Tuesday, 5 January 2021

NEUROLOGY

Glasgow Coma score (GCS) is made up of 3 component parts and these are:

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Eye opening response/motor response/verbal response

Eye opening response/verbal response/pupil reaction to light

Eye opening response/motor response/pupil reaction to light

 

Eye opening response/limb power/verbal response

 

Correct answer

Eye opening response/motor response/verbal response

 

In the NEWS observation system, what is ACVUP?

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A replacement for GCS

An assessment for confusion

 

Assessment for the level of consciousness

 

Correct answer

Assessment for the level of consciousness

 

A patient got admitted to hospital with a head injury. Within 15 minutes, GCS was assessed and it was found to be 15. After initial assessment, a nurse should monitor neurological status every:

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15 minutes

30 minutes

45 minutes

60 minutes

 

Correct answer

30 minutes

 

Approximately how long is the spinal cord in an adult?

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30 cm

45 cm

 

60 cm

120 cm

 

Patient had undergone post lumbar tap and is exhibiting increase HR, decrease BP, and alteration in consciousness and dilated pupils. What is the patient likely experiencing?

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Headache

Shock

 

Brain herniation

Hypotension

 

 

Correct answer

Brain herniation

 

Which is not an expected side effect of lumbar tap?

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Headache

 

Back pain

Swelling and bruising

Nausea and vomiting

 

Correct answer

Nausea and vomiting

 

A patient was recommended to undergo lumbar puncture. As the nurse caring for this patient, what should you not expect as its complications:

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Swelling and bruising

Headache

 

Back pain

Infection

 

Correct answer

Infection

 

How should you position a patient after lumbar puncture?

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Flat on bed

Fowler’s

Semi-fowlers

 

Side-lying

 

Correct answer

Flat on bed

 

Which is not an indication for lumbar tap?

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For patients with increased ICP

 

For diagnostic purposes

Introduction of spinal anaesthesia for surgery

Introduction of contrast medium

 

It is unsafe for a spinal tap to be undertaken if the patient:

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Bacterial meningitis

Papilloedema

Intracranial mass is suspected

Site skin infection

All the above

 

 

After lumbar puncture, the patient experienced shock. What is the etiology behind it?

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Increased ICP

 

Headache

Side effect of medications

CSF leakage

 

Correct answer

CSF leakage

 

A client immediately following lumbar puncture developed deterioration of consciousness, bradycardia, increased systolic blood pressure. What is this normal reaction

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Client has brain stem herniation

Spinal headache

 

Correct answer

Client has brain stem herniation

 

A patient just had just undergone lumbar laminectomy, what is the best nursing intervention?

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Move the body as a unit

Move one body part at a time

Move the head first and the feet last

Never move the patient at all

 

Correct answer

Move the body as a unit

 

 

 

Lumbar post op patient moving and handling

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Move patient as a unit

 

Move patient close to side rails so he/she could assist herself

Move with leg raised/flexed

 

After lumbar laminectomy, which the appropriate method to turn the patient?

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Patient holds at the side of the bed, with crossed knees try to turn by own

 

Head is raised and knees bent, patient tries to make movement

Patient is turned as a unit

 

Correct answer

Patient is turned as a unit

 

When positioning the supine patient in bed, why should you ensure the patient is lying centrally in the bed?

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To ensure spinal and limb alignment

To ensure patient comfort

 

To ensure the airway is patent

To minimize the risk of injury to the practitioner

 

Correct answer

To ensure spinal and limb alignment

 

In what instances shouldn't you position a patient in a side-lying position?

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If they are pregnant

If they have a spinal fracture

If they have pressure sores

 

If they have lower limb pain

 

Correct answer

If they have a spinal fracture

 

In Spinal cord injury patients, what is the most common cause of autonomic dysreflexia ( a sudden rise in blood pressure)?

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Bowel obstruction

 

Fracture below the level of the spinal lesion

Pressure sore

Urinary obstruction

 

Correct answer

Urinary obstruction

 

Patient had CVA and can't speak nor read. What does the loss of speech mean?

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Dysphagia

Aphasia

Apraxia

 

Dysphasia

 

 

Correct answer

Aphasia

 

A patient suffered from stroke and is unable to read and write. This is called

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Aphasia

Dysphagia

Partial aphasia

 

Correct answer

Aphasia

 

Patient had CVA, who will assess swallowing capability?

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Physiotherapy nurse

 

Psychotherapy nurse

Speech and language therapist

Neurologic nurse

 

Correct answer

Speech and language therapist

 

Mrs Jones has had a cerebral vascular accident, so her left leg is increased in tone, very stiff and difficult to position comfortably when she is in bed. What would you do?

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·       Give Mrs Jones analgesia and suggest she sleeps in the chair

 

·       Try to diminish increased tone by avoiding extra stimulation by ensuring her foot doesn't come into contact with the end of the bed; supporting, with a pillow, her left leg in side lying and keeping the knee flexed

 

·       Give Mrs Jones diazepam and tilt the bed

 

·       Suggest a warm bath before she lies on the bed Then use pillows to support the stiff limb

 

Correct answer

Try to diminish increased tone by avoiding extra stimulation by ensuring her foot doesn't come into contact with the end of the bed; supporting, with a pillow, her left leg in side lying and keeping the knee flexed

 

A patient suffered from CVA and is now affected with dysphagia. What should not be an intervention to this type of patient?

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·       Place the patient in a sitting position / upright during and after eating

·       Water or clear liquids should be given

 

·       Instruct the patient to use a straw to drink liquids

·       Review the patient’s ability to swallow, and note the extent of facial paralysis

 

A client with CVA is found to have difficulty in swallowing. Who do you think should be informed for further assessment?

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Neurological physiotherapist

Occupatoinal physiotherapist

Speech and Language Therapist

 

 

An adult has experienced a CVA that has resulted in right side weakness. The nurse is preparing to move the patient right side of the bed so that he may then be turned to his left side. The nurse knows that an important principle when moving the patient is.

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To keep the feet close together

To bend from waist

To use body weight when moving objects

 

A twisting motion will save steps

 

The prevalence of sudden onset confusion in the hospital environment is between 20% and 50% (NICE 2010). Certain factors predispose to or are risk factors includes all of the following, except:

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Infection, post-anaesthesia and taking high doses of analgesia

Other serious illnesses such as uncontrollable cardiovascular or respiratory conditions

 

English is not their first language with existing other mental disorder such as dementia

Being inpatient for a long time with or without family and means of gauging the time of the day

 

Correct answer

Being inpatient for a long time with or without family and means of gauging the time of the day

 

Patient’s husband died. The brother of the patient saw that she was upset but mentally and physically well. After a few weeks, the patient called her brother and said that her husband died yesterday, she verbalized “I didn’t know he was sick”. She also told her brother that she has been seeing mice and rats in the house. The patient had difficulty sleeping, had incontinence and pain in urinating. A community nurse visited the patient. She observed that the patient is reclusive, passive but pleasant. What could be the problem?

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Delirium due to UTI

 

Uncoping ability because her husband just died

Onset of Alzheimer’s disease from dementia

Delayed bereavement due to dementia

 

An 83-year old lady just lost her husband. Her brother visited the lady in her house. He observed that the lady is acting okay but it is obvious that she is depressed. Three weeks after the husband's death, the lady called her brother crying and was saying that her husband just died. She even said, "I cant even remember him saying he was sick." When the brother visited the lady, she was observed to be well physically but was irritable and claims to have frequent urination at night and she verbalizes that she can see lots of rats in their kitchen. Based on the manifestations, as a nurse, what will you consider as a diagnosis to this patient?

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Urinary tract infection leading to delirium

Delayed grieving with dementia

 

Correct answer

Urinary tract infection leading to delirium

 

Which is not an appropriate way to care for patients with Dementia/Alzheimer’s?

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Ensure people with dementia are excluded from services because of their diagnosis, age, or any learning disability

Encourage the use of advocacy services and voluntary support

Allow people with dementia to convey information in confidence

Identify and wherever possible accommodate preferences (such as diet, sexuality and religion)

 

 

Correct answer

Ensure people with dementia are excluded from services because of their diagnosis, age, or any learning disability

 

A patient who has had Parkinson’s Disease for 7 years has been experiencing aphasia. Which health professional should you make a referral to with regards to his aphasia?

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Occupational Therapist

Community Matron

Psychiatrist

Speech and Language Therapist

 

 

Positioning and active movement are key in managing the influence of altered tone and abnormal patterns of movement in the recovery of motor control in patients with neurological problems. All of the following are the general principles of care with complex neurological impairments, except:

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·       Positioning is suggested as a strategy to prevent pain and to prevent loss of range of movement for patients with low tone particularly around the shoulder

 

·       Patients with little limb function secondary to soft tissue changes and contractures are at increased risk of hypotonia

 

·       Adaptation of the mechanical properties of muscle also contributes to increased tone in patients with hypertonia

·       For those with acute and long-standing neurological issues, principles of moving can be applied at any time along their treatment trajectory from undertaking rehabilitation, experiencing deteriorating function or those requiring palliative management

 

Correct answer

Patients with little limb function secondary to soft tissue changes and contractures are at increased risk of hypotonia

 

You are caring for a patient who has had a recent head injury and you have been asked to carry out neurological observations every 15 minutes. You assess and find that his pupils are unequal and one is not reactive to light. You are no longer able to rouse him. What are your actions?

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·       Continue with your neurological assessment, calculate your Glasgow Coma Scale (GCS) and document clearly

 

·       This is a medical emergency Basic airway, breathing and circulation should be attended to urgently and senior help should be sought

 

·       Refer to the neurology team

 

·       Break down the patient's Glasgow Coma Scale as follows: best verbal response V = XX, best motor response M = XX and eye opening E = XX Use this when you hand over

 

 

Correct answer

This is a medical emergency Basic airway, breathing and circulation should be attended to urgently and senior help should be sought 

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