condition?
a. Widening pulse pressure
b. Decrease in the pulse rate
c. Dilated, fixed pupil
d. Decrease in LOC
B. CONTRAST- selfish allergy, renal insufficiency, look at BUN/CREATINE LEVEL to see if
there is a type of renal issue, make sure they are well hydrated so contrast medium
can be excreted from the body.
C. AFTER any neuro surgery, pt cannot strain for any BM because it cause cause an
increase ICP so stool softener is used.
D. Know major complications is INFECTION Catheter insertion
E. tion client, maintaining the head in midline. Keep HOB elevated 30 degrees, higher
elevation may lower ICP but decrease systemic blood pressure.
F. Sodium levels
G. CRANIAL FRACTURE POSSIBLE? Dont want to insert an NG tube
H. TBI INTERVENTION ABC MANAGEMENT
I. BRAIN TUMORS- any part of the brain or spinal cord ( primary) Metastasis- (secondary)
most common type new onset of migrainesred flag.
J. Check O2 sat for trauma
K. Hob 30 degrees
L. Hypernatremia fluid and electrolyte balance for ICP/ cerebral edema.

NEURO TEST QUESTIONS


M.

N. CSF Should be:


i. Clear, colorless
ii. Specific gravity= 1.007
iii. pH= 7.35
iv. Pressure less than 60-150 mm H2O
v. Protein 5-45 mg/dL
vi. Glucose 40-70 mg/dL
vii. WBCs= 0-5 cells/mcL
viii. No bacteria or RBCs
notify HCP of CSF leakage at puncture site.
Intracranial pressure (ICP) is the hydrostatic force measured in the brain CSF
compartment. Under normal conditions in which intracranial volume remains relatively
constant, the balance among the three components (brain tissue, blood, CSF) maintains
the ICP. Factors that influence ICP under normal circumstances are changes in (1) arterial
pressure; (2) venous pressure; (3) intraabdominal and intrathoracic pressure; (4) posture;
(5) temperature; and (6) blood gases, particularly carbon dioxide levels. The degree to
which these factors increase or decrease the ICP depends on the brain's ability to adapt to
changes.

NEURO TEST QUESTIONS

OPEN TB-I TYPE OF FRACTURES


SUBDURAL HEMATOMA SUBACUTE
2/15/16

Know about neuron and structure


Do neuro check upon admit or sudden change of mental status.
o How do you check your mental status?
ORIENTATION: Person, place, time, and situation.
** Make sure you do ALL parts of the assessment because you want to get a
proper baseline.
15 highest and best score for gloscow coma scale.
Make sure if your patient is in a coma, put a T after the score.
know the difference between corticated and decorate postureing
know about lumbar puncturing, postion, care before and after procedure.
ABC important, how to control pain, know about CSF Clear colorless, pH, normal pressure*
(60-150)
ICP
Know s/s of ICP decrease LOC, headache, projectile vomiting, tachycardia,
increases systolic, tachythen brady down, slow and regular respirations, visual
and sensory and motor function
Transducer and common complications? INFECTION
INFANT: bulging fontanels, lethargy, increased head circumference
Sunset eyes
How to tx ICP
Interventions to avoid
Flexion of hips, extension of neck, coughing, avoid cluster nursing activities space
out
Know respiratory functioning after, especially every type of procedure
Know the difference between different types of fractures****
Know about post concussion syndrome and focal injury lacerations which is actual tearing
of brain tissue, contusion is bruising of the brain in a local area.
any hemorrhage can be life threatening
NEURO CHECKS AND ALWAYS ABCS

Know what to do before and after any surgical procedure


Dressing check what would you do? Dont change it, measure drainage, make
marks, notice a lot of drainage? Notify physician and the surgeon.
Know difference between primarywithin brain/spinal cord and secondary
metastisis from elsewhere, most common.

NEURO TEST QUESTIONS

2/15/16

Meningitis
o Bacterial-- medical emergency
Fever, headache, Petechiae blood culture and CT scan
o Viral

SYMPTOMS OF A THROMBOTIX STROKE EVOLVE FROM A PERIOD OF SEVERAL HOURS TO DAYS.


LEFT BRAIN STROKE = MEMORY PROBLEMS RELATED TO LANGUAGE AND MAKING DECISION
RIGHT BRAIN STROKE TEND TO BE IMPULSIVE
DONT KNOW THEIR LIMITATIONS
GET CT UPON ADMIT
ABC are important for an ischemic stroke, high bp, monitor for seizure, ICP,
seizure- turn them on their side just in case they start vomiting and PROTECT THEIR HEAD
o

Why is oral care so important? Because it can lead to pneumonia

ACUTE CAREPOSTION THEM ON WEAK AND AFFECTED SIDE FOR 30 MINUTES ONLY

Key distinction between delirium and dementia ---Sudden cognitive impairment and
cogitation delirium rather than dementia
KNOW DIFFERENT BETWEEN SPINAL AND NEUROGENIC SHOCKNEURO CHARACTERIZED
BY HYPOTENSION AND BRADYCARDIA.

CORD INJURY MONITOR RESPIRATORY FUNCTION


CERVICLE INJURY ABOVE C4-> MECHANICAL VENTILATION IS MOST LIKELY REQUIRED FOR
THESE PATIENTS AND MAKE SURE THAT YOU MAINTAIN THE AIRWAY
o Dental hygiene is important for children with cerebral palsy
o PT/OT is one of the most important care for this type of patient, encourage
family to be involved in the patients care.

Care management jaw control

NEURO TEST QUESTIONS


FOLIC ACID 0.4 MG/DAY IF HX OF DEFECTS 4MG/DAY

Major complication of shunts is infection