Certified Neuroscience Registered Nurse Flashcards

A patient's neurological examination has been deteriorating after a severe occurrence that may have caused hypoxic brain injury. She does not respond to unpleasant stimuli, take spontaneous breaths while on the ventilator, or dilate in response to light. If the family declines a palliative care consultation, which of the following is appropriate?

Answer: Initiate brain death protocol.

The patient's neurological examination findings—no response to noxious stimuli, no spontaneous respirations while on the ventilator, and fixed pupils—are consistent with brain death. Even if the family declines palliative care, it is medically and ethically appropriate to initiate a brain death protocol to formally determine if brain death has occurred, as this has significant implications for care and prognosis.

Which of the following does warfarin users not need to avoid?

Answer: Iceberg lettuce

Warfarin is an anticoagulant whose effectiveness is highly sensitive to Vitamin K intake, as Vitamin K promotes blood clotting. Foods high in Vitamin K, such as kale and other dark leafy greens, can counteract warfarin's effects and should be consumed consistently or avoided. Iceberg lettuce has a very low Vitamin K content and therefore does not significantly interfere with warfarin's action.

In which of the following injuries is a percutaneous gastrostomy (PEG) tube most likely required?

Answer: C2

A C2 spinal cord injury is a very high cervical injury that typically results in complete paralysis, including diaphragmatic paralysis, requiring mechanical ventilation. Patients with such severe injuries often lose the ability to swallow safely and effectively, making a percutaneous gastrostomy (PEG) tube necessary for long-term nutritional support and to prevent aspiration.

A patient who is attempting to get pregnant asks what she may do to help prevent spina bifida from occurring in her unborn child. What is the best course of action?

Answer: Eating several oranges daily.

Spina bifida is a neural tube defect that can be largely prevented by adequate folic acid intake before and during early pregnancy. Oranges are a good natural source of folate (folic acid), making this a beneficial dietary recommendation for preventing spina bifida. Other options like alcohol, low-sugar diets, or milk intake do not directly address folic acid needs.

At the bedside, a patient's condition following a car accident is being assessed. The patient is intubated; he withdraws in response to unpleasant stimuli and his eyes open to sternal rub. What is his GCS, or Glasgow Coma Scale?

Answer: Seven

The Glasgow Coma Scale (GCS) assesses eye opening, verbal response, and motor response. For this patient: eyes open to sternal rub scores 2 (to pain); verbal response is 1 (intubated, unable to assess); and withdrawing to unpleasant stimuli scores 4 (withdraws to pain). Therefore, the total GCS score is 2 + 1 + 4 = 7.

A man who had suffered a stroke was admitted to the hospital. He has a history of using cocaine. His vital signs and lab results are as follows: blood pressure is 20/89, an EKG reveals atrial fibrillation with 110 beats per minute, his hemoglobin A1c is 5.6%, and his complete blood count and basic metabolic panel are unremarkable. How many potential causes of a stroke did this patient have?

Answer: four

This patient presents with four distinct potential causes for a stroke. These include a history of cocaine use (vasoconstriction, arrhythmias), atrial fibrillation (a major source of cardioembolic stroke), an abnormal blood pressure (whether it's hypertension or severe hypotension, both are stroke risks), and prediabetes (indicated by an Hgb A1c of 5.6%), which increases the risk of atherosclerosis and stroke.

The intensive care unit is evaluating a patient who was admitted to the hospital with an acute right-sided ischemic stroke. Which of the following would worry the medical staff the most?

Answer: Patient is no longer able to lift his left arm.

A right-sided ischemic stroke affects the left side of the body. A new or worsening neurological deficit, such as the inability to lift the left arm, indicates stroke progression or a new event. This change is a critical sign of neurological deterioration, requiring immediate medical intervention to prevent further brain damage and improve patient outcomes.