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Diagnostic Tests | 마이메르시 MyMerci
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Diagnostic Tests

NCLEX Review Guide: Neurologic Diagnostic Tests

Neurologic Diagnostic Tests Overview

Lumbar Puncture (LP)

  • Pre-procedure: Obtain informed consent, assess for increased ICP contraindications, and position patient in lateral recumbent or sitting position with spine flexed.
  • Post-procedure: Keep patient flat for 4-12 hours to prevent spinal headache, monitor for signs of infection, and assess neurologic status frequently.
  • Critical Alert: Never perform LP if increased intracranial pressure is suspected - can cause brain herniation.

Memory Aid: LP Position

"Fetal position for spinal extraction" - Knees to chest, chin tucked, spine curved like a "C"

Key Points

  • Normal CSF pressure: 60-150 mmH₂O
  • Clear, colorless fluid is normal
  • Bloody CSF may indicate subarachnoid hemorrhage

Computed Tomography (CT) Scan

  • Non-contrast CT: First-line imaging for acute stroke, head trauma, and suspected intracranial bleeding - no special preparation required.
  • Contrast CT: Requires assessment of kidney function (creatinine), allergy history, and NPO status if sedation needed.
  • Contrast reactions: Range from mild (nausea, warmth) to severe anaphylaxis requiring immediate epinephrine administration.

Key Points

  • Remove all metal objects before scan
  • Assess for claustrophobia and provide support
  • Monitor for contrast reactions during and after procedure

Magnetic Resonance Imaging (MRI)

  • Contraindications: Pacemakers, cochlear implants, metallic foreign bodies, and some aneurysm clips pose serious safety risks.
  • Patient preparation: Complete metal screening questionnaire, remove all jewelry and metal objects, and assess for claustrophobia.
  • Safety Alert: MRI uses powerful magnets - metallic objects become projectiles and can cause severe injury or death.

Memory Aid: MRI Safety

"Magnetic = Metal-free zone" - No metal anywhere on or in the patient

Key Points

  • Procedure takes 30-90 minutes
  • Loud knocking sounds are normal
  • Sedation may be needed for claustrophobic patients

Electroencephalogram (EEG)

  • Pre-procedure: Wash hair thoroughly, avoid caffeine, and continue antiseizure medications unless specifically ordered to hold.
  • During procedure: Patient remains still while electrodes measure brain electrical activity for 1-2 hours.
  • Sleep-deprived EEG: Patient kept awake 24 hours prior to increase likelihood of detecting seizure activity.

Key Points

  • Non-invasive procedure with no radiation
  • Detects seizure activity and brain death
  • Normal to feel electrode paste residue after procedure

Commonly Confused Concepts

Test Uses Contrast Radiation Metal Restrictions Main Use
CT Scan Sometimes Yes Remove jewelry Acute bleeding, trauma
MRI Sometimes No Absolute no metal Detailed soft tissue
EEG No No None Brain electrical activity

Clinical Scenario

Patient presents with sudden severe headache: CT scan without contrast is the first diagnostic test to rule out subarachnoid hemorrhage. If negative and clinical suspicion remains high, lumbar puncture may be performed to detect blood in CSF.

Study Tips & Memory Aids

NCLEX Memory Strategies

  • LP Position: "Fetal position prevents spinal headache"
  • MRI Safety: "Magnetic Resonance = Metal Removal"
  • CT vs MRI: "CT for Crises (acute), MRI for Marvelous detail"
  • EEG prep: "Clean hair, Caffeine-free, Continue meds"

Common Pitfalls

  • Don't perform LP if increased ICP suspected
  • Always assess kidney function before contrast
  • MRI contraindications are absolute - not relative
  • Post-LP headache prevented by lying flat

Quick Check Questions

  • □ Can you list 3 contraindications for lumbar puncture?
  • □ What position prevents post-LP headache?
  • □ Which test is first-line for suspected stroke?
  • □ What labs are needed before contrast CT?
  • □ Why is metal dangerous during MRI?

Remember: You've got this! Focus on safety first, patient preparation, and post-procedure monitoring. Each diagnostic test has specific nursing responsibilities that protect your patients. Trust your knowledge and clinical judgment! 🏆

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