Deck 24: Neurologic System

Question 1

When taking the health history on a patient with a seizure disorder, the nurse assesses whether the patient has an aura. Which of these would be the best question for obtaining this information?

A) "Does your muscle tone seem tense or limp?"
B) "After the seizure, do you spend a lot of time sleeping?"
C) "Do you have any warning sign before your seizure starts?"
D) "Do you experience any color change or incontinence during the seizure?"

Answer 1

"Do you have any warning sign before your seizure starts?"

Question 2

The area of the nervous system that responsible for mediating reflexes?

A) Medulla
B) Cerebellum
C) Spinal cord
D) Cerebral cortex

Answer 2

Spinal cord

Question 3

A 50-year-old woman is in the clinic for weakness in her left arm and leg that she has noticed for the past week. The nurse should perform which type of neurologic examination?

A) Glasgow Coma Scale
B) Neurologic recheck examination
C) Complete neurologic examination
D) Screening neurologic examination

Answer 3

Complete neurologic examination

Question 4

What are the two parts of the nervous system?

A) Motor and sensory
B) Central and peripheral
C) Peripheral and autonomic
D) Hypothalamus and cerebral

Question 5

During the taking of the health history, a patient tells the nurse that "it feels like the room is spinning around me." How should the nurse document this finding?

A) Vertigo
B) Syncope
C) Dizziness
D) Seizure activity

Question 6

Which statement concerning the areas of the brain is true?

A) The cerebellum is the center for speech and emotions.
B) The hypothalamus controls body temperature and regulates sleep.
C) The basal ganglia are responsible for controlling voluntary movements.
D) Motor pathways of the spinal cord and brainstem synapse in the thalamus.

Question 7

A 21-year-old patient has a head injury resulting from trauma and is unconscious. There are no other injuries. During the assessment what would the nurse expect to find when testing the patient's deep tendon reflexes?

A) Reflexes will be normal.
B) Reflexes cannot be elicited.
C) All reflexes will be diminished but present.
D) Some reflexes will be present, depending on the area of injury.

Question 8

In obtaining a health history on a 74-year-old patient, the nurse notes that he drinks alcohol daily and that he has noticed a tremor in his hands that affects his ability to hold things. With this information, what response should the nurse make?

A) "Does the tremor change when you drink alcohol?"
B) "Does your family know you are drinking every day?"
C) "We'll do some tests to see what is causing the tremor."
D) "You really shouldn't drink so much alcohol; it may be causing your tremor."

Question 9

During an assessment of an 80-year-old patient, the nurse notices the following: an inability to identify vibrations at her ankle and to identify the position of her big toe, a slower and more deliberate gait, and a slightly impaired tactile sensation. All other neurologic findings are normal. How should the nurse interpret these findings?

A) CNS dysfunction
B) Lesion in the cerebral cortex
C) Normal changes attributable to aging
D) Demyelination of nerves attributable to a lesion

Question 10

A 70-year-old woman tells the nurse that every time she gets up in the morning or after she's been sitting for a while, she gets "really dizzy" and feels like she is going to fall over. What is the best response by the nurse?

A) "Have you been extremely tired lately?"
B) "You probably just need to drink more liquids."
C) "I'll refer you for a complete neurologic examination."
D) "You need to get up slowly when you've been lying down or sitting."

Question 11

A patient has a severed spinal nerve as a result of trauma. Which statement is true in this situation?

A) Because there are 31 pairs of spinal nerves, no effect results if only one nerve is severed.
B) The dermatome served by this nerve will no longer experience any sensation.
C) The adjacent spinal nerves will continue to carry sensations for the dermatome served by the severed nerve.
D) A severed spinal nerve will only affect motor function of the patient because spinal nerves have no sensory component.

Question 12

Which of these statements about the peripheral nervous system is correct?

A) The CNs enter the brain through the spinal cord.
B) Efferent fibers carry sensory input to the central nervous system through the spinal cord.
C) The peripheral nerves are inside the central nervous system and carry impulses through their motor fibers.
D) The peripheral nerves carry input to the central nervous system by afferent fibers and away from the central nervous system by efferent fibers.

Question 13

During an assessment of the cranial nerves (CNs), the nurse finds the following: asymmetry when the patient smiles or frowns, uneven lifting of the eyebrows, sagging of the lower eyelids, and escape of air when the nurse presses against the right puffed cheek. These findings indicate dysfunction of which cranial nerve(s)?

A) Motor component of CN IV
B) Motor component of CN VII
C) Motor and sensory components of CN XI
D) Motor component of CN X and sensory component of CN VII

Question 14

The wife of a 65-year-old man tells the nurse that she is concerned because she has noticed a change in her husband's personality and ability to understand. He also cries very easily and becomes angry. What part of the cerebral lobe is responsible for these behaviors?

A) Frontal
B) Parietal
C) Occipital
D) Temporal

Question 15

A 30-year-old woman tells the nurse that she has been very unsteady and has had difficulty in maintaining her balance. Which area of the brain most concerns the nurse?

A) Thalamus
B) Brainstem
C) Cerebellum
D) Extrapyramidal tract

Question 16

What controls humans' ability to perform very skilled movements such as writing?

A) Basal ganglia
B) Corticospinal tract
C) Spinothalamic tract
D) Extrapyramidal tract

Question 17

A mother of a 1-month-old infant asks the nurse why it takes so long for infants to learn to roll over. What is the reason for this?

A) A demyelinating process must be occurring with her infant.
B) Myelin is needed to conduct the impulses, and the neurons of a newborn are not yet myelinated.
C) The cerebral cortex is not fully developed; therefore, control over motor function gradually occurs.
D) The spinal cord is controlling the movement because the cerebellum is not yet fully developed.

Question 18

While obtaining a health history of a 3-month-old infant from the mother, the nurse asks about the infant's ability to suck and grasp the mother's finger. What is the nurse assessing?

A) Reflexes
B) Intelligence
C) Cranial nerves
D) Cerebral cortex function

Question 19

A patient with a lack of oxygen to his heart will have pain in his chest and possibly in the shoulder, arms, or jaw. The nurse knows that the best explanation why this occurs is which one of these statements?

A) A problem exists with the sensory cortex and its ability to discriminate the location.
B) The lack of oxygen in his heart has resulted in decreased amount of oxygen to the areas experiencing the pain.
C) The sensory cortex does not have the ability to localize pain in the heart; consequently, the pain is felt elsewhere.
D) A lesion has developed in the dorsal root, which is preventing the sensation from being transmitted normally.

Question 20

While gathering equipment after an injection, a nurse accidentally received a prick from an improperly capped needle. To interpret this sensation, which of these areas must be intact?

A) Corticospinal tract, medulla, and basal ganglia
B) Pyramidal tract, hypothalamus, and sensory cortex
C) Lateral spinothalamic tract, thalamus, and sensory cortex
D) Anterior spinothalamic tract, basal ganglia, and sensory cortex

Question 21

To assess the head control of a 4-month-old infant, the nurse lifts up the infant in a prone position while supporting his chest. The nurse looks for what normal response?

A) Infant raises the head and arches the back.
B) Infant extends the arms and drops down the head.
C) Infant flexes the knees and elbows with the back straight.
D) Infant holds the head at 45 degrees and keeps the back straight.

Question 22

The nurse is testing superficial reflexes on an adult patient. When stroking up the lateral side of the sole and across the ball of the foot, the nurse notices the plantar flexion of the toes. How should the nurse document this finding?

A) Positive Babinski sign
B) Plantar reflex abnormal
C) Plantar reflex present
D) Plantar reflex 2+ on a scale from "0 to 4+"

Question 23

When the nurse is testing the triceps reflex, what is the expected response?

A) Flexion of the hand
B) Pronation of the hand
C) Flexion of the forearm
D) Extension of the forearm

Question 24

The assessment of a 60-year-old patient has taken longer than anticipated. In testing his pain perception, the nurse decides to complete the test as quickly as possible. When the nurse applies the sharp point of the pin on his arm several times, he is only able to identify these as one "very sharp prick." What would be the most accurate explanation for this?

A) The patient has hyperesthesia as a result of the aging process.
B) This response is most likely the result of the summation effect.
C) The nurse was probably not poking hard enough with the pin in the other areas.
D) The patient most likely has analgesia in some areas of arm and hyperalgesia in others.

Question 25

While assessing a 7-month-old infant, the nurse makes a loud noise and notices the following response: abduction and flexion of the arms and legs; fanning of the fingers, and curling of the index finger and thumb in a C position, followed by the infant bringing in the arms and legs to the body. What does the nurse recall about this response?

A) This response could indicate brachial nerve palsy.
B) This reaction is an expected startle response at this age.
C) This reflex should have disappeared between 1 and 4 months of age.
D) This response is normal as long as the movements are bilaterally symmetric.

Question 26

The nurse is performing a neurologic assessment on a 41-year-old woman with a history of diabetes. When testing her ability to feel the vibrations of a tuning fork, the nurse notices that the patient is unable to feel vibrations on the great toe or ankle bilaterally, but she is able to feel vibrations on both patellae. Given this information, what would the nurse suspect?

A) Hyperalgesia
B) Hyperesthesia
C) Peripheral neuropathy
D) Lesion of sensory cortex

Question 27

The nurse places a key in the hand of a patient and he identifies it as a penny. What term would the nurse use to describe this finding?

A) Extinction
B) Stereognosis
C) Graphesthesia
D) Tactile discrimination

Question 28

While the nurse is taking the history of a 68-year-old patient who sustained a head injury 3 days earlier, he tells the nurse that he is on a cruise ship and is 30 years old. What does this finding indicate?

A) Great sense of humor
B) Uncooperative behavior
C) Decreased level of consciousness
D) Inability to understand questions

Question 29

During the taking of the health history of a 78-year-old man, his wife states that he occasionally has problems with short-term memory loss and confusion: "He can't even remember how to button his shirt." When assessing his sensory system, which action by the nurse is most appropriate?

A) The nurse would perform the tests, knowing that mental status does not affect sensory ability.
B) The nurse would proceed with an explanation of each test, making certain that the wife understands.
C) Before testing, the nurse would assess the patient's mental status and ability to follow directions.
D) The nurse would not test the sensory system as part of the examination because the results would not be valid.

Question 30

To test for gross motor skill and coordination of a 6-year-old child, which of these techniques would be appropriate?

A) Have the child hop on one foot.
B) Have the child stand on his head.
C) Ask the child to touch his finger to his nose.
D) Ask the child to make "funny" faces at the nurse.

Question 31

The nurse is performing an assessment on a 29-year-old woman who visits the clinic reporting "always dropping things and falling down." While testing rapid alternating movements, the nurse notices that the woman is unable to pat both of her knees. Her response is extremely slow and she frequently misses. What should the nurse suspect?

A) Lesion of CN IX
B) Vestibular disease
C) Dysfunction of the cerebellum
D) Inability to understand directions

Question 32

During the assessment of an 80-year-old patient, the nurse notices that his hands show tremors when he reaches for something and his head is always nodding. No associated rigidity is observed with movement. Which of these statements is most accurate?

A) These findings are normal, resulting from aging.
B) These findings could be r/t hyperthyroidism.
C) These findings are the result of Parkinson disease.
D) This patient should be evaluated for a cerebellar lesion.

Question 33

The nurse is caring for a patient who has just had neurosurgery. To assess for increased intracranial pressure, what would the nurse include in the assessment?

A) CNs, motor function, and sensory function
B) Deep tendon reflexes, vital signs, and coordinated movements
C) Level of consciousness, motor function, pupillary response, and vital signs
D) Mental status, deep tendon reflexes, sensory function, and pupillary response

Question 34

Which of these tests would the nurse use to check the motor coordination of an 11-month-old infant?

A) Denver II
B) Stereognosis
C) Deep tendon reflexes
D) Rapid alternating movements

Question 35

When the nurse asks a 68-year-old patient to stand with his feet together and arms at his side with his eyes closed, he starts to sway and moves his feet farther apart. How should the nurse document this finding?

A) Ataxia
B) Lack of coordination
C) Negative Homan sign
D) Positive Romberg sign

Question 36

In the assessment of a 1-month-old infant, the nurse notices a lack of response to noise or stimulation. The mother reports that in the last week he has been sleeping all of the time, and when he is awake all he does is cry. The nurse hears that the infant's cries are very high pitched and shrill. What is the most appropriate response by the nurse?

A) Refer the infant for further testing.
B) Talk with the mother about eating habits.
C) Do nothing; these are expected findings for an infant this age.
D) Tell the mother to bring the baby back in 1 week for a recheck.

Question 37

The nurse is testing the function of CN XI. Which statement best describes the response the nurse should expect if this nerve is intact?

A) Patient demonstrates the ability to hear normal conversation.
B) When patient sticks out tongue it is midline and without tremors or deviation.
C) Patient follows an object with his or her eyes without nystagmus or strabismus.
D) Patient moves the head and shoulders against resistance with equal strength.

Question 38

During the neurologic assessment of a "healthy" 35-year-old patient, the nurse asks him to relax his muscles completely. The nurse then moves each extremity through full range of motion. Which of these results would the nurse expect to find?

A) Firm, rigid resistance to movement
B) Mild, even resistance to movement
C) Slight pain with some directions of movement
D) Hypotonic muscles as a result of total relaxation.

Question 39

The nurse is testing the deep tendon reflexes of a 30-year-old woman who is in the clinic for an annual physical examination. When striking the Achilles heel and quadriceps muscle, the nurse is unable to elicit a reflex. How should the nurse proceed?

A) Ask the patient to lock her fingers and pull.
B) Document these reflexes as 0 on a scale of 0 to 4+.
C) Refer the patient to a specialist for further testing.
D) Complete the examination, and then test these reflexes again.

Question 40

In assessing a 70-year-old patient who has had a recent cerebrovascular accident, the nurse notices right-sided weakness. What might the nurse expect to find when testing his reflexes on the right side?

A) Normal reflexes
B) Lack of reflexes
C) Diminished reflexes
D) Hyperactive reflexes

Question 41

A 78-year-old man has a history of a cerebrovascular accident. The nurse notes that when he walks, his left arm is immobile against the body with flexion of the shoulder, elbow, wrist, and fingers and adduction of the shoulder. His left leg is stiff and extended and circumducts with each step. What type of gait disturbance is this individual experiencing?

A) Scissors gait
B) Cerebellar ataxia
C) Parkinsonian gait
D) Spastic hemiparesis

Question 42

A 59-year-old patient has a herniated intervertebral disk. Which of the following findings should the nurse expect to see on physical assessment of this individual?

A) Hyporeflexia
B) Increased muscle tone
C) Positive Babinski sign
D) Presence of pathologic reflexes

Question 43

The nurse should test the functioning of which structure(s) when determining whether a person is oriented to his or her surroundings?

A) Cerebellum
B) Cranial nerves
C) Cerebral cortex
D) Medulla oblongata

Question 44

During an examination, the nurse notices severe nystagmus in both eyes of a patient. Which conclusion by the nurse is correct?

A) A normal occurrence
B) Indicates disease of the cerebellum or brainstem
C) A sign that the patient is nervous about the examination
D) Indicates a visual problem, and a referral to an ophthalmologist is indicated

Question 45

During an assessment of a 62-year-old man, the nurse notices the patient has a stooped posture, shuffling walk with short steps, flat facial expression, and pill-rolling finger movements. What do these findings suggest?

A) Parkinsonism
B) Cerebral palsy
C) Cerebellar ataxia
D) Muscular dystrophy

Question 46

During an assessment of a 22-year-old woman who sustained a head injury from an automobile accident 4 hours earlier, the nurse notices the following changes: pupils were equal, but now the right pupil is fully dilated and nonreactive, and the left pupil is 4 mm and reacts to light. What do these findings suggest?

A) Injury to the O.D.
B) Test inaccurately performed
C) Increased intracranial pressure
D) Normal response after a head injury

Question 47

A patient is unable to perform rapid alternating movements such as rapidly patting her knees. How should the nurse document this finding?

A) Ataxia
B) Astereognosis
C) Loss of kinesthesia
D) Presence of dysdiadochokinesia

Question 48

In a person with an upper motor neuron lesion such as a cerebrovascular accident, which of these physical assessment findings should the nurse expect?

A) Hyperreflexia
B) Fasciculations
C) Loss of muscle tone and flaccidity
D) Atrophy and wasting of the muscles

Question 49

The nurse is assessing the neurologic status of a patient who has a late-stage brain tumor. With the reflex hammer, the nurse draws a light stroke up the lateral side of the sole of the foot and inward, across the ball of the foot. In response, the patient's toes fan out, and the big toe shows dorsiflexion. How should the nurse interpret these findings?

A) Clonus, which is a hyperactive response
B) Achilles reflex, which is an expected response
C) Negative Babinski sign, which is normal for adults
D) Positive Babinski sign, which is abnormal for adults

Question 50

During an assessment of a 32-year-old patient with a recent head injury, the nurse notices that the patient responds to pain by extending, adducting, and internally rotating his arms. His palms pronate, and his lower extremities extend with plantar flexion. Which statement concerning these findings is most accurate? What do these findings indicate?

A) A lesion of the cerebral cortex
B) A completely nonfunctional brainstem
C) Normal findings that will resolve in 24 to 48 hours
D) A very ominous sign and may indicate brainstem injury

Question 51

What does testing kinesthesia assess?

A) Fine touch
B) Position sense
C) Motor coordination
D) Perception of vibration

Question 52

A man who was found wandering in a park at 2 AM has been brought to the emergency department for an examination; he said he fell and hit his head. During the examination, the nurse asks him to use his index finger to touch the nurse's finger, then his own nose, then the nurse's finger again (which has been moved to a different location). The patient is clumsy, unable to follow the instructions, and overshoots the mark, missing the finger. What does the nurse suspect?

A) Cerebral injury
B) Peripheral neuropathy
C) Cerebrovascular accident
D) Acute alcohol intoxication

Question 53

A 32-year-old woman tells the nurse that she has noticed "very sudden, jerky movements" mainly in her hands and arms. She says, "They seem to come and go, primarily when I am trying to do something. I haven't noticed them when I'm sleeping." What do these symptoms suggest?

A) Tics
B) Chorea
C) Athetosis
D) Myoclonus

Question 54

The nurse is reviewing a patient's medical record and notes that he is in a coma. Using the Glasgow Coma Scale, which number indicates that the patient is in a coma?

A) 6
B) 12
C) 15
D) 24