Neurological Assessment Practice Flashcards

Comprehensive question-and-answer flashcards covering subjective and objective neurological assessment, GCS scoring, cranial nerves, reflexes, motor and sensory testing, age-related changes, neurological deterioration, and specific neurological conditions.

What is the course code and lecture topic for the Neurological Assessment lecture?

Course code: NSG211. Lecture topic: Neurological Assessment.

What are the six learning objectives for the neurological assessment lecture?

1. Identify important topics for health promotion and risk reduction related to the neurological system. 2. Collect subjective data related to the neurological system. 3. Describe how to collect objective data using physical-examination techniques. 4. Demonstrate knowledge of the Glasgow Coma Scale (GCS). 5. Identify normal and abnormal neurological findings. 6. Document and communicate neurological assessment data using appropriate medical terminology and principles of recording.

What history areas and risk factors should the nurse collect during subjective data gathering?

Past medical and surgical history, medications, family history, and lifestyle. Risk factors include diabetes mellitus (DM), coronary artery disease (CAD), atrial fibrillation, sickle cell, smoking, high-fat diet, obesity, physical inactivity, and environmental risks.

What pain, weakness, movement, and balance symptoms reported by a patient are concerning?

Headache or other pains, limb or unilateral weakness, generalized weakness, paresthesia (including numbness), involuntary movements or tremors, balance or coordination difficulties, and dizziness or vertigo.

What swallowing, cognitive, communication, and sensory symptoms are concerning subjective findings?

Difficulty swallowing, intellectual changes, speech or language difficulties, changes in taste, touch, or smell, loss of or blurred vision, and hearing loss or tinnitus.

What four specific follow-up questions should the nurse ask if a patient reports having seizures?

1. When did you begin having seizures? 2. When was the last seizure you had? 3. How long did the seizures usually last? 4. Have you ever taken medication for the seizures? If so, what is the name of the medication or medications?

How should a nurse approach a reported neurological problem prior to conducting the physical exam?

Ask further, very specific questions to localize the problem as much as possible, read the physician's medical history first to avoid repetitive questions, and keep all collected subjective information in mind throughout the exam.

What six major areas are evaluated in the objective neurological examination?

Mental status (level of consciousness, cognitive function, and communication), cranial nerves, motor system, sensory system, coordination, and deep tendon reflexes.

How are full consciousness and lethargy defined and differentiated?

Full consciousness: alert, attentive, and follows commands; if asleep, responds promptly to external stimulation and remains attentive once awake. Lethargy: drowsy but awakens (not fully) to stimulation, answers questions and follows commands slowly and inattentively, with wandering attention.

How are obtundation, stupor, and coma defined?

Obtundation: difficult to arouse and requires constant stimulation; may follow simple commands or speak $1$ or $2$ words before drifting back to sleep. Stupor: arouses only to vigorous, continuous stimulation (usually painful stimulus like nail-bed pressure); may moan briefly, does not follow commands, and only withdraws from stimulus. Coma: no response to continuous or painful stimulation, no movement except possible reflexes, and no verbal sounds.

How are best eye opening and best verbal response scored on the Glasgow Coma Scale (GCS)?

Best eye opening: $4$ = Spontaneous, $3$ = To speech, $2$ = To pain, $1$ = None. Best verbal response: $5$ = Oriented, $4$ = Confused, $3$ = Inappropriate words, $2$ = Incomprehensible sounds, $1$ = None.

How is best motor response scored on the Glasgow Coma Scale (GCS)?

$6$ = Obeys commands, $5$ = Localizes to pain, $4$ = Withdraws from pain, $3$ = Abnormal flexion, $2$ = Abnormal extension, $1$ = None.

What is the score range for the Glasgow Coma Scale (GCS), and how is brain injury severity classified?

Range is $3\text{ to }15$. Severe brain injury: GCS $8$ or less. Moderate brain injury: GCS $9\text{ to }12$. Mild brain injury: GCS $13\text{ to }15$.

What clinical limitations and external factors can alter consciousness and yield an inaccurate GCS score?

Drug use, alcohol intoxication, shock, and low blood oxygen can alter consciousness and cause an inaccurate score. Mild injuries can cause temporary or permanent symptoms (with or without CT/MRI evidence), while moderate/severe injuries often cause long-term cognitive, physical, or emotional/behavioral impairment.

What are decorticate and decerebrate posturing, and what anatomical dysfunctions do they indicate?

Decortication (flexor posturing): abnormal flexion of arms toward the core with leg extension, indicating cortex dysfunction. Decerebration (extensor posturing): abnormal extension of arms and legs with arms away from the body, indicating brain-stem dysfunction.

How are orientation and memory assessed during the cognitive examination?

Orientation is assessed to person, place, time, and event; if all four are intact, document alert and oriented $\times 4$ ($\text{A\&O} \times 4$). Memory is assessed by asking the patient to remember three simple words.

What is the difference between aphasia and dysphagia?

Aphasia involves speech and language impairment (associated with Broca's area and Wernicke's area), whereas dysphagia involves difficulty swallowing.

What underlying medical conditions may be suggested by specific emotional states such as distress, anger, euphoria, or panic?

Distressed: hypoxemia (lack of oxygen). Angry/combative/irritable: electrolyte imbalance. Euphoric: drug overdose. Panicky: hypoxia, tension pneumothorax, status asthmaticus, or pulmonary embolism. Sedated: medicated for anxiety/sleep (risk of breathing problems).

What are the names of Cranial Nerves I through XII, and what mnemonic recalls their names?

I Olfactory, II Optic, III Oculomotor, IV Trochlear, V Trigeminal, VI Abducens, VII Facial, VIII Acoustic, IX Glossopharyngeal, X Vagus, XI Spinal, XII Hypoglossal. Name mnemonic: On Old Olympus' Towering Tops, A Finn And German Viewed Some Hops.

Which cranial nerves are sensory, motor, or both, and what mnemonic recalls this functional pattern?

I Sensory, II Sensory, III Motor, IV Motor, V Both, VI Motor, VII Both, VIII Sensory, IX Both, X Both, XI Motor, XII Motor. Mnemonic: Some Say Marry Money, But My Brother Says Bad Business Marry Money.

In the "cranial nerves by the numbers" face drawing, which numbers form the shoulders and face outline?

The shoulders are formed by number $11$ (cranial nerve XI controls neck and shoulder movement). The sides of the face and top of the head are formed by number $7$.

What is the primary focus when assessing the motor system?

Focus on symmetry of muscle bulk, tone, and strength, assessing bilaterally for direct comparison.

How are muscle tone, rigidity, and flaccidity defined?

Tone: tension or resistance to movement in relaxed muscles (normally mild, even resistance). Rigidity: steady, persistent resistance to passive stretch in flexor and extensor muscle groups. Flaccidity: absolutely no resistance to movement.

How is muscle strength graded on a scale from 0 to 5?

$0$ = No muscle contraction; $1$ = Barely detectable contraction or flicker; $2$ = Active movement with gravity eliminated; $3$ = Active movement against gravity; $4$ = Active movement against some resistance; $5$ = Active movement against full resistance.

What are the definitions of flexion, extension, dorsiflexion, plantar flexion, and hyperextension?

Flexion: decreases joint angle. Extension: increases angle to a straight line or $0^\circ$. Dorsiflexion: bends ankle with toes toward head. Plantar flexion: moves foot with toes away from head. Hyperextension: extension beyond neutral position.

What are the definitions of abduction, adduction, rotation, pronation, and supination?

Abduction: movement away from body center. Adduction: movement toward body center. Rotation: turning around a longitudinal axis. Pronation: turning forearm palm down. Supination: turning forearm palm up.

Why is central stimulation preferred over peripheral stimulation when evaluating motor response in an unconscious patient?

Central stimulation (such as sternal pressure) produces an overall body response and is more reliable. Peripheral stimulation (such as nail-bed pressure) can elicit a reflex response that is not a true indicator of motor activity.

What are reflexes, where are they mediated, and what are their primary functions?

Reflexes are involuntary responses to stimuli mediated through the spinal cord. Functions: maintain balance and tone, and provide quick responses in potentially harmful situations.

What anatomical structures are involved in the quadriceps deep tendon reflex arc illustration?

Ia axon, alpha motor neuron, quadriceps, muscle spindle, and quadriceps tendon.

How are deep tendon reflexes (DTRs) graded from 0 to 4+?

$0$ = No response (always abnormal); $1+$ = Slight response (may/may not be normal); $2+$ = Brisk response (normal); $3+$ = Very brisk response (may/may not be normal); $4+$ = Repeating reflex/clonus (always abnormal).

How is the Romberg test performed, and what constitutes a normal result?

Patient stands with feet together and arms at sides, then closes eyes while the nurse stands close to prevent falling. Maintaining position without opening eyes is normal and documented as Romberg negative.

What additional physical tests are used to evaluate motor coordination?

Heel-to-shin test, finger-to-nose test, and rapid alternating movements (RAM, including alternating hand positions and rapid finger-to-thumb movements).

How are proprioception and stereognosis assessed during the sensory exam?

Proprioception: moving the thumb or great toe up and down while the patient identifies position without looking. Stereognosis: ability to recognize an object by feeling its size and shape.

What structural and cognitive neurological changes occur with normal aging in older adults?

Brain volume decreases due to neuron shrinkage and reduced synaptic spines/synapses. Processing speed, executive function, episodic memory, response to stimuli, reflex speed, and multi-tasking capability decline.

What peripheral nervous system changes occur in older adults, and what risks do they create?

Decreased peripheral nerve function and impulse conduction reduce proprioception, impair gait, and reduce light-touch and pain sensation, increasing risks for poor balance, postural hypotension, falls, and injury.

What components must be included in an urgent or acute neurological assessment?

Rapid GCS assessment, pupillary reaction, gross motor strength and facial symmetry, gross sensation, and vital signs. If consciousness is impaired, test gag reflex, extraocular movements (EOMs), and corneal reflex.

What signs indicate acute neurological deterioration regarding mental status, posturing, and pupils?

Acute restlessness/agitation/confusion, unexplained LOC changes, seizures, new flexor/extensor posturing, pupil size changes, decreased light reactivity, and new conjugate or dysconjugate eye deviation.

What is the Cushing response, and what underlying pathology does it indicate?

The Cushing response is characterized by significantly rising blood pressure with widening pulse pressure, decreasing pulse rate, and decreasing respirations. It is a late sign of lower brain-stem compression.

What neurological signs and symptoms present later in the disease process of a brain tumor?

Progressive motor weakness (rigidity, weakness, lack of coordination, seizures), progressive sensory abnormalities (smell, vision, hearing, touch), progressive pain, and mental-status deterioration (cognition, judgment, speech, behavior).

What parameters should the nurse assess during the acute phase of a stroke (CVA), and what is the critical time window?

Assess responsiveness (LOC), spontaneous movement, PERL (pupil size), skin temperature/moisture/color, speech quality, and reflexes. The critical acute time window is $3\text{ to }4\text{ hours}$.

What causes meningitis, and what are the key acute assessment findings and nursing actions?

Caused by bacterial, mycobacterial, or viral agents. Findings: altered consciousness (check LOC hourly, maintain airway), seizure activity/twitching, and nuchal rigidity (pain when gently raising head/neck while supine).

What systems are affected by diabetic neuropathy, and what peripheral and autonomic symptoms occur?

Affects peripheral and autonomic nervous systems. Peripheral: paresthesia (numbness, tingling, coldness) and pain (burning, aching, crushing). Autonomic: orthostatic hypotension, sexual impotency, pupillary changes, abnormal sweating, bladder paralysis, and nocturnal diarrhea.

What causes a subdural hematoma, and what serious clinical risk does it present?

Caused by accidental/purposeful trauma, birth injury, or meningitis leading to bleeding in the subdural space. Risk: life-threatening pressure on the brain and/or brain stem, often presenting with severe headache and progressive hemiplegia.

What expected normal findings can be documented for mental status, pupils, movement, coordination, and reflexes?

Alert, GCS $15$, oriented $\times 4$, clear/fluent speech; PERRLA ($2\text{ to }6\,\text{mm}$); smooth/symmetrical movement, normal tone/bulk; Romberg negative, intact stereognosis/graphesthesia; CN II-VII intact; DTRs $2+$ bilaterally, negative plantar reflex.