NURS 334 EXAM QUESTIONS AND ANSWERS A
+ GRADED
Kernig's Sign
Lying supine with hip flexed at 90 degree angle, shows resistance to passive extension
of the knee
-Sign of Meningitis
Meningitis manifestations
Nuchal rigidity
Positive Kernig's sign
Positive Brudzinski's sign
Photophobia
Rash indicative of N. meningitidis
Myasthenia Gravis
Autoimmune disorder characterized by weakness and rapid fatigue of any of the
muscles under voluntary control. Caused by breakdown in the normal communication
between nerves and muscles
Myasthenia Gravis Pathophysiology
Reduction in the number of acetylcholine receptor sites (continuous binding of the
ACTH is required for muscle contraction)
Myasthenia Gravis Manifestations
Initial manifestation involves ocular muscles: diplopia (double vision) and ptosis
Blood tests reveal ACTH receptor antibodies in the blood
Postictal State Characteristics
Confusion, nausea, hypertension, headache or migraine, and amnesia
Parkinson's complications
Thinking difficulties, depression, emotional changes, swallowing problems, sleep
disorders, bladder problems, constipation, blood pressure changes (orthostatic
hypertension), smell dysfunction, fatigue, pain in specific areas of the body, sexual
dysfunction
Parkinson's Nursing Management
Controlling symptoms and maintaining functional independence
Antiparkinsonian medications and deep brain stimulation
Enhancing mobility
Enhancing self-care
Improving nutrition
Maintaining bowel function
Enhancing swallowing
Improving communication
Supporting coping ability
Encephalitis
Inflammation of the brain tissue (cerebral cortex) Often due to infection
Secondary to vituses (HIV, HSV,) bacteria, fungi, or parasites
,Multiple Sclerosis
An immune-mediated progressive demyelinating disease of the CNS
Immune system eats away at protective covering of nerves
Relapse remitting (RR) course is most common
MS nursing management
Promoting and preserving mobility, minimizing spasticity and contractures, preventing
injury, promoting bowel and bladder control
Skull fracture nursing management
Look for CSF leakage from nose, ears, bruising around the eyes, battles sign
NOTHING should be allowed in patient's nose or ears to prevent meningitis
Clinical manifestations from increased brain compression
Acute: changes in LOC, pupillary changes, hemiparesis (onesided weakness), coma,
BP changes, decreased HR/RR
Chronic: Neurologic deficits followed by headache
Epidural Hematoma
Collection of blood in the epidural space between the skull and the dura
Can result from a skull fracture that causes a rupture or laceration of the middle
meningeal artery, which causes a rapid increase in pressure of the brain
Medical emergency
Respiratory arrest can occur within minutes
Subdural Hematoma
Collection of blood between the dura and the brain
Most common cause is trauma, but it can also occur as a result of coagulopathies
(bleeding disorders) or rupture of an aneurysm
elderly are at increased risk
Could be acute or chronic
Neurogenic shock signs and symptoms
Increased heart rate and blood pressure
Decreasing cardiac output causes venous pooling which results in hypotension and
bradycardia and warm skin
Pt doesn't perspire on paralyzed areas because of the blocking of the sympathetic
nervous system- abrupt onset of fever
SCI Nursing Management
Assessing altered breathing, changes in motor or sensory function, spinal shock, urinary
retention, overdistension of the bladder, and paralytic ileus (paralysis of intestinal
muscles
Nursing interventions for Increased Intracranial pressure
Treating cerebral edema (with mannitol), controlling fever, maintaining BP and
oxygenation, reducing metabolic demand, preventing seizures, preserving the integrity
of the skin and corneas, promoting nutrition, and preserving bladder and bowel function
Sit the patient up
Cushing's Response
Occurs when cerebral blood flow decreases significantly
Compensatory measure that attempts to restore blood flow by increasing arterial
, pressure to overcome the increased intracranial pressure; includes rising systolic
pressure, widening pulse pressure, bradycardia
Cushing's Syndrome
Disorder characterized by high levels of serum cortisol
Symptoms resulting from excess free circulating cortisol from the adrenal cortex
Cushing's Syndrome Causes
Pituitary tumor that overproduces ACTH, termed Cushing's disease
An adrenal tumor that overproduces ACTH, termed Cushing's syndrome
Long-term glucocorticoid pharmacological therapy, termed iantrogenic
Overuse of corticosteroid
Cushing's Triad
Three classic signs of Cushing's disease
-bradycardia
-hypertension
-bradypnea
Represents a loss of compensatory mechanism, a presentation of brainstem
dysfunction
Herniation and brainstem occlusion of the cerebral blood flow occur if therapeutic
intervention is not initiated immediately
Assessment of Increased Intracranial Pressure
Earliest sign is change in LOC
Headache, weakness, pupillary changes
Can be monitored using intraventricular catheter or subarachnoid bolt or screw
Nurse must conduct frequent, focused neuro assessments
Diabetes Insipidus
Deficiency of ADH characterized by excessive thirst (polydipsia) and large volumes of
dilute urine
Three types: neurogenic, nephrogenic, psychogenic
DI: neurogenic
Results from damage to the posterior pituitary gland
DI: Nephrogenic
Results from drug related damage to the renal tubules
Lithium, demeclocycline, ofloxacin, orlisatt, high levels of calcium, low levels of
potassium, kidney disease, and polycystic kidney disease
Diabetes Insipidus Treatment
Replace ADH, ensure adequate fluid replacement, and identify and correct the
underlying intracranial pressure
Diabetes Insipidus Nursing Management
Maintaining adequate fluid volume, monitoring patient's weight, administering
vasopressin (ADH), monitoring vital signs, and monitoring patient's intake and output
Syndrome of Inappropriate Antidiuretic Hormone
Hypersecretion of ADH
SIADH Common Causes
Brain and spinal cord conditions (direct injury, infection, or fluid buildup), Cancer, lung
conditions, certain medicines (diabetes meds, cancer meds, or depression) Family
history of SIADH, too much physical pain or stress
+ GRADED
Kernig's Sign
Lying supine with hip flexed at 90 degree angle, shows resistance to passive extension
of the knee
-Sign of Meningitis
Meningitis manifestations
Nuchal rigidity
Positive Kernig's sign
Positive Brudzinski's sign
Photophobia
Rash indicative of N. meningitidis
Myasthenia Gravis
Autoimmune disorder characterized by weakness and rapid fatigue of any of the
muscles under voluntary control. Caused by breakdown in the normal communication
between nerves and muscles
Myasthenia Gravis Pathophysiology
Reduction in the number of acetylcholine receptor sites (continuous binding of the
ACTH is required for muscle contraction)
Myasthenia Gravis Manifestations
Initial manifestation involves ocular muscles: diplopia (double vision) and ptosis
Blood tests reveal ACTH receptor antibodies in the blood
Postictal State Characteristics
Confusion, nausea, hypertension, headache or migraine, and amnesia
Parkinson's complications
Thinking difficulties, depression, emotional changes, swallowing problems, sleep
disorders, bladder problems, constipation, blood pressure changes (orthostatic
hypertension), smell dysfunction, fatigue, pain in specific areas of the body, sexual
dysfunction
Parkinson's Nursing Management
Controlling symptoms and maintaining functional independence
Antiparkinsonian medications and deep brain stimulation
Enhancing mobility
Enhancing self-care
Improving nutrition
Maintaining bowel function
Enhancing swallowing
Improving communication
Supporting coping ability
Encephalitis
Inflammation of the brain tissue (cerebral cortex) Often due to infection
Secondary to vituses (HIV, HSV,) bacteria, fungi, or parasites
,Multiple Sclerosis
An immune-mediated progressive demyelinating disease of the CNS
Immune system eats away at protective covering of nerves
Relapse remitting (RR) course is most common
MS nursing management
Promoting and preserving mobility, minimizing spasticity and contractures, preventing
injury, promoting bowel and bladder control
Skull fracture nursing management
Look for CSF leakage from nose, ears, bruising around the eyes, battles sign
NOTHING should be allowed in patient's nose or ears to prevent meningitis
Clinical manifestations from increased brain compression
Acute: changes in LOC, pupillary changes, hemiparesis (onesided weakness), coma,
BP changes, decreased HR/RR
Chronic: Neurologic deficits followed by headache
Epidural Hematoma
Collection of blood in the epidural space between the skull and the dura
Can result from a skull fracture that causes a rupture or laceration of the middle
meningeal artery, which causes a rapid increase in pressure of the brain
Medical emergency
Respiratory arrest can occur within minutes
Subdural Hematoma
Collection of blood between the dura and the brain
Most common cause is trauma, but it can also occur as a result of coagulopathies
(bleeding disorders) or rupture of an aneurysm
elderly are at increased risk
Could be acute or chronic
Neurogenic shock signs and symptoms
Increased heart rate and blood pressure
Decreasing cardiac output causes venous pooling which results in hypotension and
bradycardia and warm skin
Pt doesn't perspire on paralyzed areas because of the blocking of the sympathetic
nervous system- abrupt onset of fever
SCI Nursing Management
Assessing altered breathing, changes in motor or sensory function, spinal shock, urinary
retention, overdistension of the bladder, and paralytic ileus (paralysis of intestinal
muscles
Nursing interventions for Increased Intracranial pressure
Treating cerebral edema (with mannitol), controlling fever, maintaining BP and
oxygenation, reducing metabolic demand, preventing seizures, preserving the integrity
of the skin and corneas, promoting nutrition, and preserving bladder and bowel function
Sit the patient up
Cushing's Response
Occurs when cerebral blood flow decreases significantly
Compensatory measure that attempts to restore blood flow by increasing arterial
, pressure to overcome the increased intracranial pressure; includes rising systolic
pressure, widening pulse pressure, bradycardia
Cushing's Syndrome
Disorder characterized by high levels of serum cortisol
Symptoms resulting from excess free circulating cortisol from the adrenal cortex
Cushing's Syndrome Causes
Pituitary tumor that overproduces ACTH, termed Cushing's disease
An adrenal tumor that overproduces ACTH, termed Cushing's syndrome
Long-term glucocorticoid pharmacological therapy, termed iantrogenic
Overuse of corticosteroid
Cushing's Triad
Three classic signs of Cushing's disease
-bradycardia
-hypertension
-bradypnea
Represents a loss of compensatory mechanism, a presentation of brainstem
dysfunction
Herniation and brainstem occlusion of the cerebral blood flow occur if therapeutic
intervention is not initiated immediately
Assessment of Increased Intracranial Pressure
Earliest sign is change in LOC
Headache, weakness, pupillary changes
Can be monitored using intraventricular catheter or subarachnoid bolt or screw
Nurse must conduct frequent, focused neuro assessments
Diabetes Insipidus
Deficiency of ADH characterized by excessive thirst (polydipsia) and large volumes of
dilute urine
Three types: neurogenic, nephrogenic, psychogenic
DI: neurogenic
Results from damage to the posterior pituitary gland
DI: Nephrogenic
Results from drug related damage to the renal tubules
Lithium, demeclocycline, ofloxacin, orlisatt, high levels of calcium, low levels of
potassium, kidney disease, and polycystic kidney disease
Diabetes Insipidus Treatment
Replace ADH, ensure adequate fluid replacement, and identify and correct the
underlying intracranial pressure
Diabetes Insipidus Nursing Management
Maintaining adequate fluid volume, monitoring patient's weight, administering
vasopressin (ADH), monitoring vital signs, and monitoring patient's intake and output
Syndrome of Inappropriate Antidiuretic Hormone
Hypersecretion of ADH
SIADH Common Causes
Brain and spinal cord conditions (direct injury, infection, or fluid buildup), Cancer, lung
conditions, certain medicines (diabetes meds, cancer meds, or depression) Family
history of SIADH, too much physical pain or stress
