PCCN Neurological System — Questions and Answers
Question 1: A patient presents with slurred speech, facial droop, and right-sided weakness. Which diagnostic test should be prioritized first?
- Electroencephalogram (EEG)
- Magnetic Resonance Imaging (MRI)
- Computed Tomography (CT) scan of the head (Correct answer)
- Carotid Doppler ultrasound
Correct answer: Computed Tomography (CT) scan of the head
A patient presenting with acute neurological deficits like slurred speech, facial droop, and weakness suggests a possible stroke. A CT scan of the head is prioritized to rapidly differentiate between ischemic and hemorrhagic stroke, as this distinction dictates immediate treatment. This quick assessment is critical for timely intervention, such as administering thrombolytics for ischemic stroke, and improving patient outcomes.
Question 2: Which of the following Glasgow Coma Scale (GCS) scores indicates moderate brain injury?
- 13–15
- 9–12 (Correct answer)
- 3–8
- 6–9
Correct answer: 9–12
The Glasgow Coma Scale (GCS) is a standardized neurological assessment tool used to measure a person's level of consciousness. A GCS score of 9–12 indicates a moderate brain injury, reflecting a significant but not severe impairment. Scores of 13–15 are considered mild, while 3–8 signify a severe brain injury, requiring close monitoring and intervention.
Question 3: A patient with a spinal cord injury at the level of T4 is at risk for which potentially life-threatening complication?
- Autonomic dysreflexia (Correct answer)
- Seizures
- Cerebral aneurysm
- Brain herniation
Correct answer: Autonomic dysreflexia
Autonomic dysreflexia is a potentially life-threatening condition that can occur in patients with spinal cord injuries at or above T6. It is characterized by an exaggerated sympathetic response to noxious stimuli below the level of injury, leading to severe hypertension, bradycardia, and headache. A T4 injury places the patient at high risk for this emergency, requiring immediate recognition and management.
Question 4: Which medication is most appropriate for treating increased intracranial pressure (ICP)?
- Morphine sulfate
- Mannitol (Correct answer)
- Lorazepam
- Amiodarone
Correct answer: Mannitol
Mannitol is an osmotic diuretic commonly used to treat increased intracranial pressure (ICP). It works by drawing fluid from the brain tissue into the vascular space, thereby reducing cerebral edema and ICP. This medication is crucial in neurocritical care to prevent secondary brain injury by maintaining adequate cerebral perfusion pressure. Other options like morphine or lorazepam are not primary treatments for ICP.
Question 5: A patient with a known seizure disorder experiences a tonic-clonic seizure lasting 8 minutes. What is the priority nursing action?
- Record the seizure activity in the chart
- Prepare for lumbar puncture
- Administer IV lorazepam (Correct answer)
- Apply soft wrist restraints
Correct answer: Administer IV lorazepam
A tonic-clonic seizure lasting 8 minutes is considered status epilepticus, a medical emergency requiring immediate intervention to prevent brain damage. IV lorazepam is a benzodiazepine that is the first-line treatment to abort prolonged seizures by enhancing GABAergic inhibition in the brain. Administering it promptly is the priority to stop the seizure activity.
Question 6: Which finding is most consistent with a left hemispheric stroke?
- Impulsive behavior and neglect
- Right-sided hemiparesis and aphasia (Correct answer)
- Left-sided weakness and visual neglect
- Intact speech with right-sided weakness
Correct answer: Right-sided hemiparesis and aphasia
The left cerebral hemisphere controls the right side of the body and is typically dominant for language in most individuals. Therefore, a left hemispheric stroke commonly results in right-sided weakness or paralysis (hemiparesis/hemiplegia) and language disturbances such as aphasia (difficulty with speech or understanding). This pattern of deficits helps localize the stroke to the left hemisphere.
Question 7: When performing a neurologic assessment, what does decerebrate posturing indicate?
- Mild brain injury
- Midbrain or brainstem dysfunction (Correct answer)
- Cervical spinal injury
- Increased oxygenation
Correct answer: Midbrain or brainstem dysfunction
Decerebrate posturing, characterized by extension and internal rotation of the arms and extension of the legs, indicates severe damage to the brainstem, specifically below the red nucleus (midbrain or pons). It signifies a more severe brain injury than decorticate posturing and often suggests a poor prognosis. This posturing reflects significant neurological dysfunction.
Question 8: Which cranial nerve is responsible for pupillary constriction in response to light?
- Cranial Nerve II (Optic)
- Cranial Nerve III (Oculomotor) (Correct answer)
- Cranial Nerve V (Trigeminal)
- Cranial Nerve VII (Facial)
Correct answer: Cranial Nerve III (Oculomotor)
Cranial Nerve III, the Oculomotor nerve, is responsible for several eye movements, including pupillary constriction (miosis) in response to light. It carries parasympathetic fibers that innervate the sphincter pupillae muscle, causing the pupil to constrict. Cranial Nerve II (Optic) is responsible for vision, but not the motor function of pupillary constriction.
Question 9: Which of the following signs is most concerning for impending brain herniation in a patient with traumatic brain injury?
- Restlessness and agitation
- Headache
- Dilated, non-reactive pupils (Correct answer)
- Vomiting
Correct answer: Dilated, non-reactive pupils
Dilated, non-reactive pupils, especially if unilateral, are a critical sign of impending brain herniation. This indicates compression of the oculomotor nerve (CN III) due to severe increased intracranial pressure, which is a neurological emergency. While restlessness, headache, and vomiting are also symptoms of increased ICP, dilated non-reactive pupils signify a more advanced and life-threatening stage of brain compression.
PCCN Neurological System
A patient presents with slurred speech, facial droop, and right-sided weakness.
Which diagnostic test should be prioritized first?