RNSG 1538 Exam 3 Review Study Guide (100%Revised &Correct) Questions and Answers 2023-2024 (A+).
RNSG 1538 - Exam 3 Review.
Intracranial
... [Show More] Regulation
Exemplars- Seizure Disorder, Stroke, Traumatic Brain Injury/Organ Donation/Brain Death, Post-Concussion
Syndrome, Brain Tumor, Meningitis, Hydrocephalus, Parkinson’s Disease
1. Compare the function and behavior of the neurological system. (Med-Surg, p 1909)
The nervous system consists of two major parts: the central nervous system (CNS), including the brain and
spinal cord, and the peripheral nervous system, which includes the cranial nerves, spinal nerves, and autonomic
nervous system. The function of the nervous system is to control motor, sensory, autonomic, cognitive, and
behavioral activities. The brain itself contains more than 100 billion cells that link the motor and sensory
pathways, monitor the body’s processes, respond to the internal and external environment, maintain
homeostasis, and direct all psychological, biologic, and physical activity through complex chemical and
electrical messages.
2. Describe the structures and functions of the central and peripheral nervous systems. (Med-Surg, p 1910)
CENTRAL NERVOUS SYSTEM
The brain is divided into three major areas: the cerebrum, the brain stem, and the cerebellum. The cerebrum is
composed of two hemispheres, the thalamus, the hypothalamus, and the basal ganglia. The brain stem includes
the midbrain, pons, and medulla. The cerebellum is located under the cerebrum and behind the brain stem.
The cerebral hemispheres are divided into pairs of lobes as follows:
• Frontal—the largest lobe, located in the front of the brain. The major functions of this lobe are concentration,
abstract thought, information storage or memory, and motor function. It contains Broca’s area, which is located
in the left hemisphere and is critical for motor control of speech. The frontal lobe is also responsible in large
part for a person’s affect, judgment, personality, and inhibitions.
• Parietal—a predominantly sensory lobe posterior to the frontal lobe. This lobe analyzes sensory information
and relays the interpretation of this information to other body position in space, size and shape discrimination,
and right–left orientation.
• Temporal—located inferior to the frontal and parietal lobes, this lobe contains the auditory receptive areas and
plays a role in memory of sound and understanding of language and music.
• Occipital—located posterior to the parietal lobe, this lobe is responsible for visual interpretation and memory.
The corpus callosum, a thick collection of nerve fibers that connects the two hemispheres of the brain, is
responsible for the transmission of information from one side of the brain to the other. Information transferred
includes sensation, memory, and learned discrimination. Right-handed people and some left-handed people
have cerebral dominance on the left side of the brain for verbal, linguistic, arithmetic, calculation, and analytic
functions. The nondominant hemisphere is responsible for geometric, spatial, visual, pattern, and musical
functions. Nuclei for cranial nerves I and II are also located in the cerebrum.
The thalami lie on either side of the third ventricle and act primarily as a relay station for all sensation except
smell. All memory, sensation, and pain impulses pass through this section of the brain. The hypothalamus is
located anterior and inferior to the thalamus, and beneath and lateral to the third ventricle. The infundibulum of
the hypothalamus connects it to the posterior pituitary gland. The hypothalamus plays an important role in the
endocrine system because it regulates the pituitary secretion of hormones that influence metabolism,
reproduction, stress response, and urine production. It works with the pituitary to maintain fluid balance through
hormonal release and maintains temperature regulation by promoting vasoconstriction or vasodilatation. In
addition, the hypothalamus is the site of the hunger center and is involved in appetite control. It contains centers
that regulate the sleep–wake cycle, blood pressure, aggressive and sexual behavior, and emotional responses
(i.e., blushing, rage, depression, panic, and fear). The hypothalamus also controls and regulates the autonomic
nervous system. The optic chiasm (the point at which the two optic tracts cross) and the mammillary bodies
(involved in olfactory reflexes and emotional response to odors) are also found in this area.
The brain stem consists of the midbrain, pons, and medulla oblongata. The midbrain connects the pons and the
cerebellum with the cerebral hemispheres; it contains sensory and motor pathways and serves as the center for
auditory and visual reflexes.
The cerebellum integrates sensory information to provide smooth coordinated movement. It controls fine
movement, balance, and position (postural) sense or proprioception (awareness of position of body parts
without looking at them).
RNSG 1538
Study Guide Exam #3
2
RNSG 1538 - Exam 3 Review.
The bones of the vertebral column surround and protect the spinal cord and normally consist of 7 cervical, 12
thoracic, and 5 lumbar vertebrae, as well as the sacrum (a fused mass of 5 vertebrae), and terminate in the
coccyx.
Auditory receptive Temporal lobe
Visual receptive Parietal & Occipital area
Expressive speaking Inferior posterior frontal areas
Expressive writing Posterior frontal area
PERIPHERAL NERVOUS SYSTEM (Med-Surg, p 1914)
The peripheral nervous system includes the cranial nerves, the spinal nerves, and the autonomic nervous system.
Twelve pairs of cranial nerves emerge from the lower surface of the brain and pass through openings in the base
of the skull. Three cranial nerves are entirely sensory (I, II, VIII), five are motor (III, IV, VI, XI, and XII), and
four are mixed sensory and motor (V, VII, IX, and X). The spinal cord is composed of 31 pairs of spinal nerves:
8 cervical, 12 thoracic, 5 lumbar, 5 sacral, and 1 coccygeal. Each spinal nerve has a ventral root and a dorsal
root. The dorsal roots are sensory and transmit sensory impulses from specific areas of the body known as
dermatomes to the dorsal horn ganglia. The sensory fiber may be somatic, carrying information about pain,
temperature, touch, and position sense (proprioception) from the tendons, joints, and body surfaces; or visceral,
carrying information from the internal organs.
The ventral roots are motor and transmit impulses from the spinal cord to the body; these fibers are also either
somatic or visceral. The visceral fibers include autonomic fibers that control the cardiac muscles and glandular
secretions.
3. Describe diagnostic tests used for assessment of suspected neurologic disorders. (Med-Surg, p 1930)
Health History
An important aspect of the neurologic assessment is the history of the present illness. The initial interview
provides an excellent opportunity to systematically explore the patient’s current condition and related events
while simultaneously observing overall appearance, mental status, posture, movement, and affect. Depending on
the patient’s condition, the nurse may need to rely on yes-or-no answers to questions, a review of the medical
record, input from witnesses or the family, or a combination of these.
Neurologic disorders may be stable or progressive, characterized by symptom-free periods as well as
fluctuations in symptoms. The health history therefore includes details about the onset, character, severity,
location, duration, and frequency of symptoms and signs; associated complaints; precipitating, aggravating, and
relieving factors; progression, remission, and exacerbation; and the presence or absence of similar symptoms
among family members.
Computed tomography (CT) scanning uses a narrow x-ray beam to scan body parts in successive layers. The
images provide cross-sectional views of the brain, distinguishing differences in tissue densities of the skull,
cortex, subcortical structures, and ventricles. Abnormalities detected on brain CT include tumor or other masses,
infarction, hemorrhage, displacement of the ventricles, and cortical atrophy
Magnetic Resonance Imaging (MRI) uses a powerful magnetic field to obtain images of different areas of the
body. The magnetic field causes the hydrogen nuclei (protons) within the body to align like small magnets in a
magnetic field. In combination with radiofrequency pulses, the protons emit signals, which are converted to
Type of Aphasia Brain Area Involved
RNSG 1538
Study Guide Exam #3
3
RNSG 1538 - Exam 3 Review.
images. An MRI scan can be performed with or without a contrast agent and can identify a cerebral abnormality
earlier and more clearly than other diagnostic tests. It can provide information about the chemical changes
within cells, allowing the clinician to monitor a tumor’s response to treatment. It is particularly useful in the
diagnosis of brain tumor, stroke, and multiple sclerosis and does not involve ionizing radiation.
Positron Emission Tomography (PET) is a computer-based nuclear imaging technique that produces images of
actual organ functioning. The patient either inhales a radioactive gas or is injected with a radioactive substance
that emits positively charged particles. PET permits the measurement of blood flow, tissue composition, and
brain metabolism and thus indirectly evaluates brain function. The brain is one of the most metabolically active
organs, consuming 80% of the glucose the body uses. PET measures this activity in specific areas of the brain
and can detect changes in glucose use.
PET is useful in showing metabolic changes in the brain (Alzheimer’s disease), locating lesions (brain tumor,
epileptogenic lesions), identifying blood flow and oxygen metabolism in patients with strokes, distinguishing
tumor from areas of necrosis, and revealing biochemical abnormalities associated with mental illness
Single-Photon Emission Computed Tomography (SPECT) is a three-dimensional imaging technique that uses
radionuclides and instruments to detect single photons. It is a perfusion study that captures a moment of cerebral
blood flow at the time of injection of a radionuclide. SPECT is useful in detecting the extent and location of
abnormally perfused areas of the brain, thus allowing detection, localization, and sizing of stroke (before it is
visible by CT scan); localization of seizure foci in epilepsy; detection of tumor progression; and evaluation of
perfusion before and after neurosurgical procedures.
Cerebral angiography is an x-ray study of the cerebral circulation with a contrast agent injected into a selected
artery. A valuable tool in investigating vascular disease or anomalies, it is used to determine vessel patency,
identify presence of collateral circulation, and provide detail on vascular anomalies that can be used in planning
interventions. With the advent of additional imaging techniques, formal cerebral angiography is less frequently
performed.
A myelogram is an x-ray of the spinal subarachnoid space taken after the injection of a contrast agent into the
spinal subarachnoid space through a lumbar puncture. The waterbased contrast agent disperses upward through
the CSF to outline the spinal subarachnoid space and show any distortion of the spinal cord or spinal dural sac
caused by tumors, cysts, herniated vertebral disks, or other lesions. Myelography is performed infrequently
today because of the sensitivity of CT and MRI scanning.
Noninvasive carotid flow studies use ultrasound imagery and Doppler measurements of arterial blood flow to
evaluate carotid and deep orbital circulation. The graph produced indicates blood velocity. Increased blood
velocity can indicate stenosis or partial obstruction. These tests are often obtained before more invasive tests
such as arteriography or are used as screening tools. Carotid Doppler, carotid ultrasonography,
oculoplethysmography, and ophthalmodynamometry are four common noninvasive vascular techniques that
permit evaluation of arterial blood flow and detection of arterial stenosis, occlusion, and plaques. These
vascular studies allow noninvasive imaging of extra- and intracranial circulation.
Transcranial Doppler uses the same noninvasive techniques as carotid flow studies but records the blood flow
velocities of the intracranial vessels. Transcranial Doppler is a noninvasive technique that is helpful in assessing
vasospasm (a complication following subarachnoid hemorrhage), altered cerebral blood flow found in occlusive
vascular disease, other cerebral pathology, and brain death.
An electroencephalogram (EEG) represents a record of the electrical activity generated in the brain. It provides
an assessment of cerebral electrical activity. It is useful for diagnosing and evaluating seizure disorders, coma,
or organic brain syndrome. Tumors, brain abscesses, blood clots, and infection may cause abnormal patterns in
electrical activity. The EEG is also used in making a determination of brain death.
An electromyogram (EMG) is obtained by inserting needle electrodes into the skeletal muscles to measure
changes in the electrical potential of the muscles. An EMG is useful in determining the presence of
neuromuscular disorders and myopathies. It helps distinguish weakness due to neuropathy (functional or
pathologic changes in the peripheral nervous system) from weakness resulting from other causes.
*Nerve conduction studies are performed by stimulating a peripheral nerve at several points along its
course and recording the muscle action potential or the sensory action potential that results. Surface or
needle electrodes are placed on the skin over the nerve to stimulate the nerve fibers. This test is useful in
the study of peripheral neuropathies and is often included as part of the EMG.
Evoked potential studies involve application of an external stimulus to specific peripheral sensory receptors
with subsequent measurement of the electrical potential generated. Electrical changes are detected with the aid
of computerized devices that extract the signal, display it on an oscilloscope, and store the data on magnetic
RNSG 1538
Study Guide Exam #3
4
RNSG 1538 - Exam 3 Review.
tape or disk. In neurologic diagnosis, they reflect nerve conduction times in the peripheral nervous system. In
clinical practice, the visual, auditory, and somatosensory systems are most often tested.
Lumbar Puncture and Examination of Cerebrospinal Fluid, A lumbar puncture (spinal tap) is carried out by
inserting a needle into the lumbar subarachnoid space to withdraw CSF. The test may be performed to obtain
CSF for examination, to measure and reduce CSF pressure, to determine the presence or absence of blood in the
CSF, and to administer medications intrathecally (into the spinal canal).
*The CSF should be clear and colorless. Pink, blood-tinged, or grossly bloody CSF may indicate a
subarachnoid hemorrhage.
*A post–lumbar puncture headache, ranging from mild to severe, may occur a few hours to several days
after the procedure. It is a throbbing bifrontal or occipital headache that is dull and deep in character. It is
particularly severe on sitting or standing but lessens or disappears when the patient lies down.
4. Define the following terms: agnosia, ataxia, Babinski reflex, clonus, flaccidity, rigidity, Romberg Test,
spasticity, vertigo. (Med-Surg, p 1909)
agnosia: loss of ability to recognize objects through a particular sensory system; may be visual, auditory, or
tactile
ataxia: inability to coordinate muscle movements, resulting in difficulty in walking, talking, and performing
self-care activities
Babinski reflex (sign): a reflex action of the toes; in adults is indicative of abnormalities in the motor control
pathways leading from the cerebral cortex
clonus: abnormal movement marked by alternating contraction and relaxation of a muscle occurring in rapid
succession
flaccidity: displaying lack of muscle tone; limp, floppy
rigidity: increase in muscle tone at rest characterized by increased resistance to passive stretch
Romberg test: test for cerebellar dysfunction that can be done with the patient seated or standing;
inability to maintain position for 20 seconds is a positive test
spasticity: sustained increase in tension of a muscle when it is passively lengthened or stretched
vertigo: illusion of movement in which the individual or the surroundings are sensed as moving
5. What are the lobes of the brain and what is the function of each lobe? (Med-Surg, p 1911)
• Frontal—the largest lobe, located in the front of the brain. The major functions of this lobe are concentration,
abstract thought, information storage or memory, and motor function. It contains Broca’s area, which is located
in the left hemisphere and is critical for motor control of speech. The frontal lobe is also responsible in large
part for a person’s affect, judgment, personality, and inhibitions.
• Parietal—a predominantly sensory lobe posterior to the frontal lobe. This lobe analyzes sensory information
and relays the interpretation of this information to other body position in space, size and shape discrimination,
and right–left orientation.
• Temporal—located inferior to the frontal and parietal lobes, this lobe contains the auditory receptive areas
and plays a role in memory of sound and understanding of language and music.
• Occipital—located posterior to the parietal lobe, this lobe is responsible for visual interpretation and memory. [Show Less]