question

Which of the following is true regarding scoliosis? a) most cases have a juvenile onset b) the 1st sign is a prominent scapula c) it is congenital in origin

answer

most cases have a juvenile onset

question

A 6 mof had a VP shunt placed today for hydrocephalus. The baby has become increasingly lethargic. As a PICU RN, you know that a) the shunt may be occluded b) its not unusual for babies w/ hydrocephalus to fatigue easily c) the shunt is functioning well d) it is the baby's usual naptime

answer

a) the shunt may be occluded

question

The most common cause of acquired hydrocephalus is a) HIV infection B) idiopathic C) maternal rubella infection d) bacterial meningitis

answer

d) bacterial meningitis

question

Common symptoms of hydrocephalus in a 4 mo old would include: A) Macewaen's sign, fused fontanelles B) macrocrania, rapid skull growth, FTT c) flat scalp veins, split sutures d) microcrania, hyperreflexia, bulging fonganelles

answer

macrocrania, rapid skull growth, FTT

question

A 3yom w/ a vp shunt placement POD2 is febrile, tachycardic, & lethargic. You should anticipate what orders? a) CBC w/ diff, CRP, sed rate, ceftazidime, cooling measures b) CSF cx, acetaminophen, azithromycin C) CT scan, CSF cx, ciprofloxacin D) levofloxacin, CT scan, CRP

answer

a) CBC w/ diff, CRP, sed rate, ceftazidime, cooling measures - need to establish presence of an infection via CBC; ceftazidime are broader spectrum coverage

question

Syringomyelia is most often seen in conjunction w/ which other neurologic problem? a. syringomyelia occurs as a unique entity b. myoclonic seizures c. Chiari II malformation d. schizenocephaly

answer

c. Chiari II malformation. it creates cysts called syrinx that grow to produce long cavities w/in the spinal cord; cavities damage the afferent spinal cord causing interruption of nerve conduction fromt he brain to the extremities which results in weakness & pain. Best identified w/ MRI

question

Which assessments should be done for a 4mof w/ hydrocephalus after a vp shunt placement? a. frequent NS, HOB 30 degrees, head midline b. VS q 15 min; hob flat, positioned on L side c. NS hourly, hob 30 degrees, positioned on R side d. head midline, prone positioning

answer

a. frequent NS, HOB 30 degrees, head midline

question

Which nursing diagnoses should be addressed for a child after a vp shunt is placed? a) increased ICP, potential for inadequate oxygenation, potential for infection, pain b. decreased ICP, potential for inadequate oxygenation, potential for infection, pain c. potential for infection, pain management, potential for dehydration d. potential for infection, pain management, alteration in nutrition

answer

a) increased ICP, potential for inadequate oxygenation, potential for infection, pain

question

What is the most common cause of hearing loss among children in the US? a) syphilis b) loud music c) CMV infection d) herpes simplex infection

answer

c) CMV infection - can cause a myriad of neuro problems; most common congenital infection in humans; most serious sequelae

question

What sign is the most useful to help diagnose hydrocephalus in an infant? a. Battle's sign b. Macewen's sign c. Lhermitte's sign d. Tredelenberg's sign

answer

b. Macewen's sign - elicited by tapping the junction of the frontal, parietal, and temporal lobes; s strong resonant sound is produced.

question

What are the 2 most common causes of a comatose state in a child younger than 5 yrs of age? a. falls & drowning b. inappropriate use of car seats & trauma c. nonaccidental trauma & near drowning d. accidental overdose & head injury

answer

c. nonaccidental trauma & near drowning (mostly due to child abuse)

question

Ingestion of which of the following drugs may lead to coma? a) diet pills, opiates b) scopolamine, opiates, ethanol c. cocaine, lithium, atropine d. ethanol, LSD, atropine

answer

b. scopolamine, opiates, ethanol drugs that are readily found in the home

question

What does the pediatric glasgow coma scale measure?

answer

eye opening, motor response, verbal response

question

A pt in an MVA suffered a basilar skull fx. What signs are indicative of a fx of the middle fossa?

answer

Battle's sign

question

a 16yom who was hit w/ a baseball bat onb the L side of his head in a game is in the PICU. What is the most sensitive indicator of his neurological status?

answer

LOC

question

A pt w/ a basilar skull fx has a stain on his pillow w/ a small amt of blood encircled by a pale yellow ring. The ring is called a

answer

halo sign. It is dangerous - meningitis can easily dvlp due toa pathway that allows bacteria to invade the oropharynx.

question

The most accurate method of measuring ICP is placement of a(n)

answer

intraventriculostomy (inserted into 1 of the lateral ventricles.

question

Normal ICP in a 3 yr old child is

answer

3-7 mmHg

question

What is the fx of the myelin sheath in the CNS?

answer

allows faster transmission of nerve impulses

question

What are the s/sx of Cushing's triad?

answer

widened pulse pressure, bradycardia, increased systolic BP (high risk for herniation and imminent death)

question

When should an LP be done on a pt w/ ICP?

answer

never - it can lead to herniation of the tentorium or brain stem and death

question

The most important indicator of deterioration of neurologic status is

answer

LOC

question

Decreased ICP may be due to a) CO2 retention b) PaO2 less than 50 mmHg C) Increased cerebrospinal fluid absorption D) increased metabolic activity

answer

C) Increased cerebrospinal fluid absorption Other choices lead to increased ICP

question

A pt has a closed head injury. He has a foley catheter. In 1 hour, his urine output increased from 30 ml/hr to 1000 ml/hr of ver pale, clear urine. The pt is suffering from.....

answer

DI

question

What is the treatment for DI?

answer

DDAVP (desmopressin) & IVF replacement w/ D5W 1/2 NS 20meq potassium titrated to replace hourly UO (D = pt is Dry)

question

Why is it important to stop seizure activity in a pt w/ SE? a) O2 depletion may occur due to an impeded airway b) there is an increased risk of CVA c) continued seizure activity causes lactic acidosis & cerebral edema d) injury risk increases w/ continued seizures

answer

c) continued seizure activity causes lactic acidosis & cerebral edema (depletes glucose and oxygen in the brain & hypocia causes cerebral edema, increased lactic acidosis & can damage neurons

question

What is the formula for calculating CPP?

answer

CPP = MAP - ICP (MIC: Map - Icp = Cpp [MIC])

question

What is the ideal range of CPP in a 4yo?

answer

50-60 mmHg

question

What cranial nerves are affected by a basilar skull fracture?

answer

CN I, VII, & VIII olfactory, facial & acoustic

question

What is nystagmus?

answer

Rhythmic tremor or shaking of the eyes

question

What are the most common causes of SIADH?

answer

bronchogenic (oat-cell) cancer, pneumonia, & head injury

question

Intact spinal reflexes indicates

answer

functional lower motor neurons (DTRs)

question

How are spinothalamic tract responses tested? a) DTRs b) Babinski C) pinprick or monofilament testing D) patellar tendon reflex

answer

C) pinprick or monofilament testing

question

In what type of injury do you see autonomic hyperreflexia?

answer

spinal cord injury S/sx are severe HTN, dysrhythmias, severe h/a, photophobia

question

What is the tx for SIADH?

answer

fluid restriction, diuretics, Na replacement, declomycin. (Siadh: S = pt is "soppy wet" and needs salt)

question

In the Doll's Eyes maneuver to test for brain death, a NORMAL response would be for the eyes to move in ____ direction as the head is turned

answer

the opposite. If the pt is brain dead, the eyes move in the same direction as the head.

question

What is the body position in decerebrate posturing?

answer

arms fully extended & internally rotated, both legs fully extended w/ toes pointed. Demonstrates midbrain & pons pressure.

question

Brown-Sequard syndrome causes ___ motor paralysis and _____ loss of pain & temperature sensation

answer

ipsilateral (same side) contralateral (opposite side)

question

A pt w/ R side head injury suddenly develops R pupil dilation. The change probably indicates ___ herniation

answer

uncal (ipsilateral). Herniation puts pressure directlyon CNIII, causing pupil dilation. It is a very poor sign for survival

question

What is the most common baceria that causes meningococcal meningitis?

answer

N. meningitidis

question

What are the common risk factors for the development of meningococcal meningitis?

answer

Youth, splenectomy, living in a dorm (or close quarters)

question

What is the hallmark symptom of meningococcal meningitis? a) headache b) petechiae c) malaise d) vomiting

answer

petechiae; the other symptoms can be seen in any form of meningitis

question

A pt had a slight cold several days ago. Today he is having ascending weakness in both legs. What is this suggestive of?

answer

Guillan-Barre syndrome. Demyelenating autoimmune process that affects the spinal & cranial nerves. The myelin sheath is interrupted or destroyed. Pt does NOT lose sensory functioning and may have a great deal of pain

question

In a child older than 6 yrs of age, a positive Babinski or plantar reflex indicates an ___ ___ ___ lesion.

answer

an upper motor neuron lesion

question

Your pt has just returned from VP shunt placement. The burr hole is in the R parieto-occipital side because the L side is near the ___ ___ ___

answer

speech comprehension center

question

Normal CSF should be ____ (color) and clear with less than 45 mg/dL of ___. WBC should be? Glucose should be?

answer

clear protein WBC count should be between 0-5 cells / mm2, glucose approx 80%

question

What cranial nerves are the 6 cardinal eye directions for eye movement testing?

answer

III - occulomotor IV - trochlear VI - abducens

question

The most common cause of hemorrhagic stroke in children is

answer

AVM - arteriovenous malformation

question

What is the RNs first priority when caring for a child w/ a CVA?

answer

Airway Breathing Circulation

question

Which area in the cerebrum controls verbal expression?

answer

Broca's area (lower edge of the frontal lobe)

question

What is the homunculus?

answer

the outer strip of the cerebral cortex which governs the motor functioning of the frontal lobe & the sensory functioning of the parietal lobe.

question

A 15 yof has Guillain-Barre syndrome. What is the most important parameter to monitor for this pt? a) BP B) NIF (negative inspiratory force) C) pain level

answer

NIF

question

What results would you expect in the eval of CSF in a pt w/ Guillain Barre syndrome? Increased: a) WBCs b) protein levels c) glucose levels d) anaerobic bacteria

answer

B - protein in the CSF is always increased w/ GB syndrome due to the destruction of the myelin sheath.

question

Your pt w/ Guillain Barre syndrome is experiencing a great deal of pain. Why is the pain occuring? a) parasympathetic fx? b) sympathetic inactivity c) autonomic dysfunction d) sympathetic function

answer

autonomic dysfunction caused by a lack of balance in the ANS.The SNS is unopposed & leads to heightened sensitivity & overresponse to even minor stimuli.

question

A relative contraindication for the admin of methylprednisolone following a spinal cord injury would be:

answer

pregnancy

question

The s/sx of spinal shock include:

answer

areflexia, autonomic dysfunction, loss of sensation & elimenatory dysfunction.

question

How does neurogenic shock differ from spinal shock?

answer

Neurogenic shock is a much more severe form of shock that may occur w/ spinal cord injuries at or above T6. The autonomic dysfunction produces an increased vagal tone, which results in severe bradycardia, decreased CO, peripheral dilatation & decreased SVR

question

AVMs are: a) commony found misshapen blood vessels b) more common in women than men c) a complex tangle of misshapen blood vessels that are susceptible to hemorrhage d) never seen in children

answer

C - complex tangle of misshapen blood vessels that are susceptible to hemorrhage. AVMs are the most common cause of stroke in kids <12 years of age

question

Spinal reflexes indicate functional ___ ____ neurons

answer

lower motor

question

A sympathetic response to stimulus results in ____ awareness, ____ bp, bronchial ____, and ____ glucogenosis

answer

heightened awareness, increased BP, bronchial constriction, increased glucogenosis

question

Cerebral aneurysms are most often found in the

answer

anterior bifurcations of the Circle of Willis

question

A pt w/ an "explosive" h/a described as "the worst h/a of my life" may have a

answer

ruptured cerebral aneurysm

question

Management of a pt w/ a cerebral aneurysm includes GCS assessments and: a) maintaining normal ICP B) maintaining BP < 120 c) ambulating & monitoring vitals & neuro status d) monitoring for cerebral vascular spasm

answer

d) monitoring for cerebral vascular spasm - a potentially life threatening problem that occurs 2ndary to meningeal irritation from the blood in the subarachnoid space. Earliest sign of vasospasm is a change in the LOC

question

S/sx of ataxia include

answer

refusal to walk, nystagmus, afebrile

question

Children who have Tourette syndrome have symptoms that will ____ as they get older

answer

fade

question

Wht tests would you expect to be ordered for a pt who has focal neuro deficits, papilledema, & increased ICP. He has no significant PMH, has not recently been treated w/ abx, but did have otitis media.

answer

CT or MRI to r/o mass or abscess (which can be a result of untreated otitis media)

question

What type of brain tumor is most common in children?

answer

astrocytoma. (isn't Astro the name of George Jetson's dog? Kids and dogs...named Astro)

question

What condition is most likely to occur w/ a pt who received a subarachnoid hemorrhage? a) communicating hydrocephalus b) DM c) lymphoma d) metastatic bone tumor

answer

a) communicating hydrocephalus - moves through the subarachnoid space where it may clog the arachnoid villi, preventing absorption of the CSF. May be permanent require a vp shunt

question

What cranial nerve is most often affeted by basilar skull fx?

answer

Oflactory - CN I - loss of smell

question

What is an early sign of uncal herniation?

answer

Ipsilateral pupil dilation

question

What test is performed to confirm or rule out Myasthenia gravis?

answer

Tensilon test

question

What is the "purple glove syndrome"? A potential complication of IV ____ administration.

answer

phenytoin - can lead to fasciotomy or amputation of a limb. P = Phenytoin AND Purple

question

Which type of seizure is treated w/ topiramate?

answer

Partial seizures (top of head you have a part; also for migraines. Street name is dopamate cause it makes you dopey)

question

In what age group do febrile seizures usually occur?

answer

6 mos - 6 yrs

question

What dose of prescribed Adderall should the pt be given if she is in the PICU for viral cardiomyopathy?

answer

none, it is contraindicated - can cause htn, tachyarrhythmias, and sudden cardiac death

question

What precautions should be taken when giving mannitol to a pt w/ cerebral edema?

answer

a powerful diuretic that can induce cardiovascular collapse if given quickly. Give inline 5-micron filter over 20-30 min

question

How quickly should phenoparbital be given to a patient?

answer

via slow ivp at a rate less than 30 milligrams per min. rapid infusion can lead to extravasation & tissue destruction

question

"Coup-contra-coup brain injury means: a) a mild concussion that resolves quickly b) a complicated brain injury that may have lasting effects c) a moderate concussion that will resolve in 4-6 mos d) a complicated brain injury that will resolve completely

answer

b) a complicated brain injury that may have lasting effects (such as h/a, seizures, memory loss). the 2nd injury results from ensuing cerebral edema

question

What is not a condition of a cerebellar tumor: a) troncal ataxia b) nystagmus c) impaired coordination d) ataxia

answer

d. ataxia

question

deep cerebral hemispheric tumors cause a) hemiplegia b) motor dysfunction c) speech dysfunction d) irritability

answer

a. hemiplegia & visual field defects (HEMI = sphere & plegia)

question

What is the separation of cranial sutures known as?

answer

diastasis

question

Where is the skull fracture on a child who has blood collecting behind the tympanic membrane?

answer

temporal bone fx

question

What is the loss of a sense of smell called when there is damage to the olfactory nerve?

answer

anosmia

question

What is inequality of pupils greater than 1 mm difference called?

answer

anisocoria

question

An injury to the sacral cord & lumbar nerve roots that results in areflexia of the lower limbs, bowel and bladder known as?

answer

conus medullaris

question

What is a depressed skull fx in infants that results in indentation or pliabls skull bones w/o loss of bone integrity called?

answer

Ping Pong depression

question

What kind of aneurysm results from a bacterial embolic arteritis?

answer

mycotic

question

What type of aneurysm is the result of atherosclerotic changes?

answer

fusiform

question

What aneurysm is a berry aneurysm?

answer

saccular

question

The type of cICP monitoring device that is inserted below the skull & above the dura mater is called an __ catheter

answer

epidural

question

The P2 wave on a normal ICP waveform represents

answer

decreased intracranial compliance

question

B wave on an abnormal ICP waveform are related to

answer

respirations (B = breathing)

question

A sustained, rapid, & moderately deep hyperpnea is called what kind of respiration?

answer

central neurogenic hyperventilation

question

A completely irregular breathing pattern w/ deep & shallow breaths is known as

answer

pyrogenic respirations

question

a moderate reduction in alertness, increased sleeping, & decreased interest in the environment is called

answer

obtundation

question

a child who is unresponsive except to repeated stimuli is

answer

stuperous

question

The IV fluid of choice to help lower cerebral htn is

answer

3% saline

question

A long term effect of anticonvulsive therapy w/ phenytoin (Dilantin) includes what kind of mouth problems?

answer

gingival hyperplasia

question

An abnormal connection between arteries & veins w/ no common capillary bed is known as

answer

AV malformation

question

a grade III periventricular hemorrhage is an intraventricular hemorrhage w/ _____ dilation

answer

ventricular

question

What is the name of the syndrome a pt has w/ a periventricular intraventricular hemorrhage w/ s/sx of hypotonia, decreased hct, & decreased LOC?

answer

salutatory syndrome

question

A pt w/ stage II Reye syndrome will present w/

answer

stupor, agitation, and delirious

question

What are the 4 variations of Guillian Barre syndrome?

answer

Ascending, descending, Miller-Fischer variant, pure motor

question

How are brain tumors different from other cancers?

answer

they do not metastasize

question

Downward deviation of both eyes w/ a head injury means what part of the brain is being compressed?

answer

midbrain

question

An infratentorial herniation that produces decerebrate posturing & small reactive pupils is known as ____ compression

answer

pontine

CCRN question bank Neurology – Flashcards

Unlock all answers in this set

Haven't found what you were looking for?

Search for samples, answers to your questions and flashcards