Deck 23: Neurologic System

Question 1

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 would be diminished but present.
D) Some would be present depending on the area of injury.

Answer 1

Reflexes will be normal.

Question 2

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

A) Because there are 31 pairs of spinal nerves, there is no effect if only one 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) This will only affect motor function of the patient because spinal nerves have no sensory component.

Answer 2

The adjacent spinal nerves will continue to carry sensations for the dermatome served by the severed nerve.

Question 3

The two parts of the nervous system are the:

A) motor and sensory.
B) central and peripheral.
C) peripheral and autonomic.
D) hypothalamus and cerebral.

Answer 3

central and peripheral.

Question 4

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) Screening neurologic examination
D) Complete neurologic examination

Question 5

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

A) The cranial nerves 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 by efferent fibers.

Question 6

A 70-year-old woman tells the nurse that every time she gets up in the morning or after she's been sitting she gets "really dizzy" and feels like she is going to fall over.The nurse's best response would be:

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 or sitting."

Question 7

When taking the 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?"

Question 8

The area of the nervous system that is responsible for mediating reflexes is the:

A) medulla.
B) cerebellum.
C) spinal cord.
D) cerebral cortex.

Question 9

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

A) There is a problem 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 pain.
C) The sensory cortex does not have the ability to localize pain in the heart, so the pain is felt elsewhere.
D) There is a lesion in the dorsal root that is preventing the sensation from being transmitted normally.

Question 10

Which of these statements concerning areas of the brain is true?

A) The cerebellum is the center for speech and emotions.
B) The hypothalamus controls 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 11

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

A) cranial nerve dysfunction.
B) lesion in the cerebral cortex.
C) normal changes due to aging.
D) demyelinization of nerves due to a lesion.

Question 12

During an assessment of the cranial nerves,the nurse finds the following: asymmetry when the patient smiles or frowns,uneven lifting of eyebrows,sagging of the lower eyelids,and escape of air when the nurse presses against the right puffed cheek.This would indicate dysfunction of which of these cranial nerves?

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

Question 13

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 14

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

A) there must be a demyelinating process 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, so control over motor function occurs gradually.
D) the spinal cord is controlling the movement because the cerebellum is not yet fully developed.

Question 15

In obtaining a 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 should the nurse's response be?

A) "Does your family know you are drinking every day?"
B) "Does the tremor change when you drink the alcohol?"
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 16

While obtaining a 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 17

The ability that humans have to perform very skilled movements such as writing is controlled by the:

A) basal ganglia.
B) corticospinal tract.
C) spinothalamic tract.
D) extrapyramidal tract.

Question 18

During the history,a patient tells the nurse that "it feels like the room is spinning around me." The nurse would document this as:

A) vertigo.
B) syncope.
C) dizziness.
D) seizure activity.

Question 19

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 and becomes angry very easily.The nurse recalls that the cerebral lobe responsible for these behaviors is the _____ lobe.

A) frontal
B) parietal
C) occipital
D) temporal

Question 20

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 would the nurse be concerned about with these findings?

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

Question 21

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

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

Question 22

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 23

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 24

During the 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." In doing the assessment of his sensory system,which action by the nurse is most appropriate?

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

Question 25

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) Astereognosis
C) Graphesthesia
D) Tactile discrimination

Question 26

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

A) Raises head and arches back
B) Extends arms and drops head down
C) Flexes knees and elbows with back straight
D) Holds head at 45 degrees and keeps back straight

Question 27

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 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 should be the nurse's appropriate response to these findings?

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

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.The nurse knows that this finding is indicative of:

A) a great sense of humor.
B) uncooperative behavior.
C) inability to understand questions.
D) decreased level of consciousness.

Question 29

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.There is no associated rigidity with movement.Which of these statements is most accurate?

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

Question 30

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) Patient has hyperesthesia as a result of the aging process.
B) This 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 31

The nurse is testing the function of cranial nerve XI.Which of these best describes the response the nurse should expect if the nerve is intact? The patient:

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

Question 32

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 and quadriceps,the nurse is unable to elicit a reflex.The nurse's next response should be to:

A) ask the patient to lock her fingers and "pull."
B) complete the examination and then test these reflexes again.
C) refer the patient to a specialist for further testing.
D) document these reflexes as "0" on a scale of 0 to 4+.

Question 33

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

Question 34

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 35

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

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

Question 36

When the nurse asks a 68-year-old patient to stand with feet together and arms at his side with his eyes closed,he starts to sway and moves his feet farther apart.The nurse would document this finding as a(n):

A) ataxia.
B) lack of coordination.
C) negative Homans' sign.
D) positive Romberg sign.

Question 37

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) Hypotonic muscles as a result of total relaxation
D) Slight pain with some directions of movement

Question 38

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) Cranial nerves, 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 39

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

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

Question 40

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

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

Question 41

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

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

Question 42

A patient is not able to perform rapid alternating movements such as patting her knees rapidly.The nurse should document this as:

A) ataxia.
B) astereognosis.
C) the presence of dysdiadochokinesia.
D) loss of kinesthesia.

Question 43

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.The nurse interprets this result as:

A) a negative Babinski's sign, which is normal for adults.
B) a positive Babinski's sign, which is abnormal for adults.
C) clonus, which is a hyperactive response.
D) the Achilles reflex, which is an expected response.

Question 44

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 of these statements about these findings is accurate?

A) This indicates a lesion of the cerebral cortex.
B) This indicates a completely nonfunctional brainstem.
C) This is a normal response that will go away in 24 to 48 hours.
D) This is a very ominous sign and may indicate brainstem injury.

Question 45

A 69-year-old patient has been admitted to an adult psychiatric unit because his wife thinks he is getting more and more confused.He laughs when he is found to be forgetful,saying "I'm just getting old!" After the nurse completes a thorough neurologic assessment,which findings would be indicative of Alzheimer's disease? Select all that apply.

A) Occasionally forgetting names or appointments
B) Difficulty performing familiar tasks, such as placing a telephone call
C) Misplacing items, such as putting dish soap in the refrigerator
D) Sometimes having trouble finding the right word
E) Rapid mood swings, from calm to tears, for no apparent reason
F) Getting lost in one's own neighborhood

Question 46

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." This description suggests:

A) tics.
B) athetosis.
C) myoclonus.
D) chorea.

Question 47

The nurse knows that testing kinesthesia is a test of a person's:

A) fine touch.
B) position sense.
C) motor coordination.
D) perception of vibration.

Question 48

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 49

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) A positive Babinski's sign
D) The presence of pathologic reflexes

Question 50

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

Question 51

During an assessment of a 22-year-old woman who has a head injury from a car accident 4 hours ago,the nurse notices the following change: pupils were equal,but now the right pupil is fully dilated and nonreactive,left pupil is 4 mm and reacts to light.What does finding this suggest?

A) Injury to the right eye
B) Increased intracranial pressure
C) Test was not performed accurately
D) Normal response after a head injury

Question 52

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.These findings would be consistent with:

A) parkinsonism.
B) cerebral palsy.
C) cerebellar ataxia.
D) muscular dystrophy.

Question 53

A man who was found wandering in a park at 2 AM has been brought to the emergency department for an examination because 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.The nurse should suspect which of the following?

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

Question 54

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

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

Question 55

The nurse knows that determining whether a person is oriented to his or her surroundings will test the functioning of which of these structures?

A) Cerebrum
B) Cerebellum
C) Cranial nerves
D) Medulla oblongata

Question 56

During the assessment of deep tendon reflexes,the nurse finds that a patient's responses are normal bilaterally.What number is used to indicate "normal" deep tendon reflexes when the documenting this finding._____+