Nokea
A patient is scheduled for a myelogram and the nurse explains to the patient that this is an invasive procedure, which assesses for any lesions in the spinal cord. The nurse should explain that the preparation is similar to which of the following neurologic tests?
- A. Lumbar puncture
- B. MRI
- C. Cerebral angiography
- D. EEG
Correct Answer: A
Rationale: Myelography involves contrast injection via lumbar puncture, so preparation is similar. MRI, angiography, and EEG have different preparation requirements.
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The nurse caring for an 80 year-old patient knows that she has a pre-existing history of dulled tactile sensation. The nurse should first consider what possible cause for this patients diminished tactile sensation?
- A. Damage to cranial nerve VIII
- B. Adverse medication effects
- C. Age-related neurologic changes
- D. An undiagnosed cerebrovascular accident in early adulthood
Correct Answer: C
Rationale: Aging reduces sensory receptor density, dulling tactile sensation. Cranial nerve VIII affects hearing, medications may cause other effects, and an old CVA is less likely without evidence.
The nurse is caring for a patient with an upper motor neuron lesion. What clinical manifestations should the nurse anticipate when planning the patients neurologic assessment?
- A. Decreased muscle tone
- B. Flaccid paralysis
- C. Loss of voluntary control of movement
- D. Slow reflexes
Correct Answer: C
Rationale: Upper motor neuron lesions cause spasticity and loss of voluntary movement control due to disrupted corticospinal signals. Decreased tone, flaccid paralysis, and slow reflexes are typical of lower motor neuron lesions.
The nurse is performing a neurologic assessment of a patient whose injuries have rendered her unable to follow verbal commands. How should the nurse proceed with assessing the patients level of consciousness (LOC)?
- A. Assess the patients vital signs and correlate these with the patients baselines.
- B. Assess the patients eye opening and response to stimuli.
- C. Document that the patient currently lacks a level of consciousness.
- D. Facilitate diagnostic testing in an effort to obtain objective data.
Correct Answer: B
Rationale: LOC in non-responsive patients is assessed by eye opening and responses to stimuli, per the Glasgow Coma Scale. Vital signs and testing are supplementary, and lack of response doesn't mean no consciousness.
During the performance of the Romberg test, the nurse observes that the patient sways slightly. What is the nurses most appropriate action?
- A. Facilitate a referral to a neurologist.
- B. Reposition the patient supine to ensure safety.
- C. Document successful completion of the assessment.
- D. Follow up by having the patient perform the Rinne test.
Correct Answer: C
Rationale: Slight swaying during the Romberg test is normal and indicates successful completion. Significant swaying prompts further evaluation, but the Rinne test assesses hearing, not balance.
A patient scheduled for magnetic resonance imaging (MRI) has arrived at the radiology department. The nurse who prepares the patient for the MRI should prioritize which of the following actions?
- A. Withholding stimulants 24 to 48 hours prior to exam
- B. Removing all metal-containing objects
- C. Instructing the patient to void prior to the MRI
- D. Initiating an IV line for administration of contrast
Correct Answer: B
Rationale: MRI uses strong magnetic fields, making removal of metal objects critical to prevent injury or image distortion. Withholding stimulants applies to EEG, voiding to lumbar puncture, and IV contrast to CT scans.