Review Practice Exericise 1

Neurologic Diagnostic Procedures > Adult Health

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Practice Exericise 1

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Total Questions : 5

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Question 1:

A patient presents with a sudden, severe headache described as "the worst headache of my life," and the physician suspects a cerebral aneurysm. Which of the following diagnostic tests is the most definitive for confirming this diagnosis?

A. Non-contrast computed tomography (CT) scan. B. Electroencephalogram (EEG). C. Cerebral angiography. D. Magnetic resonance imaging (MRI) without contrast.

Answer and Explanation

Choice A:

Non-contrast CT scan: While useful for detecting subarachnoid hemorrhage from a ruptured aneurysm, it does not provide detailed vessel imaging to confirm or characterize the aneurysm itself.

Choice B:

Electroencephalogram (EEG): EEG measures electrical brain activity and is used for seizure evaluation, not aneurysm diagnosis.

Choice C:

Cerebral angiography: This test offers the highest resolution imaging of intracranial vasculature, allowing clinicians to detect aneurysms with accuracy. It also helps evaluate the aneurysm’s shape and risk of rupture, making it essential for definitive diagnosis.Rationale for incorrect answers:

Choice D:

Magnetic resonance imaging (MRI) without contrast: MRI can detect vascular abnormalities, but without contrast or specialized techniques like MRA, it is less definitive than angiography.

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Question 2:

A nurse is preparing a patient for a cerebral angiogram. Which of the following pre-procedure actions are essential? Select all that apply

A. Assessing for any known allergies to iodine-based contrast dye. B. Ensuring the patient has been NPO for 6-8 hours. C. Checking and documenting peripheral pulses in the limb to be used. D. Obtaining a full medical history and current medication list. E. Administering a sedative to all patients to ensure they remain still.

Answer and Explanation

Choice A:

Assessing for any known allergies to iodine-based contrast dye: Essential to prevent allergic or anaphylactic reactions to the contrast used during angiography.

Choice B:

Ensuring the patient has been NPO for 6–8 hours: Reduces the risk of aspiration during the procedure, especially if sedation is required.

Choice C:

Checking and documenting peripheral pulses in the limb to be used: Provides a baseline for comparison after the procedure to detect vascular complications.

Choice D:

Obtaining a full medical history and current medication list: Critical for identifying bleeding risks (e.g., anticoagulants) and other potential contraindications.Rationale for incorrect answer:

Choice E:

Administering a sedative to all patients to ensure they remain still: Sedation is not universally required; some patients undergo the procedure under local anesthesia with minimal or no sedation. Administration depends on the patient’s condition and provider’s order.

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Question 3:

A physician orders a cerebral CT scan for a patient who has experienced head trauma. The scan is ordered without contrast. The primary reason for this is to:

A. Visualize blood more easily and quickly. B. Identify a brain tumor. C. Assess for vascular abnormalities. D. Minimize radiation exposure to the patient. E. Administering a sedative to all patients to ensure they remain still.

Answer and Explanation

Choice A:

Visualize blood more easily and quickly: Contrast dye can obscure fresh blood on imaging. A non-contrast CT is fast, widely available, and highly sensitive for detecting acute intracranial bleeding, making it the gold standard in acute head injury evaluation.Rationale for incorrect answers:

Choice B:

Identify a brain tumor: While CT scans can sometimes detect tumors, MRI is generally preferred for tumor evaluation, and contrast is often used to enhance visualization of mass lesions.

Choice C:

Assess for vascular abnormalities: CT angiography or cerebral angiography is better for vascular assessment; a plain CT is not ideal for this purpose.

Choice D:

Minimize radiation exposure to the patient: The decision to use or avoid contrast is based on diagnostic needs, not radiation exposure; contrast does not affect the radiation dose.

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Question 4:

Following a cerebral angiogram, a nurse is providing post-procedure care. Which of the following interventions and assessments are a priority? Select all that apply

A. 1. Encouraging the patient to ambulate immediately to prevent clot formation. B. 2. Checking the puncture site for bleeding or hematoma formation. C. 3. Assessing the patient's neurological status and level of consciousness. D. 1. Keeping the patient's affected limb straight and immobilized for several hours. E. 2. Monitoring for signs of allergic reaction to the contrast dye.

Answer and Explanation

Choice A:

Encouraging the patient to ambulate immediately to prevent clot formation: Early ambulation after an arterial procedure increases the risk of bleeding and hematoma formation; the patient should remain on bed rest with limb immobilization for several hours.

Choice B:

Checking the puncture site for bleeding or hematoma formation: This is critical to detect and manage hemorrhage early, which is a common complication due to the arterial puncture.

Choice C:

Assessing the patient's neurological status and level of consciousness: Neurological changes may indicate complications such as embolism or intracranial bleeding, requiring immediate intervention.

Choice D:

Keeping the patient's affected limb straight and immobilized for several hours: Immobilization reduces the risk of bleeding and allows the arterial puncture to heal properly.

Choice E:

Monitoring for signs of allergic reaction to the contrast dye: Allergic reactions can occur minutes to hours after exposure and may range from mild rash to severe anaphylaxis.Rationale for incorrect answers:

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Question 5:

A non-contrast cerebral CT scan of a patient with a sudden onset of symptoms reveals a bright, hyperdense area in the brain. This finding is most indicative of:

A. An ischemic stroke. B. A hemorrhagic stroke. C. Multiple sclerosis. D. A brain abscess.

Answer and Explanation

Choice A:

An ischemic stroke: In the early stages, ischemic strokes may appear normal or show subtle hypodense changes on CT. They do not typically present as bright, hyperdense areas.

Choice B:

A hemorrhagic stroke: Acute intracranial bleeding appears bright on a non-contrast CT because the hemoglobin in clotted blood has high attenuation. This imaging helps differentiate hemorrhagic stroke from ischemic stroke, guiding immediate treatment decisions.Rationale for incorrect answers:

Choice C:

Multiple sclerosis: MS lesions are best detected with MRI and appear as hypodense or isodense areas on CT, not bright hyperdensities.

Choice D:

A brain abscess: Abscesses may appear as ring-enhancing lesions with contrast but are not hyperdense on non-contrast CT unless calcified or hemorrhagic.

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Practice Exericise 1

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