Neurological Assessment & Monitoring Flashcards
7 cards from real ASC practice questions. Tap to flip, then mark Knew It or Still Learning — missed cards come back until you master them.
Read the first 7 Neurological Assessment & Monitoring flashcards as text
When monitoring a patient post-hemicraniectomy for malignant MCA infarction, the stroke coordinator should position the patient to avoid:
Answer: Neck flexion or rotation that impairs venous drainage
Neck flexion or rotation compresses jugular veins, impairing cerebral venous drainage and raising ICP, a critical concern post-hemicraniectomy.
A stroke patient's NIHSS score was 14 on admission. After tPA, the 24-hour score is 4. By modified Rankin Scale (mRS) standards, this improvement most likely reflects:
Answer: Near-complete neurological recovery likely yielding favorable functional outcome (mRS ≤1–2)
A 10-point NIHSS reduction with a 24-hour score of 4 typically correlates with favorable functional outcome (mRS ≤2) at 90 days.
Which EEG pattern in a comatose stroke patient is associated with the best prognosis for neurological recovery?
Answer: Alpha coma with reactivity to external stimuli
Alpha coma with reactivity (EEG responds to stimulation) carries a significantly better prognosis than non-reactive patterns in comatose patients.
A patient on therapeutic hypothermia post-cardiac arrest with stroke is being rewarmed. Which neurological monitoring finding during rewarming should prompt the team to pause rewarming?
Answer: New seizure activity on cEEG or clinical convulsions
New seizure activity during rewarming requires pausing or slowing the rewarming rate and initiating antiepileptic therapy before continuing.
In assessing a patient for cerebral autoregulation status after acute stroke, the Pressure Reactivity Index (PRx) is derived from:
Answer: Slow-wave correlation between mean arterial pressure and ICP
PRx is calculated as the moving correlation coefficient between slow waves of MAP and ICP; a positive PRx indicates impaired autoregulation.
When completing a neurological assessment, the examiner tests extinction by simultaneously stimulating both sides of the body. A patient who identifies each stimulus alone but only one when both are presented has:
Answer: Sensory extinction (double simultaneous stimulation deficit)
Sensory extinction occurs when bilateral simultaneous stimulation reveals neglect of the contralateral side despite intact sensation when each side is tested alone.
A patient with known atrial fibrillation develops sudden global aphasia and right hemiplegia with NIHSS of 22. Regarding neurological monitoring goals, the target MAP in the first 24 hours before tPA (patient arrived in window) should be maintained below:
Answer: 185 mmHg
Current AHA/ASA guidelines require MAP <185 mmHg (or BP <185/110 mmHg) before and during tPA administration to reduce hemorrhagic transformation risk.