Health Assessment: Neurological Assessment Questions & Answers

Which assessment finding would be the earliest and most sensitive indicator that there is an alteration in intracranial regulation? A. Change in level of consciousness B. Inability to focus visually C. Loss of primitive reflexes D. Unequal pupil size - ANSWERSA. Change in level of consciousness What is the CNS comprised of? - ANSWERSthe brain and spinal cord What is the peripheral nervous system? - ANSWERSall the nerve fibers (outside of the brain and spinal cord) including 12 pairs of cranial nerves, 31 pairs of spinal nerves and all of their branches What does the thalamus do? - ANSWERSrelays information for the cerebral cortex What does the brain stem do? - ANSWERScontrols breathing, heart rate, function The nurse observes that a patient's gait is unsteady and assesses a positive Romberg sign. Which area of the brain is most likely affected? A. Hypothalamus B. Medulla oblongata C. Cerebellum D. Left hemisphere - ANSWERSC. Cerebellum What is the cerebral cortex involved in? - ANSWERSthoughts, memory, reasoning, sensation and voluntary movement What are the four lobes of the cerebrum? - ANSWERSfrontal, parietal, occipital and temporal Where is Wernicke's area and what does it do? - ANSWERStemporal lobe, language comprehension Where is Broca's area and what does it do? - ANSWERSfrontal lobe, motor speech Damage to the cerebral cortex occurs when highly specialized neurologic cells are what? What is an example? - ANSWERSdeprived of blood supply, such as when a cerebral artery becomes occluded What occurs in Wernicke's aphasia? - ANSWERStrouble associating words to situations What occurs in Broca's aphasia? - ANSWERSknow what they want to say but they cant get the words out On most people speech is located on the _______ side of the brain - ANSWERSleft What is global aphasia? - ANSWERSwhen both wernicke's and broca's aphasia occurs Left cerebral cortex receives sensory information from and controls motor function to __________ side of the body - ANSWERSright The nurse is performing a mental status examination on a patient diagnosed with subdural hematoma. This test assesses which of the following? A. Cerebellar function B. Intellectual function C. Cerebral function D. Sensory function - ANSWERSC. Cerebral function What are the four main parts of the peripheral nervous system? - ANSWERSreflexes, cranial nerves, spinal nerves, autonomic nervous system What are reflexes? - ANSWERSbasic defense mechanisms of nervous system What are the four types of reflexes? - ANSWERSdeep tendon, superficial, visceral, pathologic The cranial nerves enter and exit what? - ANSWERSthe brain rather than the spinal cord What are spinal nerves? - ANSWERS31 pairs of nerves that go from the spinal cord to the rest of the body What is a dermatone? - ANSWERSCircumscribed skin area supplied mainly from one spinal cord segment through particular nerve What are the 3 parts of the autonomic nervous system? - ANSWERSsympathetic, parasympathetic and enteric What do autonomic fibers innervate? (3) - ANSWERSsmooth muscle, cardiac muscle and glands The autonomic system mediates _________________ activity - ANSWERSunconscious/involuntary What nervous system is involved with referred pain? - ANSWERSANS (autonomic nervous system) When would you do a neurological exam on a client? - ANSWERSscreening (nothing really wrong with them, just screening them), complete neurologic exam (when you suspect something wrong or when there is something wrong), neurologic recheck (want to be able to pick up on changes different then baseline) What are the two types of strokes? - ANSWERSembolic (clot) and hemorrhagic What are risk factors for stroke? - ANSWERShypertension, high cholesterol, diabetes, smoking, inactivity, obesity What ethnic group has strokes earlier in life and with more severe results than whites? - ANSWERSafrican americans What additional questions should you specifically ask to the aging adults (in regards to neurological function)? - ANSWERSany problems with dizziness, memory, tremors, vision changes What are the two types of tremors? - ANSWERSintentional (when you are moving), resting (more pathological). Caffeine and medications can also cause tremors What is the sequence for complete neurologic examinations? (5) - ANSWERSmental status, cranial nerves, motor system, sensory system and reflexes How do you test a patient's orientation? - ANSWERSdo you know your name, DOB, where you are? What are the four sections of the mental status exam that you are examining? - ANSWERS(ABCT) appearance, behavior, cognition, thought process What are the cranial nerves (in order)? - ANSWERSolfactory, optic, oculomotor, trochlear, trigeminal, abducens, facial, acoustic (vestibulocochlear), glossopharyngeal, vagus, spinal accessory, hypoglossal What is the mnemonic to remember what cranial nerves are sensory/motor/both - ANSWERSSome Say Marry Money But My Brother Says Big Brains Matter Most What is the function of CN 1? - ANSWERSsmell What is the function of CN 2? - ANSWERSvision What is the function of CN 3? (4) - ANSWERSmost extraocular muscle movement, opening of eyelids and pupil constriction and lens accomodation What is the function of CN 4? - ANSWERSdown and inward movement of eye What is the function of CN 5? - ANSWERSmuscles of mastication, sensation of face, scalp, cornea, mucous membranes of mouth and nose What is the function of CN 6? - ANSWERSlateral movement of eye What is the function of CN 7? - ANSWERSfacial muscles, close eye, labial speech, close mouth, taste on anterior two thirds of tongue What is the function of CN 8? - ANSWERShearing and equillibrium What is the function of CN 9? - ANSWERSpharynx (phonation and swallowing), taste on one third of tongue, gage reflex, parotid gland and carotid reflex What is the function of CN 10? - ANSWERSpharynx and larynx (talking and swallowing), general sensations from carotid body, carotid sinus, pharynx and visera What is the function of CN 11? - ANSWERSmovement of trapezus and sternomastoid muscles What is the function of CN 12? - ANSWERSmovement of tongue Mnemonic to remember the names of the cranial nerves (not super appropriate) - ANSWERSOh, Oh, Oh, To Touch And Feel Virgin Girls Vagina And Hymen How do we test CN1? - ANSWERSdo not test routinely, but want to do check both nostrils, using familiar convenient smells such as coffee, toothpaste, orange, vanilla, alcohol, peppermint How do we test CN2? - ANSWERSTest visual acuity and visual fields by confrontation Using ophthalmoscope, examine ocular fundus to determine color, size, and shape of optic disc How do we test CN 3, 4 and 6? (3) - ANSWERSmake sure palpebral fissures are equal, test pupils for PERRLA, cardinal/diagnostic positions test What does PERRLA stand for? - ANSWERSpupils equal round reactive to light and accomodation What is nystagmous? Is it normal? What can cause it? - ANSWERSback-and-forth oscillation of the eye, no caused by diseases and medications What are the average pupil size range? - ANSWERS3-4 mm What is miosis? - ANSWERSpupils smaller than 2 mm What is mydriasis? - ANSWERSpupils greater than 5 mm What is anisocoria? It is okay as long as what? - ANSWERSpupillary asymmetry, is okay as long as there is not a big difference Brisk or sluggish pupillary responses can occur due to what? - ANSWERSpain medication How do we test CN5? - ANSWERSassess muscles of mastication by palpating temporal and masseter muscles as person clenches teeth, with person's eyes closed, test light touch sensation by touching a cotton wisp to designated areas on person's face: forehead, cheeks, and chin What are the three areas of the face do you touch a cotton ball to when testing CN 5? - ANSWERSforehead, both cheeks and chin (divisions known as ophthalmic, maxillary and mandibular) How do we test the corneal reflex? Do we normally test it? - ANSWERScontact with a wisp of cotton that should stimulate a blink in both eyes, dont normally test it because it can be irritating Decreased corneal reflex (such as with use of contacts) can lead to an increased chance of what occuring? - ANSWERScornea abrasion How do we test CN 7? - ANSWERSNote mobility and facial symmetry as person responds to requests to smile, frown, close eyes tightly (against your attempt to open them), lift eyebrows, show teeth Have person puff cheeks, then press puffed cheeks in, to see that air escapes equally from both sides What is a difference between Bells palsy and a stroke? - ANSWERSbells palsy is temporary and only effects the face, consequences of a stroke can last a lifetime, and can effect not only the fact but the body as in weakness on one side How do we test CN 8? - ANSWERSTest hearing acuity by ability to hear normal conversation and by whispered voice test How do we test CNs 9 and 10? - ANSWERSDepress tongue with tongue blade, and note pharyngeal movement as person says "ahhh" uvula and soft palate should rise in midline, and tonsillar pillars should move medially, gag reflex, voice. Also taste on posterior 1/3 of tongue How do we test CN 11? - ANSWERSsternomastoid and trapezius muscles for equal size, Strength: rotate head against resistance applied to side of chin, shrug shoulders