Download SCRN EXAM Questions with Correct Answer Latest Updates 202 and more Exams Nursing in PDF only on Docsity!
SCRN EXAM
Questions with Correct
Answer Latest Updates 2024
Penumbra - Answer Salvageable tissue
- oxygen
- blood pressure
- Glucose Perfusion - Answer What oxygen delivers to the brain. Above the necklace-Anterior Circulation= - Answer Unilateral deficits Below the necklace-Posterior circulation= - Answer Bilateral deficits Circle of Willis-Collateral circulation= - Answer Aneurysm Cerebrum - Answer largest part of the brain Cerebrum: Frontal Lobe - Answer Motor function, personality, Brocca speech Brocca's aphasia-frontal lobe - Answer problem with the production and grammar speech syntax, people know what they want to say but they cant produce the words. temporal lobe - Answer Seizure, Wernicke speech, hearing Wernicke's aphasia (receptive aphasia)-temporal lobe - Answer impaired auditory reception; speech may be fluent but is often meaningless or nonsensical parietal lobe - Answer sensory input for touch and body position-neglect
- teach patient to scan the room occipital lobe - Answer vision basal ganglia - Answer Hypertensive bleed Thalamus - Answer sensory switchboard, located on top of the brainstem;
- Patient waxing and waning
- Patient asleep/awake
- Thalamic pain syndrome thalamic pain syndrome - Answer a condition caused by damage to the thalamus resulting in burning or tingling sensations and possibly hypersensitivity to things that would not normally be painful such as light touch or temperature change Cerebellum - Answer Balance and coordination
Left (Dominant) Hemisphere Stroke - Answer - Left gaze preference (looks toward stroke area)
- Right hononomous hemianopia
- Right hemiparesis
- Right hemisensory loss
- Aphasia Right (Nondominant) Hemisphere Stroke - Answer - Right gaze preference
- Left hononomous hemianopia
- Left hemiparesis, plegia
- Left hemisensory loss *Neglect-left *Agnosia (failure to recognize objects) Posterior circulating stroke syndromes= - Answer Wallenburg (Medulla) Horner's Syndrome Wallenberg syndrome - Answer Nystagmus, Vertigo Horner's syndrome - Answer ipsilateral ptosis miosis anhidrosis Ipsilateral - Answer on the same side of the body Contralateral - Answer on the opposite side of the body Miosis - Answer constricted pupils anhidrosis - Answer absence of sweating Locked-in syndrome - Answer PONS How do you communicate with someone with locked-in syndrome? - Answer Blinking eye movement Cerebral Venous Thrombosis - Answer Hypercoagulopathy state Post-partum/PREGNANCY Carotid or Vertebral dissection-TRAUMA - Answer Trauma most common cause TX: anticoagulation Arterio-venous Fistula - Answer Ptosis-eyeball pops out Hears swishing Carotid Cavernous Fistula - Answer Arterial venous connection between carotid artery and cavernous sinus---"the bulging red eye"
- can be high-flow or low-flow
- high flow results in patients with atherosclerosis and HTN with carotid aneurysms that rupture within sinus or secondary to closed head trauma (basal skull fracture)
Ischemic stroke - Answer a type of stroke that occurs when the flow of blood to the brain is blocked Neuroplasticity - Answer is remodeling process of the brain
- creating new pathways via PT, OT, Speech
- Neuroplasticity of penumbra is continuous repetition of the deficit-ROBOTIC repetition. Neuroplasticity & Stroke Recovery - Answer Begins 1 - 3 days post stroke
- Regains lost function after injury
- Success of recovery depends on DESIRE of individual to gain functional ability The BE FAST acronym stands for: - Answer Balance Eyes Face Arms Speech Time 7 D's of stroke care - Answer Detection-Facial droop, arm weakness Dispatch-Ambulance gets PT Delivery-Pt deliver to ER Door-Pt arrives Data-CT scan Decision-Should tPA be given Drug-what drug Door to treatment Times - Answer Door to ED physician exam=10 min Door to Stroke expertise=15 min Door to CT scan= 20 min Door to CT interpretation= 45 min Door to lab results= 45 min Door to Drug (rt-PA)= 60 min (2018: 45 min) A CT Scan without contrast can reveal what in the presence of headache? - Answer Blood/Hemorrhage Blood is WHITE Ischemia/edema does not show up for 12 - 24 hours Brain parenchyma is gray Hypodensity on CT Scan - Answer Hypo-Dark=Infarction Infarction-darker areas-occurs 12 - 24 hours post infarction Hyperdensity (on CT) - Answer Hyper-White=Bleed/Hemorrhage Hyperdense MCA sign - Answer White Line=Clot MCA Occlusion Large infarct Poor outcome Thrombectomy stent-like device to take out clot
Blood on MRI - Answer "Dead Chicken" Predicting ICH expansion - Answer Sluggish White dot inside ICH Risk for rebleed Spot sign on CTA with contrast - Answer White dot inside ICH-risk for rebleed Hunt & Hess grading system for SAH - Answer 0 - 5 (prognosis good for 0 - 1; intermediate 3; poor 4-5) 0 - Unruptured 1 - Asymptomatic / headache 2 - mod-severe headache, nuchal rigidity, nothing focal 3 - decreased LOC, mind focal deficit 4 - stupor, hemiparesis 5 - coma, decerberate Hunt and Hess Classification and Prognosis - Answer 0 Unruptured aneurysm 1 Asymptomatic or minimal HA/slight nuchal rigidity (30%) 2 Mod-severe HA; nuchal rigidity; no FND except CN palsy (40%) 3 ↓ LOC, confusion, or FND (50%) 4 Stupor; mod-severe hemiparesis (80%) 5 Deep coma; decerebrate posturing; moribund (90%) Hunt and Hess - Answer assess for cerebral aneurysm CT perfusion - Answer - angiography= full brain coverage (good for localization of clot), more radiation
- perfusion= requires dedicated software, limited area of brain imaged, measures cerebral blood flow/blood volume; can identify "penumbra" CT Perfusion of the Brain - Answer Tracks arterial blood in brain Indicates viable tissue Perfusion Maps: RED is DEAD GREEN is GO Significant mismatch=Green is greater than 20% of the red CT angiography (CTA) - Answer Details blood vessel flow Large vessel occlusions Acute interventional treatment MRI (magnetic resonance imaging) - Answer Obtain 24 hours after initial stroke Localizes stroke **Preferred test for brainstem or cerebellum stroke
- bony artifact on CT Scan in posterior fossa
- Eyes: 4= open spontaneously 3= open to speech 2= open to pain 1= no opening
- Verbal: 5= oriented 4= confused 3= inappropriate words/random 2= incomprehensible sounds 1= none
- Motor: 6= obeys commands 5= localizes to pain 4= withdraws from pain (pulls away) 3= flex. in response to pain (decorticate) 2= ext. in response to pain (decerebrate) 1= no response NIHSS Stroke Scale - Answer Measures Stroke Severity-locate Stroke location ****Does NOT measure gait **First Try IS Score Carotid duplex - Answer - Inexpensive, Safe
- Non-invasive for Carotid Stenosis
- Highly accurate greater than 60%
- Patient that cannot receive contrast or MRA
- 90% sensitivity and specificity Lab work for stroke - Answer Glucose BUN/Creatinine PT/PTT INR CBC with differential Platelet count CXR - Answer Evaluate size of the heart Pneumonia NIHSS - Answer National Institutes of Health Stroke Scale 0 - 1=Normal 1 - 4=MinorStroke 5 - 15=Moderate Stroke 15 - 20=Moderately Severe Stroke +20=Severe Stroke *****Does NOT measure Gait! ABCD score - Answer Age, Blood Pressure, Clinical Features, Duration of Symptoms and Diabetes
Age > 60 = 1 Point Blood Pressure >140/>90 = 1 Point Clinical Features - Unilateral Weakness - 2 Points, Speech Disturbances - 1 Point Neuro Sx > 60 Mins = 2 Points 10 Mins to 60 Mins = 1 Point DM = 1 Point Score 0 to 3: Low Stroke Risk-may not be needed unless afib Score 4 to 5: Moderate Risk-hospital obs justified in most situations Score 6 to 7: High Risk-hospital observation worthwhile Alberta Stroke Program Early CT ASPECT Score= - Answer Assesses early MCA on CT Scan-everybody gets 10 points Subtract 1 point for each ischemic area on CT scan Score of equal to or less than 7 correlates with poor functional outcome and possible hemorrhage ABCD - Answer Higher the score=you are going to stroke in 2 days Hunt and Hess-Neuro deficit for SAH - Answer 1 - GREAT 2 3 4 5 - BAD ICH score - prediction of mortality - Answer 0 - No mortality 1 - 13% 2 - 26% 3 - 72% 4 - 97% 5 - 100% 6 - Death Hunt and Hess Classification*** - Answer 1. Asymptomatic or mild headache
- Moderate to Severe headache, nuchal rigidity, NO focal deficits other than cranial nerve palsy
- Confusion, lethargy, or mild focal deficits other than cranial nerve palsy 1V. Stupor or moderate to severe hemiparesis V. Coma, extensor posturing, moribund appearance Fischer Miller Grading Score - Answer 0 No SAH or IVH 1 Minimum or thin SAH, NO IVH in lateral ventricles 2 Minimum or thin SAH, WITH IVH in lateral ventricles 3 Thick SAH, NO IVH in either lateral vetricle 4 Thick SAH, with IVH in both lateral vetricles Hyperacute Care treatment considerations- - Answer NPO until swallowing screen performed
Inclusion criteria for tPA - Answer Clinical Diagnosis of ischemic stroke causing measurable neurologic deficit; Onset of symptoms less than 3 hours/4.5 hrs before beginning treatment, Age over 18 years Exclusion criteria for tPA - Answer - after 3/4.5 hrs or:
- age >
- Head trauma/stroke prev 3 months
- SAH
- oral anticoagulant use
- recent brain/spine sx
- HX: ICH
- CT with multilobar infarction
- Active internal bleeding
- major surgery or trauma within 2wks
- arterial puncture at noncompressible site within 1wk
- heparin within previous 2d
- glucose <50; INR>1.7; PT >15sec, plt <100K
- SBP>185 and DBP> Relative exclusion criteria for tPA - Answer - improving symptoms
- Pregnancy
- SZ with postictal impairment
- Major sx or trauma last 14 days
- Recent GI or GU hemmorrhage last 21 days
- Recent MI last 3 months Post-TPA complications - Answer Intracranial Hemorrhage 6%
- 17% with NIHISS >80 yrs old
- Stop tPA, draw labs, CT scan, Cryoprecipitate 10IU Orolongual Angioedema 5%
- Assess use of ACE inhibitor
- Treat with methylprednisone, diphenhydramine, ranitidine*******know Post-administration tPA care: - Answer Perform Neuro Assessment:
- Every 15 min for 2 hours
- Every 30 min for 6 hours
- Every 60 min for 16 hrs Monitor BP
- Every 15min for 2 hrs
- Every 30 mins for 6 hrs
- Every 60mins for 16 hrs Hemicraniectomy - Answer TX: Malignant infarctions-EDEMA
- perform within 48 hrs of stroke onset
- reduce mortality from 78%-29%
- Favorable outcomes Intra-Arterial Thrombolysis - Answer tPA injection directly into the clot with a small catheter
Mechanical embolectomy Penumbra Catheter - Answer - Suction device that grabs clot
- Up to 24 hrs
- Restores blood flow Correct Coagulopathy Reversal Agents: - Answer Warfarin(INR >1.7)-VIT K Heparin-Protamine sulfate Thrombocytopenia(platelets <100,000)-give 6U platelets Dabigatran, Rivaroxaban, Apixaban-give PCC Thrombosis-Give FFP Ventriculostomy - Answer ICP monitoring Drains CSF Manage ICP - Answer HOB 30 degrees Cerebellar Bleed - Answer Decompress-take off bone Manage ICP interventions: - Answer Control increasing ICP (20- 25 mmHg) HOB 30 degrees Analgesics/sedation Mannitol/HYPERtonic state Ventriculostomy Neuromuscular blockade Hyperventilation (PCO2 30 - 35mmHg) CPP >50mm HG HYPOthermia Hemicraniectomy Barbituarate coma Generalized Stroke Care: - Answer Initiate rehabilitation upon addmission Quality Stroke Metrics: - Answer Participate in quality improvement projects
- Plan
- Do
- Study _Act Plan-do-study-act (PDSA) cycle - Answer A performance improvement model designed specifically for healthcare organizations Diagnositic studies Ischemic Stroke: - Answer CT Scan CTA MRI Carotid US Echocardiogram Permissive hypertension - Answer Witholding antihypertensive unless SBP >220 mm Hg or DBP > 120 mmHg
Treatment Option 3 - Answer Atrial Fibrillation Management CHADS (CHF, HTN, Age >76, DM, prior Stroke) CHADS=0-Give ASA CHADS=1-Give ASA or COUMADIN or ASA + PLAVIX or Dagigatran or Rivaroxaban or Apixaban CHADS=2-Give Coumadin or Dagigatran or Rivaroxaban or Apixaban or ASA + Plavix Treatment Options 3 - Answer Surgical Intervention Carotid Endarterectomy
- recommend if there is *>80% occlusion with no symptoms *>70% occlusion with symptoms *69% occlusion, male, hemispheric event Treatment Option 4 - Answer Fluid management Nutrition Risk of Infection Bowel and Bladder care VTE prophylaxis Skin Care Diagnositic Studies - Answer CT Scan Angiogram Monitor and Migate Vasospasm - Answer Peaks at 7 - 10 days following SAH Provide hypertensive and euvolemia therapy Monitor Vasospasm - Answer Monitor for changes in neurological deficits Seen within 3-14 days following SAH Narrowing of cerebral blood vessel, reduced blood flow distally Lead to delayed ishemic deficit & cerebral infarction Mitigate Vasospasm - Answer Angiography CEREBRAL SALT WASTING-TX: SODIUM & FLUID REPLACEMENT Nimodipine=CCB-60mg every 4 hrs for 21 DAYS Monitor Fluid & Electrolyte Balance - Answer ***CEREBRAL SALT WASTING-TX: Sodium and Fluid replacement ***Osmololatity- NORMAL RANGE=282- 295 mOsm/L Ventriculostomy Catheter EVD Shunt - Answer Level EVD at Foramen of Monroe CSF diversion craniotomy vs craniectomy - Answer Craniotomy-Bone flap returned Craniectomy-Bone flap NOT returned Aneurysmal clipping= - Answer Hunt & Hess Grade 1 - 111
Anterior circulation location < 3mm size Giant with neck > 5mm < 60 years old Aneurysmal Clipping= - Answer ALL Hunt & Hess Grades Posterior circulation
60 yrs old Treatment Option Endovascular Management - Answer Glue Particles Metal coils Alcohol Medical management - Answer Glucose-treat 140 - 180 with insulin ICP control SZ prevention and management Temperature-Reduce fever-give antipyretic Levels of Rehabolitation - Answer Provides at LEAST 3 HOURS THERAPY per day and can include PT, OT, Speech and recreational therapy Therapy is provided 5 - 7 DAYS PER WEEK Modified Rankin Scale - Answer QUANTIFY THE DISABILITY OF A PERSON WHO SUFFERED A STROKE **SEVERE Disability=bedridden, incontinent, requiring constant nursing care and attention Rehabilitation issues - Answer Spasticity-ROM, antispasmotics Cognition-Frequent reminders, less decision making Psychosocial-Post-Stroke depression Dysphagia-Aspiration risk Elimination-Bladder & bowel program Functional Independence Measure (FIM) - Answer Assess phhysical & cognitive disability Measures patient progress and assesses rehabilitation outcomes Scored on level of assisstance required for patient to perform ADLs Scores range 18- 126 HIGHER SCORE=More indepence with ADLs Barthel Index-Bathroom - Answer This index was designed to measure functional levels of self-care and mobility and it rates the ability to feed and groom oneself, bathe, go to the toilet, walk (or propel a wheelchair), climb stairs, and control bowel and bladder. Higher score=more independent Modified Ranking - Answer High score=6=DEAD Stroke education: - Answer Risk factor management
Smoking and Oral contraceptives increase in women Discontinuation shown a reduction in stroke risk 5 A's - ASK, ADVISE, ASSESS, ASSIST, and ARRANGE Chronic Kideny disease - Answer Increased risk for stroke with Creatinine > 1. GFR < 60 Sleep Apnea - Answer Increases risk factor for stroke or death 2 - fold Severe sleep apnea has 3 to 4 fold incresed odds of stroke Occurs in 2/3 to 3/4 of poststroke patients Continuous positive pressure improves outcomes 81% Atrial Fibrillation - Answer Powerful risk factor Increases risk 5-fold all ages Anticoagulation reduces risk by 68% Physical inactivity - Answer Moderate to vigorous decreases risk by 35% Walking shows NO benefit MODERATE intensity exercise > 30 minutes most days Obesity - Answer Maintain BMI < 25 Alcohol - Answer Men no more than 2 drinks/day Women no more than 1 drink/day 1.5 oz hard liquor 4 oz wine 12 ounces beer Drug abuse - Answer Amphetamines, cocaine, heroin Occurs first time or long-term user Intracerebral hemorrhage Antiplatelet Agents - Answer ASA 50 - 325mg Plavix 75mg Aggrenox (ASA/Dipyridamole) 25/200mg BID
- cannot take 2 doses if miss one
- Take with or without food
- Take it to prevent another stroke
- Tell MD ishaving surgical procedure Anticoagulants - Answer Heparin Enoxaparin (Lovenox) Dalteparin (Fragmin) Warfarin (Coumadin) Rivaroxaban (Xarelto) Dabigatran (Pradaxa) Fondaparinux (Arixtra)
Anticoagulants patient care - Answer Monitor PTT for Heparin Monitor PT & INR for Warfarin Instruct pt to avoid alcohol, NSAIDS, or other aspirin-containing products Lipid-lowering agents - Answer Statin Stop Liver from making cholesterol People with low HDL benefit most from statins Lower stroke risk by decrease in BP Naturally derived statin Mevacor show greatest bebefit for stroke Antihypertensive drugs - Answer Btea Blockers ACE inhibitors ANgiotensin 11 Receptor Blockers Calcium Channel Blockers Statin Patient Education - Answer Dietary modification Decrease intake of saturated fat < 7% Decrease intake of cholesterol <200mg/dl Increase intake of plant sterols, soluble fiber Regular exercise
- decrease LDL, increase HDL, decrease weight
- 30 - 45 mins 3 - 5 days a week
- WArm-up, cool down Weight control Monitor drug therapy
- Take drug at night, monitor side effects
- Avoid eating grapefruit
- Fast 12 hours prior to blood draw Diuretics: Thiazide - Answer Increases excretion of Na and water by inhibiting Na reabsorption of distal tubule Promotes excretion of chloride and potassium HCTZ and Indapamide Diurectics-Loop - Answer Inhibit reabsorption of Na-K from loop of Henle Lasik, Bumex Diuretics Potassium-sparing - Answer Modest effects on BP Conserves potassium Aldactone, Midamor,Dyrenium Glycemic control - Answer sq insulin Oral hypoglycemics Antispasmotics - Answer Baclofen Anticonvulsants - Answer Keppra Dilantin Tegretol
Just treat the seizure if it occurs occipital lobe stroke or brainstem stroke - Answer May cause vision difficulty Left side brain stroke - Answer Aphasia Brocca-Nonfluent BN Wernicke-Fluent WtF Right side brain stroke - Answer Neglect Safety, falls, arm difficulty on the left ****teach pt to scan the room Dysarthia-right side stroke - Answer Clarity of speech-'Tip Top" dysarthic speech-right side stroke - Answer motor speech disorder. The muscles of the mouth, face, and respiratory system may become weak, slow, or paralyzed after brain injury; slurred, soft, hoarse, rapid "mumble" quality, limited movement, abnormal intonation, changing vocals, breathiness frontal stroke - Answer Motor strip-weakness Obstructive hydrocepalus - Answer 4th ventricle Brainstem stroke symptoms - Answer CNIII palsy, contralateral hemiplegia, ataxia C/O facial numbness, facial weakness Cerebellum stroke - Answer Coordination Balance Nystagmus Basiar artery - Answer comes through the pons and midbrain bifucation stroke - Answer Afib clot travels to motor strip taking out both leg and arm ACA-takes out leg-'There is an Ant on my Leg MCA-takes out Arm-"My Arm is weak" Motor strip - Answer ACA-Leg MCA-Arm Arm has an 'M" and MCA has an "M" Is an artery more prone to Embolis (clot) or Thrombosis (Atherosclerosis)? - Answer Embolis/Clot Afib DVT with PFO Embolis - Answer traveling blood clot thrombus - Answer stationary blood clot Throbosis larger stroke risk factors - Answer HTN, DM, Smoking
Cerebellar stroke symptoms - Answer ataxia dizzy nystagmus Basilar artery stroke - Answer Presents with quadriplegia, coma, or locked-in syndrome (intact mentation with loss of all motor control except upward gaze). Vertebral Stroke - Answer Bulbar signs bulbar signs - Answer Slurred speech carotid stroke - Answer Visual deficit Homonymous Hemianopia - Answer Loss of vision in half of the visual field on the same side of both eyes 'same side both eyes' Half of the RIGHT visual field is lost in LEFT MCA stroke Truama/hit head= - Answer Trauma to CN2-visual loss on same side hit head on right-vision affected on the right Left homonymous hemianopsia= - Answer Right-side stroke Right homonymous hemianopsia= - Answer left-side stroke Brain stem cranial nerves - Answer Medulla stroke - Answer Bulbar signs
- CN 9 & 10, 11, 12 Back of tongue difficulty swallowing dysarthria weak shoulder shrugging 1st cranial nerve on the brain stem (midbrain) - Answer CN Brainstem consists of - Answer midbrain, pons, medulla CN2 - Answer Optic Nerve =TIA most common symtom CN3 - Answer Ptosis (lid lag)-3rd nerve palsy CN5 - Answer Trigeminal-Blink reflex CN6 - Answer Lateral gaze-"Look over here" Lateral dyscongate-one eye moves, the other eye does NOT. CN7 - Answer Facial
