Archer NCLEX review 2 QUESTIONS
AND ANSWERS
Skull fractures - ANSWER>>- Open fractures —> torn dura
- closed Fracture —> Dura is intact
- Basilar skull fracture - battle sign bruising over mastoid process - raccoon eyes
periorbital bruising cerebrospinal rhinorrhea test drainage of CSF halo test and
glucose test
- Never insert an NG tube in the client with a basilar skull fracture
Why do you never insert an NG tube with a basilar skull fracture - ANSWER>>Can
go into the brain
Epidural hematoma - ANSWER>>Dura peeled off skull
Arterial blood
Quick onset of symptoms
- Usually middle meningeal artery, dura mater, arachnoid mater
Subdural hematoma - ANSWER>>Dura attached to skull
Venous blood
Slow onset of symptoms
- dura mater, arachnoid mater
Glasgow coma scale - ANSWER>>eye opening, verbal response, motor response
- eye-opening, spontaneous 4, to sound 3, to pressure 2, none 1
- Verbal response oriented 5, confused 4, words 3, sounds 2, none 1
- motor response obeys commands 6, localizing 5, normal-flexion 4, abnormal
flexion 3, extension 2, none 1
burr hole - ANSWER>>a hole drilled into the skull using a form of drill
,Cerebral spinal fluid - ANSWER>>A clear odorless liquid found in your brain and
spinal cord
Intracranial pressure - ANSWER>>Pressure inside skull
- Normal is 5-15
- Monro Kellie hypothesis- the skull is a rigid container, filled with blood, brain,
and CSF if one of these three increases another must decrease
- Causes of tumor, bleeding, hydrocephalus, and Adema
Increased intercranial pressure symptoms - ANSWER>>- mental status changing
LOC, confusion, education, theurgy, drowsy, stuporous, decreasing GCS
- Headache, vomiting,
- vital signs Cushing triad increased systolic BP, decreased HR alteration and
respirations
- speech changes in speech, slurring, and confusion
- Eyes pupillary changes nystagmus, papiledema
- Posturing hypotonic, decerebrate decorticate, hypotonic, flaccidity, decreased
reflexes
Cushing triad - moderate signs of intercranial pressure - ANSWER>>Increase blood
pressure, low heart rate, abnormal aspirations. These are moderate signs.
Hydrocephalus - ANSWER>>Increased accumulation of cerebral spinal fluid
- increases ICP
- Caused by tumor, hemorrhage, infection, congenital
External ventricular drain and VP shunt for hydrocephalus - ANSWER>>-
ventricular space in the brain
- peritoneum membrane lining the abdominal compartment
- shunt that drains extra CSF from the brain to the abdomen where it can then be
excreted as urine
Meningitis - ANSWER>>- inflammation of the spinal cord or brain
, - Usually caused by a virus or bacteria, rarely caused by fungi of parasites
- Bacterial is the most dangerous
Assessment of meningitis - ANSWER>>nuchal rigidity and photophobia, Kernigs
sign, brudzinski sign
Late signs of intracranial pressure - ANSWER>>Posturing, biniski reflexes
Early signs of increased intercranial pressure - ANSWER>>Irritation
Kernig's sign - ANSWER>>With the client plays, supine, passive flexion of the neck
causes involuntary flexion of the knee and hips
Brudzinski's sign - ANSWER>>With the client placed supine and the hip flexed, the
knee cannot be completely extended due to pain
Treatment of meningitis - ANSWER>>Steroids ● Analgesics ● Antibiotics - only if
bacterial!! ● Isolation precautions ○ Viral - contact precautions ○ Bacterial -
Droplet precautions ■ Bacterial meningitis is VERY contagious!! Medical
emergency!! ● Prevention ○ Hib vaccine ○ Recommended for college students
due to living in close quarters in dorms
What are seizures? - ANSWER>>- seizures are not a disease in themselves. They
are symptom of the underlining disorder. - increased ICP, infection in the brain,
injury to the brain, drug abuse, hyper, or hypoglycemia, hyponatremia,
medication's
Epilepsy - ANSWER>>A neurological disorder marked by sudden reoccurring
episodes of sensory disturbance, loss of consciousness, or convulsions associated
with abnormal electrical activity in the brain no other underlining disorder
Tonic clonic seizure - ANSWER>>Phases of tonic muffled stiffening/rigidity and
clonic rhythmic jerking spasm, immediate loss of consciousness
AND ANSWERS
Skull fractures - ANSWER>>- Open fractures —> torn dura
- closed Fracture —> Dura is intact
- Basilar skull fracture - battle sign bruising over mastoid process - raccoon eyes
periorbital bruising cerebrospinal rhinorrhea test drainage of CSF halo test and
glucose test
- Never insert an NG tube in the client with a basilar skull fracture
Why do you never insert an NG tube with a basilar skull fracture - ANSWER>>Can
go into the brain
Epidural hematoma - ANSWER>>Dura peeled off skull
Arterial blood
Quick onset of symptoms
- Usually middle meningeal artery, dura mater, arachnoid mater
Subdural hematoma - ANSWER>>Dura attached to skull
Venous blood
Slow onset of symptoms
- dura mater, arachnoid mater
Glasgow coma scale - ANSWER>>eye opening, verbal response, motor response
- eye-opening, spontaneous 4, to sound 3, to pressure 2, none 1
- Verbal response oriented 5, confused 4, words 3, sounds 2, none 1
- motor response obeys commands 6, localizing 5, normal-flexion 4, abnormal
flexion 3, extension 2, none 1
burr hole - ANSWER>>a hole drilled into the skull using a form of drill
,Cerebral spinal fluid - ANSWER>>A clear odorless liquid found in your brain and
spinal cord
Intracranial pressure - ANSWER>>Pressure inside skull
- Normal is 5-15
- Monro Kellie hypothesis- the skull is a rigid container, filled with blood, brain,
and CSF if one of these three increases another must decrease
- Causes of tumor, bleeding, hydrocephalus, and Adema
Increased intercranial pressure symptoms - ANSWER>>- mental status changing
LOC, confusion, education, theurgy, drowsy, stuporous, decreasing GCS
- Headache, vomiting,
- vital signs Cushing triad increased systolic BP, decreased HR alteration and
respirations
- speech changes in speech, slurring, and confusion
- Eyes pupillary changes nystagmus, papiledema
- Posturing hypotonic, decerebrate decorticate, hypotonic, flaccidity, decreased
reflexes
Cushing triad - moderate signs of intercranial pressure - ANSWER>>Increase blood
pressure, low heart rate, abnormal aspirations. These are moderate signs.
Hydrocephalus - ANSWER>>Increased accumulation of cerebral spinal fluid
- increases ICP
- Caused by tumor, hemorrhage, infection, congenital
External ventricular drain and VP shunt for hydrocephalus - ANSWER>>-
ventricular space in the brain
- peritoneum membrane lining the abdominal compartment
- shunt that drains extra CSF from the brain to the abdomen where it can then be
excreted as urine
Meningitis - ANSWER>>- inflammation of the spinal cord or brain
, - Usually caused by a virus or bacteria, rarely caused by fungi of parasites
- Bacterial is the most dangerous
Assessment of meningitis - ANSWER>>nuchal rigidity and photophobia, Kernigs
sign, brudzinski sign
Late signs of intracranial pressure - ANSWER>>Posturing, biniski reflexes
Early signs of increased intercranial pressure - ANSWER>>Irritation
Kernig's sign - ANSWER>>With the client plays, supine, passive flexion of the neck
causes involuntary flexion of the knee and hips
Brudzinski's sign - ANSWER>>With the client placed supine and the hip flexed, the
knee cannot be completely extended due to pain
Treatment of meningitis - ANSWER>>Steroids ● Analgesics ● Antibiotics - only if
bacterial!! ● Isolation precautions ○ Viral - contact precautions ○ Bacterial -
Droplet precautions ■ Bacterial meningitis is VERY contagious!! Medical
emergency!! ● Prevention ○ Hib vaccine ○ Recommended for college students
due to living in close quarters in dorms
What are seizures? - ANSWER>>- seizures are not a disease in themselves. They
are symptom of the underlining disorder. - increased ICP, infection in the brain,
injury to the brain, drug abuse, hyper, or hypoglycemia, hyponatremia,
medication's
Epilepsy - ANSWER>>A neurological disorder marked by sudden reoccurring
episodes of sensory disturbance, loss of consciousness, or convulsions associated
with abnormal electrical activity in the brain no other underlining disorder
Tonic clonic seizure - ANSWER>>Phases of tonic muffled stiffening/rigidity and
clonic rhythmic jerking spasm, immediate loss of consciousness
