Neuroscience Registered Nurse Certification Flashcards

Symptoms of a fever, headaches, and confusion have been present for two days in a 33-year-old lady. Her vital signs are normal. It is typical for her to receive an immediate non-contrast head CT. Her medical team believes she may have viral encephalitis. What diagnostic procedure is most suitable?

Answer: Lumbar puncture

Viral encephalitis is an inflammation of the brain, often diagnosed by analyzing cerebrospinal fluid (CSF). A lumbar puncture (spinal tap) is the most suitable diagnostic procedure as it allows for collection of CSF, which can then be tested for viral markers, cell count, protein, and glucose to confirm the diagnosis and rule out other conditions. While a brain MRI can show inflammation, CSF analysis is often definitive for identifying the pathogen.

An elderly guy worries about his wife who has Alzheimer's disease and spends the entire day sitting in front of the TV without doing anything else. He's looking for things they can both do together. What exercise should the nurse advise the patient to do?

Answer: Stringing beads or winding yarn

For a patient with Alzheimer's disease, activities that are simple, repetitive, and engage fine motor skills are often most beneficial and manageable. Stringing beads or winding yarn provides a structured, low-stress activity that can be done together, promoting engagement and cognitive stimulation without being overwhelming. More complex activities like traveling or crossword puzzles might be too challenging or frustrating for someone with advanced Alzheimer's.

A 36-year-old man complains of low back pain when he visits the pain clinic. His symptoms started suddenly two weeks ago after he attempted to raise a hefty piece of furniture. According to him, the discomfort "shoots down" his left leg. What physical examination signs are most indicative of L4 radiculopathy?

Answer: Left foot drop

L4 radiculopathy typically affects the L4 nerve root, which innervates muscles responsible for dorsiflexion of the foot. A 'foot drop' on the left side, characterized by weakness in lifting the front part of the foot, is a classic sign of L4 nerve root compression. Other options like Babinski sign relate to upper motor neuron lesions, and Achilles reflex (S1) or extensor digitorum brevis wasting (L5/S1) are associated with different nerve root levels.

A 65-year-old woman and her son arrive at the clinic complaining of recent mental and personality changes. Her lack of social interaction, her slowness when executing manual jobs, and her tendency to forget things have all been noted by the son. The patient reports having the occasional headaches but denies having experienced any head trauma. What CT scan finding in this patient might point to a chronic subdural hematoma?

Answer: Hypodense crescent-shaped lesion in the subdural space

A chronic subdural hematoma develops slowly over weeks to months, often after minor head trauma that may not be recalled, especially in elderly patients with brain atrophy. On a CT scan, as blood ages and liquefies, it becomes less dense. Therefore, a chronic subdural hematoma typically appears as a hypodense (darker than brain tissue) crescent-shaped collection in the subdural space.

A patient with pain behind the right eye and around the right temple attends the clinic. On the same side, he also experiences rhinorrhea and lacrimation. The client has previously experienced a handful of these episodes, which typically lasted 30 to 60 minutes and were labeled as cluster headaches. He took two ibuprofen tablets at home without any alleviation. What would a nurse consider the best course of action with the fewest adverse effects?

Answer: 100% oxygen

For acute cluster headache attacks, 100% oxygen administered via a non-rebreather mask is a highly effective first-line treatment with minimal side effects. It works by causing cerebral vasoconstriction and inhibiting trigeminal nerve activity, often providing relief within 15-20 minutes. While triptans are also effective, oxygen is generally preferred due to its rapid action and excellent safety profile.

A 45-year-old man comes in with weak arms and legs that have been developing gradually. He is having trouble breathing as the weakness has now spread to his chest. He claims the weakness began in his extremities and has progressed to swallowing difficulties. Over the last three months, he has shed around 15 lbs (6.8 kg). His lower limbs have fasciculations, and an examination of his nervous system reveals hyperreflexia in his upper limbs. His gag reaction is lessened, but his jaw jerk is accentuated. Which of the following statements most accurately sums up the patient's clinical pathogenesis?

Answer: Degeneration and gliosis of axons within the anterior and lateral columns of the spinal cord

The patient's symptoms, including progressive weakness, fasciculations (lower motor neuron signs), hyperreflexia and accentuated jaw jerk (upper motor neuron signs), dysphagia, and respiratory involvement, are classic for Amyotrophic Lateral Sclerosis (ALS). ALS is characterized by the degeneration of both upper and lower motor neurons, specifically affecting the anterior horn cells and the corticospinal tracts in the lateral columns of the spinal cord and brainstem, leading to gliosis.

A 65-year-old man comes in with a bad headache that started suddenly. His medical history is crucial for both diabetes and high blood pressure. The results of the cranial nerve evaluation are normal. There are no visible motor or sensory abnormalities, although there is bilateral Babinski sign and positive nuchal rigidity. The right Sylvian fissure and basal cisterns show hyperdensity on a brain CT scan. Which of the following, given the expected diagnosis, is the most frequent complication and the main reason for postponed morbidity and mortality?

Answer: Vasospasm

The CT findings (hyperdensity in Sylvian fissure and basal cisterns) and symptoms are highly indicative of a subarachnoid hemorrhage (SAH). While rebleeding is an immediate concern, cerebral vasospasm is the most frequent and devastating delayed complication of SAH, typically occurring 3-14 days after the initial bleed. It leads to delayed cerebral ischemia and is the primary cause of postponed morbidity and mortality in SAH survivors.