Medical-Surgical Nursing: Nervous & Sensory Systems Practice Flashcards

Flashcard deck containing 300 question-and-answer study cards covering Peripheral Nervous System Disorders, Cerebrovascular Disorders, Central Nervous System Disorders, Sensory System Function & Disorders, and Neurological Assessment based on Understanding Medical-Surgical Nursing (7th Edition).

What is the primary pathophysiology of Multiple Sclerosis (MS)?

Degeneration of the myelin sheath leading to inflamed nerves and slowed or blocked nerve impulses.

What are the common signs and symptoms associated with Multiple Sclerosis?

Muscle weakness, numbness, fatigue, slurred speech, vision disturbances, vertigo, ataxia, dysphagia, bowel/bladder problems, sexual dysfunction, and mood alterations.

How is Relapsing-Remitting Multiple Sclerosis (RRMS) characterized?

It is characterized by partial or total recovery (remissions) after exacerbations (relapses) that resolve.

What defines Primary Progressive Multiple Sclerosis (PPMS)?

A progressive worsening of neurological condition and disability throughout the course of the disease without distinct remissions.

What common factors are known to trigger exacerbations in patients with Multiple Sclerosis?

Stress or illness.

What diagnostic tests are used to evaluate a patient for suspected Multiple Sclerosis?

History and physical examination, cerebrospinal fluid (CSF) analysis, and magnetic resonance imaging (MRI).

What is the primary underlying cause of muscle weakness in Myasthenia Gravis (MG)?

Antibodies destroy acetylcholine (ACh) receptors, preventing ACh from stimulating muscle contraction.

Which anatomical structure is commonly abnormal or involved in the etiology of Myasthenia Gravis?

The thymus gland (thymus disorders).

What early visual clinical sign is classically observed in Myasthenia Gravis?

Ptosis (drooping of the upper eyelid).

What diagnostic test involves the intravenous injection of a anticholinesterase agent to temporarily improve muscle strength in Myasthenia Gravis?

The Tensilon test.

What symptom manifestations characterize a cholinergic crisis in Myasthenia Gravis?

SLUDGE symptoms: Salivation, Lacrimation, Urination, Diarrhea, Gastrointestinal cramping, and Emesis (along with severe muscle weakness).

Why should bathing schedules for patients with Myasthenia Gravis be modified to the morning?

Patients with Myasthenia Gravis have more energy in the morning and experience increased fatigue later in the day.

What is another common name for Amyotrophic Lateral Sclerosis (ALS)?

Lou Gehrig's disease.

What is the fundamental pathophysiology of Amyotrophic Lateral Sclerosis (ALS)?

Motor neurons degenerate, nerve impulse transmission is blocked, and muscle weakness and atrophy result.

Which medication is specifically FDA-approved to treat Amyotrophic Lateral Sclerosis by slowing disease progression?

Riluzole (Rilutek).

What immediate action should the nurse take if a patient with ALS begins coughing and sneezing during meals?

Make the patient NPO, notify the healthcare provider of aspiration risk, and collaborate with a speech therapist for a swallowing assessment.

What primary complication leads to death in patients with Amyotrophic Lateral Sclerosis?

Pulmonary complications and respiratory failure.

What is the typical progression pattern of paralysis in Guillain-Barré Syndrome?

Segmental demyelination occurring in an ascending pattern (starting in feet/legs and moving upward).

What occurs during Stage 1 of Guillain-Barré Syndrome?

Abrupt onset of weakness and ascending paralysis lasting from 24 hours to 3 weeks, which may affect respiration.

What is Stage 2 of Guillain-Barré Syndrome called and how long does it last?

The plateau stage, lasting 2 to 14 days, where progression of symptoms stops.

Which assessment takes highest priority in a patient diagnosed with Guillain-Barré Syndrome?

Respiratory rate and depth (vital capacity and respiratory status).

What therapeutic intervention is frequently used in Guillain-Barré Syndrome to remove circulating antibodies?

Plasmapheresis.

When does Postpolio Syndrome typically manifest in former polio victims?

10 to 40 years after the initial polio infection.

What neurotransmitter imbalance is implicated in Restless Legs Syndrome?

Dopamine and serotonin imbalance.

What non-pharmacological interventions can assist in relieving symptoms of Restless Legs Syndrome?

Application of heat or cold, leg massage, and warm baths.

Which cranial nerve is affected in Trigeminal Neuralgia?

Cranial Nerve V (Trigeminal nerve).

Which three sensory branches comprise the trigeminal nerve?

Ophthalmic, Maxillary, and Mandibular branches.

What type of pain medication class is commonly prescribed to relieve pain in Trigeminal Neuralgia?

Anticonvulsants (such as Neurontin / gabapentin).

What is the primary pathophysiology of Bell Palsy?

Inflammation and edema of Cranial Nerve VII (Facial nerve) causing loss of motor control.

What visual physical signs are associated with Bell Palsy on the affected side of the face?

Forehead not wrinkled, eyeball rolls up with inability to close eyelid, flat nasolabial fold, and lower face paralysis.

What eye protection measures are critical for a patient with Bell Palsy?

Using lubricating eye drops, eye patching, or taping the eye shut to prevent drying and injury due to inability to blink.

What defines a Transient Ischemic Attack (TIA)?

A temporary impairment of cerebral circulation that deprives the brain of glucose and oxygen, with symptoms resolving completely.

What percentage of strokes are preceded by a Transient Ischemic Attack (TIA)?

$$15\%$$

What is the main difference between thrombotic and embolic ischemic strokes?

Thrombotic stroke involves clot buildup occluding a vessel (often carotid); embolic stroke involves a clot or plaque travelling from elsewhere until lodged in a brain vessel.

What are the two major anatomical classifications of hemorrhagic stroke?

Subarachnoid hemorrhage (surface of brain, usually ruptured aneurysm) and Intracerebral hemorrhage (deep in brain tissue, usually due to hypertension).

What are four modifiable risk factors for stroke?

Cigarette smoking, high blood pressure, diabetes mellitus, and high total cholesterol.

What stroke risk factors are specifically applicable or modifiable in women?

Pregnancy, oral contraceptives, hormone replacement therapy, high triglycerides, history of migraines, and thick waist.

What score on the Stroke Risk Scorecard indicates a High Risk requiring immediate clinical consultation?

A total score of $\ge 3$.

What does the FAST acronym stand for regarding stroke warning signs?

Face droop, Arm drift, Speech slurred/strange, Time to call 911 immediately.

What deficits are characteristic of a left-sided cerebral hemisphere infarct?

Right-sided weakness or paralysis, aphasia (in left-brain-dominant individuals), and depression related to disability.

What deficits are characteristic of a right-sided cerebral hemisphere infarct?

Left-sided weakness or paralysis, impaired judgment/safety risk, unilateral neglect, and indifference to disability.

What diagnostic imaging procedure must be performed immediately upon arrival for a suspected stroke?

A Computed Tomography (CT) scan of the head without contrast.

What is the recommended protocol before giving any oral food, fluid, or medication to a suspected stroke patient?

A swallow (dysphagia) screening test using about $30\,\text{mL}$ of water after checking facial symmetry.

What is the administration time window for Alteplase (tPA) following ischemic stroke symptom onset?

$$3\text{ to }4.5\,\text{hours}$$

What surgical procedure involves making a neck incision to remove plaque occlusion from the carotid artery?

Carotid endarterectomy.

What is pseudobulbar affect following a stroke?

Emotional lability or instability characterized by sudden unprovoked laughing or crying.

What is the definition of a Berry aneurysm?

A sac-like outpouching of a cerebral artery wall that poses a risk for rupture and subarachnoid hemorrhage.

What vascular malformation consists of a chaotic tangle of delicate blood vessels prone to rupture?

Arteriovenous Malformation (AVM).

What surgical option is used to isolate a berry aneurysm from cerebral circulation?

Craniotomy with placement of a metal clip across the neck of the aneurysm.

What device is surgically placed to drain excess cerebrospinal fluid into the abdominal cavity in hydrocephalus?

A Ventriculoperitoneal Shunt.

To optimize cerebral tissue perfusion, at what angle should the head of the bed be maintained?

$$20\text{ to }30^\circ$$

What nursing action helps a patient with unilateral neglect compensate for sensory loss?

Teach the patient to consciously scan the environment toward the affected side.

What visual nonverbal communication tool can be provided for patients with expressive speech deficits?

A picture board.

What is Receptive Aphasia?

An impairment in which the patient is unable to comprehend spoken or written language.

What is Expressive Aphasia?

An impairment where the patient understands language but has difficulty producing spoken or written words.

What type of isolation precautions are required for a patient with confirmed bacterial meningitis?

Droplet precautions.

What are the common bacterial causative agents of meningitis?

Neisseria meningitidis, Streptococcus pneumoniae, Group B streptococcus, and Haemophilus influenzae type B.

What is the single-dose post-exposure prophylaxis medication for bacterial meningitis exposure?

Ciprofloxacin (Cipro) $500\,\text{mg}$ single dose.

How is Kernig's sign elicited and identified?

Flexing the hip to $90^\circ$ and attempting to extend the knee; positive if pain/resistance occurs in the hamstring.

How is Brudzinski's sign elicited and identified?

Passive flexion of the neck/head forward; positive if involuntary flexion of hips and knees occurs.

What environmental modifications should be provided for a patient with acute meningitis?

A dark, quiet environment with reduced sensory stimulation.

What is the most common non-insect-borne viral cause of encephalitis?

Herpes simplex virus (HSV).

What antiviral medication is administered for encephalitis caused by Herpes simplex virus?

Acyclovir (Zovirax).

What threshold defines abnormally increased intracranial pressure (ICP)?

An ICP greater than $15\,\text{mmHg}$.

What are the earliest indicators of rising intracranial pressure?

Restlessness, irritability, and a decrease in level of consciousness (LOC).

What three clinical signs constitute Cushing's Triad?

1. Increased BP with widened pulse pressure, 2. Bradycardia, 3. Irregular/decreased respirations.

What is the clinical significance of Cushing's Triad?

It is a late, life-threatening sign indicating impending brain herniation.

What invasive device monitors ICP and allows therapeutic drainage of cerebrospinal fluid?

An External Ventricular Drain (EVD) / ventricular catheter.

What underlying mechanism causes tension headaches?

Persistent contraction of scalp, facial, cervical, and upper thoracic muscles.

What are the four phases of a migraine headache?

Prodromal, aura, headache, and resolution phases.

What defines Epilepsy?

A chronic neurological disorder characterized by recurrent unprovoked seizure activity.

How do partial seizures differ from generalized seizures?

Partial seizures begin in a localized area on one side of the cerebral cortex; generalized seizures involve both cerebral hemispheres.

What is the key distinguishing factor between a simple partial seizure and a complex partial seizure?

Consciousness is maintained in simple partial seizures; consciousness is lost ($2\text{ to }15\,\text{minutes}$) in complex partial seizures.

What are the characteristics of an Absence seizure (petit mal)?

A brief lapse in awareness (several seconds) characterized by staring, common in children.

What sequence occurs during a Tonic-Clonic seizure?

Aura may occur, loss of consciousness, tonic rigidity, followed by clonic muscle contraction/relaxation, incontinence, and a postictal period.

What nursing actions are essential during active seizure activity?

Maintain airway, position on side to prevent aspiration, pad side rails, protect from injury, do not restrain, and do not place objects in mouth.

What safety restrictions apply to patients with uncontrolled seizures?

They cannot drive, operate heavy machinery, or go swimming, and should wear a medical alert bracelet.

What defines Status Epilepticus?

$30\,\text{minutes}$ of continuous, uninterrupted seizure activity.

What emergency intravenous medications are administered to terminate Status Epilepticus?

IV Diazepam (Valium) or Lorazepam (Ativan).

What is the difference between a Subdural Hematoma and an Epidural Hematoma?

Subdural involves slow venous bleeding below the dura (loss of consciousness days later); Epidural involves rapid arterial bleeding above the dura (lucid interval followed by rapid loss of consciousness).

What is Battle's sign and what does it indicate?

Ecchymosis (bruising) behind the ear over the mastoid process, indicating a basilar skull fracture.

What is Raccoon Eyes sign?

Periorbital ecchymosis (bruising around the eyes) secondary to a basilar skull fracture.

How is the Halo sign identified when testing drainage from the nose or ear?

Blood drops onto a white paper/gauze and a clear ring of CSF separates and surrounds the central red blood ring.

What procedures are strictly prohibited when a basilar skull fracture is suspected?

Nasotracheal (NT) suctioning and nose blowing.

What osmotic diuretic is administered intravenously to reduce cerebral edema in TBI?

Mannitol.

What is brain herniation?

Displacement of brain tissue (e.g., temporal lobe or brainstem) through anatomical openings like the tentorial notch due to uncontrolled ICP.

What priority safety action must be taken postoperatively for a patient who underwent brain tumor resection?

Pad the side rails of the bed (seizure precautions).

What anatomical structure herniates in a herniated disc, causing spinal nerve compression?

The nucleus pulposus.

What are the most common anatomical regions affected by herniated discs?

Cervical and lumbar spine.

What post-operative movement technique is essential following spinal fusion or laminectomy?

The log-rolling technique to maintain spinal alignment.

What is the prognosis for spinal cord injuries occurring at C3 or above?

Usually fatal due to loss of phrenic nerve innervation to the diaphragm.

What functional outcome is expected for a patient with a C4 spinal cord injury?

Quadriplegia, paralyzed from the neck down.

At what level of spinal cord injury does the risk for Autonomic Dysreflexia occur?

Injuries above T6.

What is the most common trigger for Autonomic Dysreflexia?

Bladder distention (full bladder).

What key clinical manifestations characterize Autonomic Dysreflexia?

Pounding headache, extreme hypertension (up to $300\,\text{mmHg}$ systolic), bradycardia (as low as $30\,\text{bpm}$), gooseflesh, and cool pale skin below injury.

What priority assessment should the nurse perform if a patient with a C6 SCI suddenly exhibits severe hypertension?

Perform a bladder scan or check urinary catheter tubing for obstruction.

What external halo traction device is used to stabilize cervical spine injuries?

A halo brace.

How does delirium differ from dementia?

Delirium is a temporary, acute mental disturbance that is a medical emergency; dementia is a chronic, progressive, irreversible loss of intellectual function.

What key pathological brain changes occur in Parkinson Disease?

Destruction of the substantia nigra, leading to decreased dopamine production and a relative excess of acetylcholine.

What symptoms comprise the classic triad of Parkinson Disease?

1. Tremor (pill-rolling at rest), 2. Rigidity, 3. Bradykinesia.