Neuroscience Nursing CNRN
Neuroscience Nursing Review CNRN
A patient has bilateral periorbital ecchymosis and rhinorrhea. These findings suggests a fracture of the skull's
A. middle fossa.
B. posterior fossa.
C. foramen magnum.
D. anterior fossa.
Answer: D. anterior fossa.
Basilar skull fractures involve the floor of the skull. The skull base is divided into the anterior fossa, middle fossa, and posterior fossa. The anterior fossa consists of the frontal and ethmoid bones. 70% of skull base fractures are anterior. The weakest portion of the skull base is the middle vault, where fractures occur 20% of the time. 5% of fractures are posterior. Periorbital ecchymosis (bleeding from an anterior fracture site) is also referred to as raccoon eyes. If the dura mater is torn, the patient exhibits rhinorrhea. Battle's sign (post auricular hematoma) occurs with middle fossa fractures and is associated with otorrhea if the dura is disrupted. Posterior fossa skull fractures are rare but serious. Most of these patients present comatose, with lower cranial nerve injuries and associated cervical spinal injuries.
A patient who experienced an acute posterior fossa stroke exhibits dysarthria, dysphagia, and difficulty maintaining a patent airway. These findings indicate
A. central pain syndrome.
B. bulbar dysfunction.
C. extrapyramidal symptoms.
D. cortical atrophy.
Answer: B. bulbar dysfunction.
Cranial nerves IX, X, XI and XII originate in the brainstem. Damage to these "bulbar" nerves weakens neck muscles and compromises speech and swallowing. Nerve deficits result in dysarthria (impaired muscles of speech), dysphagia (difficulty swallowing), and tongue paresis (nerve-related muscular weakness). Extrapyramidal disorders affect movement. Symptoms range from akinesia (inability to initiate movement) to akathisia (inability to remain motionless). Extrapyramidal symptoms may be chronic (e.g., Parkinson disease) or acute (e.g., a neuroleptic drug side effects). Cortical atrophy (e.g., Alzheimer's disease) involves the progressive loss of neurons, causing deterioration of both intellectual and motor function. Central pain syndrome is a chronic condition caused by CNS damage from stroke, multiple sclerosis, spinal cord injury, or brain tumors.
A child is diagnosed with a medulloblastoma. Which of the following assessment findings would the nurse anticipate?
B. Gaze deviation
C. Intentional tremor
Answer: D. Ataxia
60%-70% of childhood brain tumors occur in the posterior fossa. Medulloblastomas are the most common primary CNS tumors in children; age of onset peaks at 3-8 years. Tumors are typically located in the 4th ventricle or cerebellum. Findings include poor coordination, lethargy, headache, nausea, vomiting, and ataxia. These tumors do not cause tinnitus, gaze deviation, or intentional tremors. Such findings would be consistent with a CEREBRAL (versus cerebellar) tumor location. Other pediatric posterior fossa tumors include primitive neuroectodermal tumors (PINETs), astrocytomas, ependymomas, and medulloblastomas, as well as pineoblastomas. Because of their critical location on the cerebellum or brainstem, even small tumors can cause brainstem compression, herniation, and death.
The signs and symptoms of a brain abscess are largely related to
A. the organisms contained in the abscess.
B. the size of the abscess.
C. whether or not the abscess is encapsulated.
D. the location of the abscess.
Answer: D the location of the abscess.
The manifestations of a brain abscess are a combination of signs and symptoms caused by increased intracranial pressure (the abscess is a space-occupying lesion) and focal neurological deficits specific to the abscess location. Location, more than abscess size, dictates clinical findings. When an abscess ruptures into a ventricle the result is catastrophic and generally fatal. Brain abscesses are characteristically polymicrobial in nature; organism type has little bearing on patient symptoms. Classically, as brain abscess development progresses, abscess walls thicken and the lesion becomes encapsulated. Most abscesses can then be identified on contrast enhanced computed tomography, because the capsule ring is readily visible. However, the presence of an abscess capsule has no relationship to patient symptoms.
A patient is diagnosed with a Chiari malformation. What other congenital abnormality is often found in conjunction with this disorder?
B. Down syndrome
C. Biliary atresia
D. Tetralogy of Fallot
Answer: A. Syringomyelia
A Chiari malformation is a congenital neurologic defect in which the cerebral tonsils protrude through the foramen magnum. In patients with this condition, the normal flow of cerebrospinal fluid is impeded, leading to obstructive hydrocephalus and syringomyelia development. A syringomyelia (pronounced: sear- REEN-go-my-EEL-ee-ah) is a fluid-filled cyst or "syrinx" that develops within the spinal cord. Although syringomyelia has several known causes, the most common is the presence of a Chiari malformation. Down syndrome, biliary atresia, and tetralogy of Fallot have no direct effect on the spinal cord.
Neuroscience Nursing Review CNRN
Neuroscience Nursing Review CNRN®
Pocket Study Guide Volume 3
Rosemarie Girardeau BS RN CNRN SCRN CCRN CEN
Laura M. Criddle PhD RN CNRN SCRN CCRN CEN FAEN