Deck 21: Neurosurgery

Question 1

The most frequently occurring tumors of the spine are metastatic,and the spine is the most common site for skeletal metastasis.From which organs or disease processes do most secondary spinal tumors originate?

A) Lung, breast, prostate, and blood
B) Intestines, thyroid, soft tissue sarcoma, and breast
C) Osteosarcoma, lymphoma, and pancreas
D) Myeloma, gastric, biliary, and lung

Answer 1

A
Secondary spinal tumors most often originate from carcinomas of the lung,breast,prostate,and blood.Pain is the earliest and most prominent symptom,followed by weakness.

Question 2

Identify the large dura fold that separates the right and left cerebral hemispheres.

A) Falx cerebri
B) Tentorium cerebelli
C) Falx cerebelli
D) Tentorium cerebri

Answer 2

A
The dura mater is a tough,shiny,fibrous membrane that is close to the inner surface of the skull and folds to separate the cranial cavity into compartments.The largest fold is the falx cerebri-an arch-shaped,vertically placed,midline structure separating the right and left cerebral hemispheres.

Question 3

Interventional neuroradiology uses fluoroscopy to gain access to the intracranial circulation by way of a percutaneous transfemoral catheter.The endovascular approach to the treatment of both ruptured and unruptured cerebral aneurysms is endosaccular occlusion.This is an excellent technique for aneurysms that are complex,have a neck that is too short for clipping,or are difficult to reach via traditional craniotomy.This approach is less invasive than the traditional open craniotomy with identification and clipping of the aneurysm followed by cranial closure and extended recovery.Select the true endovascular procedure that has been designed as an alternative to its open surgical option.

A) Endovascular coil occlusion of an aneurysm
B) Endovascular approach for ventriculoperitoneal (VP) shunt insertion
C) Endovascular evacuation of intracranial hemorrhage
D) Endovascular ultrasound

Answer 3

A
Endovascular coil occlusion of the aneurysm is appropriate if the aneurysm is deemed treatable by either endovascular coiling or surgical clipping.There are several neurovascular disorders that are amenable to an endovascular procedure.

Question 4

Trigeminal neuralgia is an extremely painful and debilitating condition characterized by unilateral intense pain in the ear,eye,lips,nose,scalp,forehead,teeth,or jaw.A variety of treatments,including microvascular surgical decompression,are available.Select a minimally invasive targeted therapy that has demonstrated significant success in ablation of the entry of the trigeminal nerve.

A) Endovascular ablation
B) Stereotactic alcohol injections
C) Gamma Knife radiosurgery
D) Cavitron ultrasonic surgical ablation

Question 5

The neurosurgical perioperative nurse is the circulating nurse on a cranial procedure.She is helping a new surgical resident on his first day with the neurosurgical surgery service.She observes and coaches him carefully as he removes the patient's hair from the intended incision site with the clippers and then combs the remaining hair away from the incision,holding it back with prepping solution.When the resident asks the scrub person for methylene blue and a sterile cotton-tipped applicator on a wood stick,the nurse intervenes and offers him a gentian violet surgical skin marker.What was the nurse's rationale for not using methylene blue as a skin marker?

A) Methylene blue produces an inflammatory reaction in CNS tissue.
B) Methylene blue markings tend to wash off during the prep.
C) Methylene blue will not be able to be seen through the povidone-iodine.
D) Methylene blue is not compatible with povidone-iodine.

Question 6

Meticulous hemostasis is extremely important in neurosurgery.Numerous interventions and types of materials are used to limit blood loss.Which of the following describes a best practice toward the goal of achieving hemostasis during neurosurgery?

A) Gelatin sponge is commonly used to pack burr holes.
B) Soft gauze sponges are routinely used to control bleeding around delicate neural tissue.
C) Bone wax is commonly applied to oozing surfaces.
D) Gelatin sponge, which is absorbable, can be left in the body.

Question 7

A 69-year-old pipe smoker with a history of cardiac disease and atrial rhythm disturbance is scheduled for a supratentorial craniotomy and is securely positioned in a semi-sitting position.Intermittent pneumatic compression devices have been placed on both legs.Pulmonary lines have been placed and the nurse has prepared an area for preparation of transesophageal electrocardiography (TEE),if needed.During the procedure,the patient reacted with a decrease in arterial pressure and end-tidal CO₂.Precordial "washing machine" sounds emanated from the Doppler.What could be the cause of his deteriorating physiologic status?

A) Increased pressure from the intermittent pneumatic compression device
B) Ischemic cerebral vascular occlusion
C) Venous air embolism (VAE)
D) Air bubbles in the arterial line

Question 8

Achieving hemostasis in delicate areas can be a challenge for the neurosurgeon.In addition to using meticulous technique to prevent bleeding,topical agents are routinely used as an adjunct to hemostasis.Some hemostatic products form a composite clot that seals a bleeding site by using a thrombin component that converts fibrinogen in the patient's blood to fibrin.Select the two hemostatic products that provide hemostasis by topical application,essentially acting as a patch rather than a clotting factor.

A) Oxidized cellulose and topical thrombin
B) Bone wax and topical thrombin
C) Bone wax and oxidized cellulose
D) Gelatin matrix and collagen hemostat

Question 9

Brain tumors are either malignant or benign,depending on the cell type.Primary tumors generally do not resemble the carcinomas and sarcomas found elsewhere in the body and rarely metastasize outside the CNS.Select the tumor that has been identified as an extremely rare and very malignant neoplasm.

A) Germinoma
B) Teratoma
C) Meningioma
D) Choriocarcinoma

Question 10

What is the term for the bloodless plane that contains loose areolar tissue and permits mobility of the scalp?

A) Pericranial plane
B) Galea
C) Subgaleal space
D) Outer skull periosteum

Question 11

Brain tumors are either malignant or benign,depending on the cell type.Both primary and metastatic tumors of the brain and its membranes are included in the term intracranial tumors.Which two tumor types are the most frequently seen central nervous system (CNS)tumors in adults?

A) Meningioma, oligodendroglioma
B) Glioblastoma, metastatic tumors
C) Medulloblastoma, metastatic tumors
D) Astrocytoma, hemangioma

Question 12

Twelve pairs of cranial nerves arise within the cranial cavity.Although they are part of the peripheral nervous system,from a surgical standpoint they are considered part of the anatomy of the head.Which three pairs of nerves,conveniently considered together because of their motor influence on the eye,are subject to toxic,inflammatory,vascular,and neoplastic lesions?

A) Ninth, tenth, and eleventh cranial nerves
B) Second, third, and fourth cranial nerves
C) Third, fourth, and sixth cranial nerves
D) First, second, and third cranial nerves

Question 13

A familiarity with basic neurologic assessment tools gives the nurse the ability to perform a standardized neurologic exam that can be used preoperatively to establish a baseline assessment and postoperatively to establish a return to baseline or assess postoperative neurologic stability.The Glasgow Coma Scale (GCS)is commonly used to assess patients with brain injury using three indicators of cerebral function: eye opening,verbal communication,and motor response to verbal and noxious stimuli.Within the scoring range for the GCS,the best possible score is _____,and the worst possible score is ______.

A) 15; 3
B) 12; 0
C) 3; 15
D) 0; 12

Question 14

Select the statements that are accurate descriptions of the sensory and motor functions of the brain.

A) Another name for the homunculus is the dermatome grid.
B) Areas of fine motor and sensory control have more neurons.
C) The right motor and sensory cortices control the right side of the body.
D) The left motor and sensory cortices control the right side of the body.

Question 15

The perioperative nurse in the circulating role is planning for her three neurosurgical procedures for the day.She is explaining the basic processes of the three procedures to the scrub person: (1)exploration of a severe head injury with increased intracranial pressure (ICP)to evacuate a hematoma and possible excision of brain tissue,(2)a VP shunt insertion,and (3)a reconstructive craniosynostosis procedure for an infant with severe deformity.To give the brain room to swell in the first procedure,the bone flap may need to be sterile-wrapped and stored for later replacement.What is the appropriate surgical approach to the brain for each of the procedures?

A) (1) craniectomy, (2) craniotomy, and (3) cranioplasty
B) (1) craniotomy, (2) burr hole, and (3) craniectomy
C) (1) craniotomy, (2) cranioplasty, (3) and craniectomy
D) (1) cranioplasty, (2) craniectomy, and (3) burr hole

Question 16

Microsurgical techniques have been applied to cranial,spinal,and peripheral nerve operations.Each time the surgeon must look away and then back to the surgical field,open wound time and anesthesia time are increased while the surgeon becomes reoriented to the field.A nursing action,in the scrub person role,directed toward assisting the surgeon in efficiency and expediting the microsurgical procedure would be to:

A) have the patient prepped and draped before the time-out.
B) place the instruments and accessories within the surgeon's peripheral vision.
C) hand instruments proficiently, in direction of use, without delay.
D) transfer microwiped instruments and accessories via the first assistant.

Question 17

Most patients will have undergone diagnostic procedures before arriving in the neurosurgery OR.Radiologic and other diagnostic studies are of great significance to the surgical team for determining a surgical diagnosis and developing a plan for treatment.Magnetic resonance imaging (MRI)is the gold standard imaging scan for the diagnosis of tumors,abscesses,tissue/ligamentous injury,and disk herniation.Which three diagnostic tests of neurologic activity can be performed before surgery and also concurrently during the procedure?

A) Stereotactic computed tomography (CT) scan
B) Electroencephalogram (EEG)
C) Stereotactic MRI
D) Ultrasound
E) Evoked potentials (EPs)
F) Myelogram

Question 18

The brain stem is located in the posterior fossa and forms the floor of the fourth ventricle.It is the site of many ascending and descending fiber tracts that allow for communication among the structures of the brain and between the brain and spinal cord.The brain stem consists of which three structures?

A) Dura, epidural space, and subdural space
B) Midbrain, pons, and medulla oblongata
C) Mesencephalon, cephalon, and cerebrum
D) Pons, medulla, and foramen magnum

Question 19

At each vertebral level is a pair of spinal nerves,each consisting of an anterior and a posterior root.Select the statement that represents true information about motor or sensory distribution.

A) The posterior root is the sensory root.
B) Skin dermatomes represent motor innervations.
C) The anterior root is the sensory root.
D) Spinal ganglia exit the spinal cord through the cauda equina.

Question 20

An important area of the brain that is critical for learning and memory is the ___________,while emotion and social behavior are regulated by the ____________.

A) parahippocampal gyri; limbic system
B) amygdala; cingulate
C) hypothalamus; septum
D) hippocampus; amygdala

Question 21

A spinal cord stimulator (SCS)is an implantable,nondestructive medical device used to treat chronic,intractable pain of the trunk and limbs.The device generates an electrical impulse to the epidural space.The goal of stimulation is to:

A) resolve pain.
B) lower perception of pain.
C) obliterate a small spinal target.
D) reduce medication use.
E) increase function.

Question 22

The perioperative circulating nurse has prepared the OR for a craniotomy for tumor excision and has assembled the primary bed base attachments for the head fixation positioning system.She has verified with the surgeon and anesthesia provider that the bed attachment is properly secured before the start of patient positioning and is prepared for positioning and securing the patient's head with the skull clamp.After the skull pins are secured,the nurse will step back to view the head placement and symmetry,ensuring that:

A) the pins in the rocker arm are equidistant from the centerline of the patient's head.
B) the single pin in the extension arm is exactly at the centerline.
C) the rocker arm is in the "CLOSED" position.
D) the pins are at an angle of 90 degrees.
E) the necessary pounds of clamping force are applied.
F) the pins avoid the areas of the frontal sinus, temporal fossa, blood vessels, and nerves.

Question 23

A 29-year-old man is admitted through the ambulatory surgery center for a microdiskectomy,one of several spinal surgeries performed to relieve pain caused by disk herniations.Select the appropriate criteria required for a patient to be considered a candidate for microdiskectomy as an ambulatory procedure.

A) Leg pain more than 2 weeks' duration with foot numbness
B) Ability to tolerate general and/or spinal anesthesia
C) MRI confirmation of the nerve root compression level
D) Leg pain longer than 6 weeks' duration
E) History and physical verifies candidacy for ambulatory surgery
F) Ability to tolerate prone position
G) Minimal relief received from prescribed pain medications
H) Inability to ambulate without crutches or wheelchair