EXTERNAL INA2: NEUROLOGIC DISORDERS

BSN 4E | 2ND SEM | ENDTERM | SIR KRISTOFER TOM LABONETE 05/04/2024

I. NEUROLOGIC DISORDERS ● Medication: Levodopa, tablet, 300 mg

BID or 200 mg TID
1. Parkinson’s Disease
Carbidopa – Levodopa Carbidopa – Levodopa SR
Total Daily Dose Suggested
Levodopa (mg) Dosage Regimen
300-400 200 mg twice daily
500-600 300 mg twice daily or 200 mg three
times daily
700-800 A total of 800 mg in 3 or more
divided doses (e.g 300 mg early pm
● Degenerative disease and 200 mg later pm)
● Absence of dopamine 900-1000 A total of 1000 mg in 3 or more
divided doses (e.g 400 mg am, 400
○ Dopamine (from basal ganglia)– a mg early pm, and 200 mg later pm)
neurotransmitter responsible for 2. Stroke
movement, mood, attention, sleep,
working, memory
● 3 Cardinal signs: (Parkinsonian
Syndrome) *not all patients with
parkinsonian syndrome have
Parkinson’s
○ Tremor
○ Rigidity
○ Bradykinesia
● Manifestations: ● Cerebrovascular accident
○ Cog wheeling ● Blockage or blood vessel bleeding that
○ Pill rolling interrupts/reduces the brain blood
○ Shuffling gait supply
○ Micrographia – small writing ● Risk:
○ Dysphonia – having an abnormal ○ Men of 55
voice, glottis also vibrates ○ African American
○ Depression ○ Hypertension
● Complications: ○ Heart disease
○ Respiratory dysfunction – ○ Smoking
pneumonia (cannot cough ○ Obesity
properly due to tremors) ○ TIA
○ Urinary dysfunction – cannot
urinate properly
○ Falls

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● Losses: 3. Transient Ischemic Attack (TIA)
○ Motor – hemiplegia
(paralysis)/paresis (weakness), ataxia
(sudden), apraxia (used to do)
○ Language – aphasia
■ Expressive aphasia – wanting to
say something but can’t
■ Receptive aphasia – impaired
language comprehension
○ Vision – hemianopsia

● A stroke that lasts only a few minutes

● Happens when the blood supply to part
of the brain is briefly blocked
○ Sensory – paresthesia ● Symptoms are like other stroke
○ Cognition – memory loss, decreased symptoms, but DO NOT LAST LONG;
attention and concentration happen SUDDENLY on one side of body
○ Emotion – depression, fear, anger, ○ Numbness
isolation ○ Weakness
● Types:
○ ISCHEMIC – disruption of blood flow
of brain
■ Large artery thrombosis 20%
(atherosclerotic cause)
■ Small penetrating artery 25%
■ Cardiogeneic embolic stroke 20%
(heart to brain)
■ Cryptogenic 30% (unknown)
■ Other 5% (smoking, migraine)
○ HEMORRHAGIC –
intracranial/subarachnoid bleeding
■ Causes:
● Aneurysms
● Any bleeding within the brain
that compresses and injures
brain tissue
● Management: (thrombolytics)
○ Warfarin (coumadin)
○ Heparin
○ Aspirin
○ Recombinant tissue
Plasminogen activator (tPa) –
must be given at the first 3 hrs
○ Analgesics for headache
○ Elastic compression stocking for
DVT

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4. Multiple Sclerosis 5. Guillain-Barre Syndrome
● Bilateral ascending paralysis
● Etiology and incidence:
○ Unknown origin
○ 30 and 50 to men and women

● Demyelination of myelin sheath

● Autoimmune, unknown (idiopathic)
● Damage to CNS caused by the immune
system that produces a variety of neuro
symptoms. These develop scar tissues ● Clinical manifestations:
which gives the name–multiple scarring ○ 1st sign: Clumsiness
or multiple sclerosis ■ From feet to hand
● Risk factors:
○ Women
● Signs and symptoms:
○ Charcot’s triad
■ Scanning speech - words are
broken up with pauses
between syllables
■ Intention tremor
■ Nystagmus
● Nursing interventions:
○ Corticosteroid – to reduce
inflammation
○ Plasmapheresis – plasma exchange
○ Exercise – to prevent tremors
○ No heating pads – patient is numb
○ Baclofen – to reduce spasms

● Management:
○ IV IG
○ Plasma pheresis
○ Assistive devices such as walker
○ Prioritize airway – diaphragm
paralysis
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6. Myasthenia Gravis 7. Autonomic Dysreflexia
● Descending paralysis
● Autoimmune
● Risk factors:
○ Young women
● Cholinesterase activation – in muscle
contraction, acetylcholine at a
neuromuscular junction triggers a
contraction, but for the muscle to relax
afterward, rather than remaining locked
in a tense state, the acetylcholine must
be broken down by a cholinesterase
○ Cholinesterase – erases Ach

● A condition where the brain is unable to

● Signs and symptoms:
receive signals of distress from the
○ Ptosis
nervous system requiring the body to
○ Muscle atrophy
use other methods to convey
● Diagnostic assessment:
information.
○ Tensilon test (cholinesterase
● Patients with lesions above T7 are most
inhibitor) – short-acting
susceptible to AD because the large
■ If given to underdosed
splanchnic blood vessels (supply blood
weak patient, they will
to the liver and spleen) are supplied by
become stronger
sympathetic fibers carried from T6 to
(Myasthenia crisis)
T10.
■ If given to overdosed weak
patient, they will become
weaker (Cholinergic crisis)
● Prepare @ bedside: ET
tube because patient
cannot breathe

● Nursing management:
○ Anticholinesterase – Prostigmin
preferably before meals,
Neostigmine (oral)
○ Plasma exchange
○ Watch out for crisis (Myasthenic
and Cholinergic)
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 8. Alzheimer’s Disease

● Degenerative disorder of brain with

impaired intellectual and function loss

● Management:
○ Sit up head to 90 degrees, remain ● 4 A’s
until BP returns to normal ○ Amnesia
○ Loosen tight clothing ○ Agnosia – unable to recognize
○ Assess empty bowel/bladder → and identify objects, persons, or
catheter sounds
○ Monitor BP q 5 minutes ○ Aphasia
○ Bedside: Nifedipine and nitrates ○ Apraxia
(nitroglycerine paste, should be ● Stages:
placed on the skin above the level ○ Stage 1: Early confusion
of injury) ■ Difficulty recalling names
○ Stage 2: Moderate
■ Unable to perform
complex task
○ Stage 3: Early dementia
■ Needs assistance for
survival
■ Reminders to bath and
other daily function
○ Stage 4: Severe dementia
■ Forgets spouse and family
■ Unaware of surroundings
■ Paranoia, delusions,
agitations
○ Stage 5: Very severe dementia
■ Limited to 5 words or less
■ Person may scream or
make other sounds
■ Unable to hold head erect
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● Collaborative management: II. CRANIAL NERVE DISORDERS
○ Supervision 1. Trigeminal Neuralgia
○ Doors ● tic douloureux
○ ID bracelet ● 5th cranial nerve compression
○ Toxic substances ● Manifested by sharp, stabbing facial
○ Wander in safe places pain
○ Prevent shadows ● occurs spontaneously, but is sometimes
○ Call by name associated with facial trauma or dental
○ One question at a time procedures. The condition may be
○ Calendar and clock caused by a blood vessel pressing
○ Structured activities, against the trigeminal nerve, also known
■ Keep It Short and Simple as vascular compression.
○ Prevent sundown syndrome
○ AVOID change of routine
● Medications: (cholinesterase inhibitors)
○ Cognex – Citicoline; nerve
protecting medication
○ Aricept – prevents acetylcholine
breakdown (muscle action,
learning, and memory)
○ Reminyl – prevents acetylcholine
breakdown (muscle action,
learning, and memory)
○ Exelon – Rivastigmine; prevents
acetylcholine breakdown (muscle
action, learning, and memory)
● In the later stages of dementia,
medications that help with memory and
thinking are less likely to help as much. ● Management:
However, they still may improve ○ Narcotic analgesics
symptoms slightly. ○ Anticonvulsants
○ Chew on good side
○ Alcohol injections
○ Avoid extremes
● Surgical Management: Neurectomy

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2. Bell’s Palsy
● damage to the facial nerve (CN 7)
● unexplained episode of facial muscle
weakness or paralysis

● Manifestations:
○ Unilateral facial weakness
○ Drooling
○ Bell’s phenomenon
○ Tearing
○ Ringing in the ear (tinnitus)

● Treatment:
○ Protect eyes from dryness –
artifical tears
○ Frequent oral care *aspiration
○ Analgesics to relieve pain
○ Steroids – to reduce facial nerve
edema
○ Possible electrotherapy
○ Surgery for persistent paralysis

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Test I. 13. What medical condition mimics stroke?
1. What reflex is normally lost in the a. Crohn’s disease
elderly? b. Hypoglycemia
a. Blink reflex c. Myocardial infarction
b. Gag reflex 14. What is bulbar palsy?
c. Achilles reflex – risk for fall a. Cerebellar palsy
2. What part of the brain is susceptible to b. Neuropathic palsy
hypoxia? c. Brainstem palsy
a. Frontal lobe 15. Monro-Kellie Doctrine skull components
b. Hippocampus – memory a. Brain (10%) blood (80%) CSF
c. Pituitary gland (10%)
3. Most frequently reported trigger of b. Brain (80%) Blood (10%) CSF
migraines (10%)
a. Weather c. Brain (10%) CSF (20%) Air (80%)
b. Stress 16. Stroke patient, diet
4. What part of the nervous system does a. Pineapple juice – risk for
Parkinson’s Disease mostly affect? aspiration
a. Nervous system b. Champorado
b. Motor system 17. Cranial nerve that is mostly affected
c. Circulatory system during migraines
5. Mechanism in the elderly that can lead a. Optic nerve
to hyperthermia b. Trigeminal nerve
a. Bradypnea c. Facial nerve
b. Reduced sweating 18. Morphine
c. Increased metabolism a. Used for moderate pain
6. Common cause of bacterial meningitis b. Used for intense pain
aside from N. meningitis c. Used for acute pain
a. S. pneumoniae 19. Monro-Kellie hypothesis suggests that
b. E. coli the brain is 80% inclusion of the skull?
c. H. pylori How about the blood and CSF?
7. Complications of chronic rigidity in a. Blood 5% CSF 15%
Parkinson’s disease b. Blood 10% CSF 10%
a. Extended posture 20. Post-ictal phase happens when?
b. Flexed posture a. After stroke
8. Nursing precaution when giving sleep b. After seizure
medication to the elderly 21. Tension headaches are
a. Risk of falls and injury a. Unilateral
b. Not waking up b. Bilateral
9. A defining feature of infantile meningitis 22. Common cause of increased ICP
a. Sunset eyes – hydrocephalus a. Tumors
b. Bulging fontanels b. Decreased CSF
c. High-pitched cry – increased ICP c. Decreased blood supply
10. Most common CN neuropathy caused 23. How do we see an image?
by diabetes mellitus a. Upside down
a. CN 1 b. Upright
b. CN 3 24. What happens in obstructive
11. This Greek term when translated into hydrocephalus?
English means “to thrust into/to send a. Blockage of circulation causing
down” and is used today in medicine as back pressure
a. Injection b. Too much supply of circulation
b. Catheter causing build up
c. Endoscope 25. First thing to investigate on a patient
12. Migraines are most likely caused by with headache
a. Constriction of vessels a. Eye pain
b. Dilation of vessels b. Blood pressure
c. Both c. Pulse
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26. What causes phonation? 40. No blood supply to the brain
a. Flapping of the epiglottis a. Ischemic stroke
b. Opening and closing of glottis b. Hemorrhagic stroke
c. Vibration of trachea 41. What is the Greek term when translated
27. Parkinson’s risk into English means “wound”?
a. Men of 60 a. Erythro
b. Women of 50 b. Trauma
28. Tension headaches tend to be bilateral c. Rubro
while migraine pain is focused where? 42. Expressive aphasia in stroke
a. Unilateral a. Cannot say what he wants to say
b. Frontal b. Cannot understand what he is
c. Occipital seeing and hearing
29. Bulbar palsy which affects the 43. Receptive aphasia
brainstem shows problem where? a. Cannot say what he wants to say
a. Swallowing b. Cannot understand what he is
b. Walking seeing and hearing
30. Proper attire for Parkinson’s disease 44. A stroke patient with weakness on left
a. Polo shirt with buttons side
b. Polo shirt with velcro a. Instruct patient to hold cane on
31. How does increased ICP cause left side
damage? b. Instruct patient to hold cane on
a. Increased BP right side
b. Brain compression 45. It means “to lean” in Greek
32. Parkinson’s priority a. Supine
a. Memory b. Clinic – incline
b. Safety c. Sleep
33. What changes are seen in the eyes of a 46. Anti-seizure medication
patient with increased ICP? a. Phenobarbitals
a. Pupils initially dilate then b. Valium – muscle relaxant
constrict 47. It means “docere” in Greek
b. Pupils initially constrict then a. To heal
dilate b. To teach
34. Medication for Parkinson’s 48. Post seizure, priority
a. Levodopa a. LOC
b. Edrophonium – Myasthenia b. Oriented 3 times
Gravis 49. Selegiline hydrochloride (Eldepryl)
35. A patient with bulbar palsy presents with a. Medication for Parkinson’s
dysphagia, what is the priority? b. Medication for Alzheimer’s
a. Airway c. Medication for Multiple Sclerosis
b. Safety 50. Parkinson’s disease
c. Consciousness a. Decreased dopamine
36. Stroke, risk b. Decreased serotonin
a. Men of 55 Test II.
b. Women of 50 51. Patient complains of headache that
37. Rapid opening and closing of the glottis lasted for days, this may be a
causes phonation that produces? manifestation of?
a. Swallowing a. Migraine
b. Voice b. Tension headache
38. Patient dizzy after seizure 52. Myasthenic crisis happens when?
a. Expected a. You gave too much medication
b. Call doctor b. You gave too little medication
39. ECT, patient started having seizures 53. Cause of earth of Guillian Barre cases
a. Immobilize arms to stop a. Respiratory failure
movement b. Paralytic ileus
b. Immobilize arms to minimize
movement
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54. Cerebrum damage, effect 68. Common first symptom of multiple
a. Cannot hear – temporal sclerosis
b. Cannot see – occipital a. Paralysis
c. Cannot move b. Eye pain
55. Cluster headache, risk factors c. Numbness
a. Obesity 69. Can the brain feel pain?
b. Tobacco a. Yes
c. Alcohol b. No
56. Stroke, health teaching 70. Symptoms of multiple sclerosis worsen
a. Complete bed rest when in contact with
b. Ambulation a. Cold
57. Patient with migraine complains of b. Heat
headache since last week, the pain may 71. Where in the spine are children more
be described as? likely to have injuries?
a. Dull a. Cervical
b. Throbbing b. Thoracic
c. Sharp c. Lumbar
58. Stroke, health teaching 72. Myasthenia gravis, avoid
a. Exercise a. Coffee
b. DBE b. Relaxation medicines – patient is
59. Cholinergic crisis happens because of? already weak
a. Giving too much medication 73. Myasthenia gravis, medications
b. Giving too little medication a. Before meals – so they will have
60. If migraine pain is focused on one side, the strength to eat
tension headache is bilateral, then b. After meals
cluster headache pain is located where? 74. Myasthenic crisis in a weak patient
a. Occipital means?
b. At the back of the eye a. Endrophonium will make the
c. At the temporal area patient strong
61. Myasthenia gravis, target group b. Endrophonium will worsen the
a. Women weakness
b. Men 75. Cervical injuries are common in children
62. First sign of myasthenia gravis for the reason that
a. Ptosis a. They are more mobile
b. Urinary frequency b. They have heavier heads
c. Falls c. They have weak neck muscles
63. Tensilon test, positive 76. Hearing impaired patient
a. Return of muscle strength for the a. Speak with high pitched voice –
whole day for pediatric patients
b. Temporary muscle strength in b. Speak with low-pitched voice
minutes 77. What is hyperflexion?
64. Priority, myasthenia gravis a. Forward movement of the head
a. Airway b. Backward movement of the head
b. Bladder control c. Forward movement of the spine
65. Hippocampus damage, effect 78. Meniere’s disease, diet
a. Patient forgot his breakfast a. Decrease sodium in diet
b. Patient cannot understand what b. Maintain sodium in diet
has been said to him 79. Guillain-barre, age target
c. Patient cannot see peripherally a. Between 30 and 50
66. Spinal shock, manifestation b. Men of 55
a. No reflexes 80. Meniere’s disease, cause
b. No pupil dilation a. Inner ear inflammation
67. Patient with cluster headache reported b. Fluid accumulation in the inner
pain in one eye which is described as ear
a. Burning
b. Penetrating
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81. Excessive forward movement of the 93. Ischemic stroke which occurs MORE
head leads to hyperflexion, which can be compared to the 13% of hemorrhagic
caused by strokes is defined as?
a. Frontal collision a. Reduction of blood supply to the
b. Back collision brain
c. Side collision b. Bleeding within the brain
82. Optic neuritis (eye pain) initially happens 94. Guillain-Barre, first sign
in multiple sclerosis and is followed a. Ptosis
sooner by b. Clumsiness
a. Eye edema 95. What condition can lead to embolic
b. Diplopia – too much shaking of ischemic stroke?
the muscles will weaken the a. VTach
pupils b. AFib
c. Blindness c. VFib
83. Vertigo, priority 96. Diagnostic test for GB syndrome
a. Safety a. MRI
b. Vomiting b. Electromyelogram
84. Status epilepticus 97. Meneiere’s disease, avoid
a. Episodal convulsion of 5 or more a. Coffee – stimulant
per day b. Decrease sodium
b. Seizure lasting more than 5 98. Brainstem parts
minutes – a. Pons, Medulla, Ganglia bodies
convulsion-unconscious (patient b. Pons, Medulla, Midbrain
is not waking up = brain damage) c. Pons, Medulla, Thalamus
85. Management for stroke 99. Hallucinations
a. Warfarin a. No proof of evidence
b. Aquamephyton – vitamin K b. Altered interpretation of stimulus
86. How many % of strokes are considered – illusion
ischemic? 100. Atrial fibrillation can be a risk factor
a. 87% for an embolic type of ischemic stroke
b. 13% – hemorrhagic stroke that can lead to
87. Autonomic dysreflexia can be simply a. Blockage of supply to the brain
described as b. Bleeding within the brain
a. Hypersensitive NS after spinal Test III.
cord 101. Epidural hematoma in a nutshell
b. Hyposensitive NS after spinal a. Scalp-skull-dura
cord matter-bleeding-brain
88. Vertigo, correct b. Scalp-skull-bleeding-dura
a. Avoid sudden head movements matter-brain
b. Maintain sodium foods 102. A head fracture can most likely lead
89. Stroke, health teaching to?
a. Stockings a. Epidural hematoma
b. Warming gloves b. Subdural hematoma
90. A simple stimulus can be excessive 103. The first sense being impacted by
when it comes to autonomic dysreflexia, Alzheimer’s
and this can cause a. Sense of touch
a. Severe rise in blood pressure – b. Sense of smell
with headache c. Sense of hearing
b. Severe drop in blood pressure 104. Guillain-Barre syndrome occurrences
91. Multiple sclerosis a. Both sexes
a. Common in men b. Men
b. Common in women 105. Declining consciousness can be
92. Guillain-Barre syndrome seen in what type of hematoma?
a. Ascending paralysis a. Epidural
b. Descending paralysis b. Subdural

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106. Trigeminal neuralgia, cause 117. How long will the brain stop
a. Unknown functioning if deprived of oxygen?
b. Trauma a. After 90 seconds
107. What cells are lost in multiple
b. After 5 minutes
sclerosis?
a. Oligodendrocytes – makes the 118. Bell’s palsy, management
myelin sheath a. Warm compress on the affected
b. Osteocytes side – to dilate blood vessels
108. Define locked-in syndrome b. Cold compress
a. Unconscious but aware 119. Trigeminal neuralgia
b. Paralyzed but aware a. Pain on both sides
c. Awake but numb
b. Pain on one side
109. How will a patient with GB syndrome
recover when it comes to strength? 120. Alzheimer’s, priority
a. Upper body recovers first then a. Memory
going down b. Safety
b. Lower extremities recover first 121. Trigeminal neuralgia, nursing
then going up diagnosis
110. What cells cause the inflammation in a. Pain
MS?
b. Depression
a. B cell
b. T cell 122. What is the meaning of the Greek
111. Cause of death in Alzheimer’s term “encephalon”?
a. Motor problems a. Nerves
b. Lung problems b. Brain
c. Cognitive problems c. Skull
112. Locked-in syndrome, an infarction of
123. Bell’s palsy
the Pons can lead to
a. Death a. Both sides of face paralyzed
b. Paralysis b. One side of face paralyzed
c. Stroke 124. Bell’s palsy, cause
113. As the patient with subdural a. Blockage of nerve
hematoma gradually loses b. Unknown
consciousness, the anticipated mgmt by 125. Irreversible damage to the brain
the hospital will be
happens after?
a. Airway management
b. Craniotomy a. 2 days
c. Epinephrine administration b. 3 hours
114. Number 1 risk factor for stroke c. 1 hour
a. Hypertension 126. How do you measure sounds?
b. Smoking a. Hertz
c. Diabetes b. Decibel
115. Patient diagnosed with stroke,
c. Milli ampere hour
presenting with weakness on both legs
127. Bell’s palsy, risk
a. Advise to use wheelchair – would
a. Risk for aspiration, dysphagia
not promote rehabilitation
b. Disturbed sensory perception,
b. Advise to use crutches – injured
ptosis
legs
128. How many divisions of the nervous
c. Advise to use walker
system?
116. Trigeminal neuralgia, AVOID
a. 2 – CNS and PNS
a. Electric fan on face
b. 4
b. Room temperature foods

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129. You are gonna assess CN1, what do 142. Trigeminal neuralgia
you need? a. No cure
a. Penlight b. Has cure
b. Perfume c. Manageable
c. Metronome 143. Fill in the boxes
130. Bell’s palsy, caused unkown, usually Epidural Hematoma Subdural
occurs after Below skull Below dura
LOCATION
a. Bacterial infection matter
b. Viral infection Lucid interval Declining
CONSCIOUSNESS
consciousness
131. Number 1 risk factor for stroke is
Head impact CAUSE Concussion
increased blood pressure, what is the
Arterial blood BLOOD Venous blood
second?
a. Smoking
b. Heart disease
c. Diabetes
132. Alzheimer’s patient protocol
a. Safety
b. Familiarity
133. Bell’s palsy
a. 7th CN affectation
b. 5th CN affectation
134. GB syndrome, FIRST
a. Loss of bladder control
b. Difficulty swallowing
135. Alzheimer’s patient, priority
a. Safety
b. Familiarity
136. Cholinergic crisis means?
a. Too little medication was given
b. Too much medication was given
137. Bell’s palsy
a. Facial drooping
b. Ptosis
138. Alzheimer’s patient, where is his
room?
a. Near nurses’ station
b. Far from nurses’ station
c. With other Alzheimer’s patient
139. Myasthenia Gravis
a. Descending weakness
b. Ascending weakness
140. Bell’s palsy
a. No cure
b. 8 weeks
141. We have 12 pairs of CN, some are for
sensation, some are for motor, some are
mixed, how many CN are mixed?
a. 3
b. 4
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