Chapter 18 Workbook Flashcards by Tom Bowl

A period following a seizure that typically includes labored respirations and altered mental status

Postictal state

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Low blood glucose levels

Hypoglycemia

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A surge of electrical activity in the brain, classified as generalized, partial, or status epilepticus

Seizure

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Experiencing a warning sense prior to an event

Aura

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Part of the brain located above the cerebellum; divided into right and left hemispheres

Cerebrum

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Loss of bowel or bladder control

Incontinence

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Stroke symptoms that go away in less than 24 hours

Transient ischemic attack

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Weakness of one side of the body

Hemiparesis

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A seizure lasting longer than 30 minutes or multiple repetitive seizure episodes without regaining consciousness

Status epilepticus

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An interruption of blood flow to the brain that results in a loss of brain function

Stroke

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Controls basic functions of the body, such as breathing and blood pressure

Brainstem

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A lack of oxygen that causes cells to not function properly

Ischemia

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A swelling or enlargement of part of an artery resulting from weakness of the arterial wall

Aneurysm

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An inability to produce or understand speech

Aphasia

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Controls muscle and body coordination

Cerebellum

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A __________ is typically characterized by unconsciousness and a generalized severe twitching of all of the body’s muscles that lasts several minutes or longer.
A. stroke
B. postictal state
C. simple partial seizure
D. generalized seizure

D. generalized seizure

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The __________ controls the most basic functions of the body, such as breathing, blood pressure, swallowing, and pupil constriction.
A. Brainstem
B. Cerebellum
C. Cerebrum
D. Spinal cord

A. Brainstem

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At each vertebra in the neck and back, __________ nerves, called spinal nerves, branch out from the spinal cord and carry signals to and from the body.
A. Two
B. Three
C. Four
D. Five

A. Two

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All of the following are associated with altered mental status EXCEPT:
A. Coma
B. Seizure
C. Incontinence
D. Intoxication

C. Incontinence

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When blood flow to a particular part of the brain is cut off by a blockage inside a blood vessel, the result is:
A. A hemorrhagic stroke
B. Atherosclerosis
C. An ischemic stroke
D. A cerebral embolism

C. An ischemic stroke

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The patients who are at the highest risk of hemorrhagic stroke are those who have:
A. Untreated hypertension
B. Hypotension
C. Diabetes
D. Atherosclerosis

A. Untreated hypertension

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Patients with a ruptured aneurysm typically complain of a sudden severe:
A. Bout of dizziness
B. Headache
C. Altered mental status
D. Thirst

B. Headache

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The plaque that builds up in atherosclerosis obstructs blood flow and interferes with the vessel’s ability to:
A. Constrict
B. Dilate
C. Diffuse
D. Exchange gases

B. Dilate

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A transient ischemic attack (TIA), or mini-stroke, is the name given to a stroke when symptoms go away on their own in less than:
A. Half an hour
B. 1 hour
C. 12 hours
D. 24 hours

D. 24 hours

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Patients with a decreased level of consciousness: A. Should not be given anything by mouth B. Should be given glucose regardless of the underlying condition C. Do not require medical care D. Require immediate assessment of their pupils

A. Should not be given anything by mouth

Hypoglycemia can mimic conditions such as: A. cystic fibrosis B. myocardial infarction C. high fevers D. stroke

D. stroke

When assessing a patient with a history of seizure activity, it is important to: A. determine whether this episode differs from any previous ones B. ask if the patient has had any recent surgeries C. assess whether the patient has swallowed his or her tongue D. ask whether anyone else in the household has had a seizure

A. determine whether this episode differs from any previous ones

Signs and symptoms of possible seizure activity include all the following EXCEPT: A. altered mental status B. incontinence C. muscle rigidity and twitching D. petechiae

D. petechiae

Common causes of altered mental status include all of the following EXCEPT: A. body temperature abnormalities B. hypoxia C. unequal pupils D. hypoglycemia

C. unequal pupils

The principal difference between a patient who has had a stroke and a patient with hypoglycemia almost always has to do with the: A. papillary response B. mental status C. communication D. capillary refill time

B. mental status

Consider the possibility of __________ in a patient who has had a seizure. A. hyperkalemia B. hyperglycemia C. hypoglycemia D. hypertension

C. hypoglycemia

__________ headaches are thought to be caused by changes in blood vessel size in the base of the brain. A. Sinus B. Tension C. Migraine D. Compression

C. Migraine

Headache, vomiting, altered mental status, and seizures are all considered early signs of: A. increased intracranial pressure B. decreased intracranial pressure C. increased extracranial pressure D. decreased extracranial pressure

A. increased intracranial pressure

People with __________ have a higher risk of hemorrhagic stroke. A. uncontrolled hyperglycemia B. uncontrolled hypertension C. high fevers D. meningitis

B. uncontrolled hypertension

Headaches caused by muscle contractions in the head and neck are typically associated with: A. sinus headaches B. migraine headaches C. compression headaches D. tension headaches

D. tension headaches

The following conditions may simulate a stroke EXCEPT: A. hyperglycemia B. a postictal state C. hypoglycemia D. subdural bleeding

A. hyperglycemia

When assessing a patient with a possible cerebrovascular accident (CVA), you should check the ______ first. A. pulse B. airway C. pupils D. blood pressure

B. airway

A ______ is usually a warning sign that a larger, significant stroke may occur in the future. A. heart attack B. seizure C. transient ischemic attack D. migraine headache

C. transient ischemic attack

Which mnemonic is used to check a patient's mental status? A. OPQRST B. SAMPLE C. AVPU D. PEARRL

C. AVPU

You are called to a home and find a 56-year-old woman supine in her bed. She appears alert but has slurred speech. Her family tells you she has a history of TIAs and hypertension. Her vital signs are as follows: blood pressure 174/116, heart rate 112 beats/minute, respiratory rate 16 breaths/minute, SpO₂ 95%, and blood glucose 97 mg/dL. How would you best determine the probability of this patient having a stroke? A. By using AVPU B. By using the Cincinnati Prehospital Stroke Scale C. By using the Glasgow Coma Scale D. By assessing her blood glucose

B. By using the Cincinnati Prehospital Stroke Scale

You are called to a home and find a 56-year-old woman supine in her bed. She appears alert but has slurred speech. Her family tells you she has a history of TIAs and hypertension. Her vital signs are as follows: blood pressure 174/116, heart rate 112 beats/minute, respiratory rate 16 breaths/minute, SpO₂ 95%, and blood glucose 97 mg/dL. Which of the following would NOT be pertinent information regarding her condition? A. Knowing the time of onset of symptoms B. Gathering a list of patient medications C. Determining if the patient has a facial droop D. Asking the patient about childhood illnesses

D. Asking the patient about childhood illnesses

You are called to a home and find a 56-year-old woman supine in her bed. She appears alert but has slurred speech. Her family tells you she has a history of TIAs and hypertension. Her vital signs are as follows: blood pressure 174/116, heart rate 112 beats/minute, respiratory rate 16 breaths/minute, SpO₂ 95%, and blood glucose 97 mg/dL. You ask the patient, “What day is it today?” Her reply is “butterfly.” Which area of the brain is likely affected? A. Occipital lobe B. Left hemisphere C. Cerebellum D. Right hemisphere

B. Left hemisphere

You are called to a home and find a 56-year-old woman supine in her bed. She appears alert but has slurred speech. Her family tells you she has a history of TIAs and hypertension. Her vital signs are as follows: blood pressure 174/116, heart rate 112 beats/minute, respiratory rate 16 breaths/minute, SpO₂ 95%, and blood glucose 97 mg/dL. If the receiving facility told you the cause of her stroke was due to a buildup of calcium and cholesterol, forming a plaque inside the walls of her blood vessels, you would know that this patient has; A. atherosclerosis B. multiple sclerosis C. polyarteritis D. liver dysfunction

A. atherosclerosis

You are called to a home and find a 56-year-old woman supine in her bed. She appears alert but has slurred speech. Her family tells you she has a history of TIAs and hypertension. Her vital signs are as follows: blood pressure 174/116, heart rate 112 beats/minute, respiratory rate 16 breaths/minute, SpO₂ 95%, and blood glucose 97 mg/dL. Treatment for this patient should include all of the following EXCEPT: A. providing oxygen to maintain SpO₂ of at least 94% B. providing rapid transport C. continuously talking to the patient D. providing oral glucose

D. providing oral glucose

True/False Longer and more severe seizures will usually result in a longer postictal period.

True

True/False A low oxygen level can affect the entire brain, often causing anxiety, restlessness, and confusion.

True

True/False Febrile seizures result from sudden high fevers and are generally well tolerated by children.

True

True/False Hemiparesis is the inability to speak or understand speech.

False

True/False Patients with migraine headaches are sometimes sensitive to light and sound.

True

True/False Right-sided facial droop is most likely an indication of a problem in the right cerebral hemisphere.

False

True/False Serious conditions that include headache as a symptom are hemorrhagic stroke, brain tumors, and meningitis.

True

True/False A cerebral embolism is an obstruction of a cerebral artery caused by a clot that was formed somewhere else and traveled to the brain.

True

True/False Hemorrhagic stroke is the most common type of stroke.

False

True/False Patients with a stroke affecting the right hemisphere of the brain can usually understand language, but their speech may be slurred.

True

True/False A patient who has bleeding in the brain may have very low blood pressure.

False

True/False All seizures involve muscle twitching and general convulsions.

False

True/False A patient having a seizure may become cyanotic from a lack of oxygen.

True

True/False Hypoglycemia should be considered in a patient following a motor vehicle collision (MVC) with an altered mental status.

True

True/False Patients with a decreased level of consciousness should not be given anything by mouth.

True

True/False Psychological problems and complications of medications can cause altered mental status.

True

True/False Patients who have had a stroke can lose their airway or stop breathing without warning.

True

True/False You should wait until you get an accurate pulse oximeter reading on a seizure patient before administering oxygen.

False

True/False Letting the hospital know the specifics regarding the patient’s neurologic symptoms is generally not important.

False

True/False A key piece of information to document is the time of onset of the patient’s signs and symptoms.

True

There are ______ cranial nerves.

Playing the piano is coordinated by the ______.

cerebellum

The two main types of strokes are ______ and ______.

ischemic, hemorrhagic

The brain is most sensitive to ______, ______, and ______ levels.

oxygen, glucose, temperature

An incident in which you have more than one patient complaining of a headache may indicate ______ ______ ______.

carbon monoxide poisoning

A(n) ______-______ ______ seizure may cause twitching of the extremity muscles that may spread slowly to another body part.

focal-onset aware

Each hemisphere of the cerebrum controls activities on the ______ side of the body.

opposite

Focal-onset, impaired-awareness seizures result from abnormal discharges from the ______ lobe of the brain.

temporal

______ is a loss of bowel and bladder control and can be due to a generalized seizure.

Incontinence

Dilantin and Tegretol are medicines used to control ______ ______.

epileptic seizures

A period following a seizure in which the muscles relax and the breathing becomes labored is called a(n) ______ ______.

postictal state

Weakness on one side of the body is known as ______.

hemiparesis

A person who was eating prior to having a seizure may have a(n) ______ ______ ______.

foreign body obstruction

All patients with an altered mental status should have a(n) ______ ______ ______ score calculated.

Glasgow Coma Scale

______ ______ may reverse stroke symptoms and even stop the stroke if given within 3 to 6 hours of the onset of symptoms.

Thrombolytic therapy

A. Cerebrum B. Skull C. Brainstem D. Cerebellum E. Spinal cord

A. Cerebrum B. Cerebellum C. Brainstem D. Foramen magnum E. Spinal cord F. Spinal nerves

Short Answers Discuss the Cincinnati Prehospital Stroke Scale, including normal and abnormal findings.

1. Facial droop—Ask patient to show teeth or smile. Normal: Both sides of the face move equally well. Abnormal: One side of the face does not move as well as the other. 2. Arm drift—Ask patient to close eyes and hold arms out with palms up. Normal: Both arms move the same, or both arms do not move. Abnormal: One arm does not move, or one arm drifts down compared to the other side. 3. Speech—Ask patient to say, “The sky is blue in Cincinnati.” Normal: Patient uses correct words with no slurring. Abnormal: Patient slurs words, uses inappropriate words, or is unable to speak.

Short Answers Why is prompt transport of stroke patients critical?

New therapies for stroke are available but must be used as soon as possible after the start of symptoms. You should minimize time on the scene, and notify the receiving hospital as soon as possible.

Short Answers Describe the characteristics of a postictal state.

A period of time after a seizure, generally lasting from 5 to 30 minutes, in which a patient is unresponsive at first and gradually regains consciousness. The postictal state is over when the patient regains a complete return of his or her normal level of consciousness. The patient will likely appear dazed, confused, and fatigued.

Short Answers What is the difference between a focal-onset aware and a focal-onset, impaired-awareness seizure?

A focal seizure begins in one part of the brain and is classified as aware or impaired-awareness. In a focal-onset aware seizure, there is no change in mental status. Patients may complain of numbness, weakness, or dizziness. The patient may report sensory disturbances. A focal-onset aware seizure may also cause twitching of the muscles and extremities that may spread slowly from one part of the body to another, but it is not characterized by the dramatic, severe twitching and muscle movements seen in a generalized seizure. In a focal-onset impaired-awareness seizure, the patient has an altered mental status and does not interact normally with his or her environment. This type of seizure results from abnormal discharges from the temporal lobe of the brain. Other characteristics may be lip smacking, eye blinking, and isolated convulsions or jerking of the body or one part of the body, such as an arm.

List three conditions that may simulate stroke.

1. Hypoglycemia 2. Postictal state 3. Subdural or epidural bleeding

Determine the Glasgow Coma Scale score for the following patients. You respond to the scene of a 45-year-old woman with hypoglycemia. As you walk into the room, the patient looks at you and smiles. The patient is oriented to place but does not know the day of the week or the year. When you ask the patient to raise her arms, she smiles at you. When you pinch her hand, she pushes your hand away and says, “Ouch.”

Eye Opening—4—Patient is looking at you. Verbal—4—Patient is confused about the date/year. Motor—5—Patient does not respond to commands, localized to pain. Total: 13

Determine the Glasgow Coma Scale score for the following patients. You are at a nursing home where an 84-year-old man was found on the floor next to his bed, having a seizure. The patient is now postictal and opens his eyes when you pinch his hand. When you ask the patient whether he remembers what happened, he responds with garbled speech. The patient is unable to follow your commands but pulls away when you pinch his hand.

Eye Opening—2—Patient opens eyes to painful stimulus. Verbal—2—Patient uses incomprehensible sounds. Motor—4—Patient withdraws to pain. Total: 8

Determine the Glasgow Coma Scale score for the following patients. You respond to the scene of an MVC. On arrival, you find a 25-year-old man who was ejected from his vehicle as it rolled down an embankment. The patient fails to open his eyes to any external stimuli. The bystanders state that he has been unresponsive since the crash and has not moved. You place an oral airway into the patient and continue to manage his airway and provide cervical spine immobilization. You attempt multiple times to elicit a painful response; however, the patient does not move his extremities or open his eyes.

Eye Opening—1—Patient does not open eyes to any stimuli. Verbal—1—Patient has no verbal response. Motor—1—Patient does not move extremities to any stimuli. Total: 3

Determine the Glasgow Coma Scale score for the following patients. You and your partner are eating at a local restaurant when your server tells you the manager is not feeling well. As you approach the manager, he apologizes to you for interrupting your meal. The patient tells you that he has not felt right since he opened the restaurant this morning. The manager is able to tell you the daily specials on the menu and is able to roll up his sleeves so that you can take his blood pressure.

Eye Opening—4—Patient is looking at you. Verbal—5—Patient is able to have an oriented conversation. Motor—6—Patient is able to follow commands. Total: 15

Ambulance Calls You are dispatched to a private residence for a “confused man.” You arrive to find an older man sitting in a recliner. As you begin your assessment, you notice that he has right-sided weakness and does not seem to understand your questions. He is alone in the home, and it appears that no one lives with him in the residence. How would you best manage this patient?

Given these signs, your patient is likely experiencing a left hemispheric stroke. Any problems related to his ability to understand or use language will be frustrating for both you and the patient. After performing your primary assessment, the Cincinnati Prehospital Stroke Scale can provide valuable information regarding the presence of a stroke. This assessment measures abnormalities in speech and the presence of facial droop and arm drift. Stroke is a true emergency that requires prompt transport. You should apply oxygen to maintain an SpO₂ of at least 94% and take care during transport to prevent injury of affected body parts because the patient will not be able to protect them on his own. It is helpful to place the patient on the affected side and elevate his head approximately 6 inches (15 cm) to facilitate swallowing. Be sure to relate your positive findings of stroke to the hospital to avoid any unnecessary delays in patient care on arrival to the emergency department.

Ambulance Calls You are dispatched to a 36-year-old man who had seizure activity at least an hour ago. The patient is incontinent, cold, clammy, and unresponsive. His friends tell you that the “shaking” stopped and he has not woken up. They thought he might just be tired until they discovered they could not wake him. He has no history of seizure activity. He has diabetes, for which he takes medication. How would you best manage this patient?

Maintain the airway—assist ventilations with high-flow oxygen, if needed. Consider placement of an oral or nasal airway. Suction, if necessary, or position lateral recumbent to clear secretions. Check glucose level. Provide rapid transport.

Ambulance Calls You are dispatched to a local business for “woman with severe headache.” The 55-year-old patient states that she has had headaches in the past, but this headache is the worst she has ever had in her life. She feels like the room is spinning around, she is seeing “double,” and she feels sick to her stomach. She has a history of hypertension. She tells you that she stopped taking her blood pressure medicine about 6 to 8 months ago because she could no longer afford it. How would you best manage this patient?

This patient’s signs and symptoms cause you to suspect the presence of a hemorrhagic stroke. You should consider applying oxygen (if appropriate) and provide immediate transport. This patient will be more likely to experience seizure activity than patients suffering from ischemic stroke. There is no way for you to determine the type or extent of her stroke because this can be accomplished only in the hospital. Your job is to recognize the seriousness of the situation, provide supportive measures within your scope of practice, provide prompt transport, and notify the receiving facility.

3. Gait

You are dispatched to a local residence for a change in mental status. On arrival, you find a 67-year-old man sitting at his kitchen table. The patient seems to be having trouble speaking and is leaning to his left. The patient’s wife called 9-1-1 because she thought her husband was having a stroke. The patient’s wife tells you the patient has a history of hypertension, myocardial infarction, renal failure, diabetes, and gastroesophageal reflux disease (GERD). Based on the patient’s history, what are possible conditions that could explain his symptoms? 1. Heart attack 2. Hypoglycemia 3. Hyperglycemia 4. Hyperkalemia

2. Hypoglycemia

You are dispatched to a local residence for a change in mental status. On arrival, you find a 67-year-old man sitting at his kitchen table. The patient seems to be having trouble speaking and is leaning to his left. The patient’s wife called 9-1-1 because she thought her husband was having a stroke. As you are packaging the patient, the wife says she called 9-1-1 right away because she read about how time was an important factor with stroke patients. With regard to thrombolytic therapy at the hospital, what is the timeline that will allow this therapy to be most effective? 1. Given within 3 hours of symptom onset 2. Given within 12 hours of symptom onset 3. Given within the first 24 hours of symptom onset 4. There is no optimal time requirement for this treatment.

1. Given within 3 hours of symptom onset

You are dispatched to a local residence for a change in mental status. On arrival, you find a 67-year-old man sitting at his kitchen table. The patient seems to be having trouble speaking and is leaning to his left. The patient’s wife called 9-1-1 because she thought her husband was having a stroke. While transporting the patient to the hospital, his left-sided weakness and speech improve. By the time you reach the hospital, the patient appears almost normal. Which of the following is most likely to be the underlying cause of the patient’s condition? 1. Hemorrhagic stroke 2. Ischemic stroke 3. Transient ischemic attack 4. Partial simple seizure

3. Transient ischemic attack

Chapter 18 Workbook Flashcards

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