Which of the following is the correct way to test for the Oculocephalic reflex?
Hold patient's eyelids open and turn their head to left or right while assessing direction of eye movement
Instill cold water into patient's auditory canal and assess eye movement
Shine light in patient's eye to assess for pupillary constriction
Tap patient's knee to assess for a knee-jerk response
The Correct Answer is A
A. Hold patient's eyelids open and turn their head to left or right while assessing direction of eye movement is correct. The oculocephalic reflex (doll’s eyes reflex) tests the integrity of the brainstem in comatose patients. When the head is turned, the eyes should move in the opposite direction of head rotation if the brainstem is intact. Absence of this movement indicates possible brainstem dysfunction.
B. Instill cold water into patient's auditory canal and assess eye movement is incorrect for the oculocephalic reflex; this describes the oculovestibular reflex (caloric test). In this test, cold or warm water or air is instilled into the external auditory canal to stimulate the vestibular system, and eye movement is observed. It is also a test of brainstem function, but it is more invasive, requires intact tympanic membranes, and is not the same as the doll’s eyes maneuver.
C. Shine light in patient's eye to assess for pupillary constriction is incorrect because this tests the pupillary light reflex, which involves the optic nerve (CN II) and oculomotor nerve (CN III). While important for neurological assessment, it does not evaluate the brainstem pathways responsible for the oculocephalic reflex, and it cannot replace assessment of the doll’s eyes maneuver in a comatose patient.
D. Tap patient's knee to assess for a knee-jerk response is incorrect because this evaluates a spinal reflex (patellar reflex) mediated by local spinal cord circuits, not the brainstem. It is useful for assessing peripheral and spinal cord integrity, but it does not provide information about brainstem function or the oculocephalic reflex.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
A. Do you have a history of asthma? is incorrect because asthma is not directly related to the development of acute tubular necrosis. While general health history is important, asthma does not contribute to ATN pathophysiology.
B. Who is your nephrologist? is incorrect because while it is helpful to know the healthcare provider involved in the patient’s care, this information does not identify risk factors or causes of ATN.
C. Which medications are you currently taking or have taken recently? is correct because medication history is critical in assessing risk factors for ATN. Certain medications, such as aminoglycoside antibiotics, NSAIDs, contrast dyes, or chemotherapeutic agents, can be nephrotoxicand directly cause tubular injury. Identifying recent or ongoing use helps determine the etiology of ATN and guide interventions to prevent further kidney damage.
D. What is your blood type? is incorrect because blood type is not relevant to the development or management of ATNunless considering transplant, which is unrelated to the acute event.
Correct Answer is A
Explanation
A. Mannitol is correct because it is an osmotic diuretic commonly used to reduce intracranial pressure. Mannitol increases plasma osmolality, drawing water out of cerebral tissue and into the intravascular space, which decreases cerebral edema and lowers ICP. It is frequently ordered in patients with increased ICP due to intracranial bleeding, such as a subdural hemorrhage.
B. Ibuprofen is incorrect because nonsteroidal anti-inflammatory drugs increase the risk of bleeding and do not reduce intracranial pressure. In a patient with an active intracranial hemorrhage, ibuprofen may worsen bleeding and is contraindicated.
C. IV heparin is incorrect because anticoagulants increase the risk of continued or worsening intracranial bleeding. Heparin would be avoided in a patient with a subdural hemorrhage unless there is a compelling and unrelated indication.
D. Warfarin is incorrect because it is an oral anticoagulant that significantly increases bleeding risk. In the setting of a subdural hemorrhage and increased ICP, warfarin would worsen hemorrhage and is contraindicated.
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