Deck 25: Neurological System

Question 1

A patient with a lack of oxygen to his heart will have pain in his chest,and also possibly in his shoulders,arms,or jaw.Which of the following best explains why this occurs?

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 these areas.
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.

Answer 1

The sensory cortex does not have the ability to localize pain in the heart,so the pain is felt elsewhere.

Question 2

A patient has a severed spinal nerve as a result of trauma.Which of the following 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 the 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

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.

Answer 3

vertigo.

Question 4

Which of the following statements concerning areas of the brain is accurate?

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 brain stem synapse in the thalamus.

Question 5

The two parts of the nervous system are:

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

Question 6

A 30-year-old woman tells the nurse that she has been very unsteady and has had difficulty in maintaining her balance.With these findings,which area of the brain would concern the nurse?

A)Thalamus
B)Brain stem
C)Cerebellum
D)Extrapyramidal tract

Question 7

While obtaining a history of a 3-month old infant from its mother,the nurse asks about the baby'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 8

The human ability 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 9

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 neurological examination."
D)"You need to get up slowly when you've been lying or sitting."

Question 10

The wife of a 65-year-old man tells the nurse that she is concerned because she has noted 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 behaviours is which of the following?

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

Question 11

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)The nurse will not be able to elicit any deep tendon reflexes.
C)All reflexes would be diminished,but they would be present.
D)Some reflexes would be present,depending on the area of injury.

Question 12

In obtaining a history for 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 13

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

A)there must be a demyelinating process occurring with the baby.
B)myelin is needed to conduct these impulses,and the neurons of a newborn are not 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 14

A 50-year-old woman is visiting the clinic for "weakness in my left arm and leg for the past week." The nurse will perform which type of neurological examination?

A)Glasgow Coma Scale
B)Neurological recheck examination
C)Screening neurological examination
D)Complete neurological examination

Question 15

When doing the history on a patient with a seizure disorder,the nurse assesses whether the patient has an aura.Which of the following would be the best question to ask in order to obtain 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 colour change or incontinence during the seizure?"

Question 16

During an assessment of a patient's cranial nerves,the nurse finds a lack of blink in the right eye with corneal reflex,intact ability to sense light touch on the face,and loss of movement with facial features on the right side.This would indicate dysfunction of which of the following cranial nerves (CNs)?

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 17

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 18

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

A)The cranial nerves enter the brain through the spinal cord.
B)Efferent fibres 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 fibres.
D)The peripheral nerves carry input to the central nervous system by afferent fibres and away by efferent fibres.

Question 19

While gathering equipment for an intravenous injection,a nurse accidentally received a prick from an improperly capped needle.To interpret this sensation,which of the following 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 20

During an assessment of an 80-year-old patient,the nurse notes the patient's inability to identify vibrations at the ankle and to identify the position of the big toe,a slower and more deliberate gait,and slightly impaired tactile sensation.All other neurological findings are normal.The nurse knows that these findings indicate:

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

Question 21

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 and supination of the forearm

Question 22

During the assessment of an 80-year-old patient,the nurse notes that his hands show tremors when he reaches for something and that his head is always nodding.There is no associated rigidity with movement.Which of the following 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 degenerative arthropathy.
D)This patient should be evaluated for a cerebellar lesion.

Question 23

The nurse is testing the function of CN XI.Which of the following best describes the response the nurse would expect if the nerve is intact?

A)Demonstrates full range of motion of the neck
B)Sticks tongue out midline without tremors or deviation
C)Follows an object with the eyes without nystagmus or strabismus
D)Moves the head and shoulders against resistance with equal strength

Question 24

During the neurological assessment of a "healthy" 35-year-old patient,the nurse asks him to relax his muscles completely.The nurse then moves each extremity through the full range of motion.Which of the following 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 25

While assessing a 7-month-old infant,the nurse makes a loud noise and notes abduction and flexion of the arms and legs;fanning of the fingers,and curling of the index finger and thumb in a "C" position;and the infant bringing in its arms and legs toward its 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 symmetrical bilaterally.

Question 26

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 27

The nurse is testing the deep tendon reflexes of a 30-year-old woman during her annual physical examination.When striking the Achilles and quadriceps,the nurse is unable to elicit reflexes.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 28

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 to 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 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 his arm and hyperalgesia in others.

Question 29

Which of the following would the nurse use to test the motor coordination of an 11-month-old infant?

A)Nipissing District Developmental Screen
B)Denver II
C)Deep tendon reflexes
D)Rapid alternating movements

Question 30

In assessing a 70-year-old patient who has had a recent cerebrovascular accident,the nurse notes 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 31

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

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

Question 32

The nurse is performing a neurological assessment for a 41-year-old woman with a history of diabetes.When testing her ability to feel the vibrations of a tuning fork,the nurse notes that the woman is unable to feel vibrations on the great toe or ankle bilaterally but 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 33

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 would 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 34

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 might the nurse suspect?

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

Question 35

In the assessment of a 1-month-old infant,the nurse notes a lack of response to noise or stimulation.The mother reports that in the last week he has been sleeping most of the time,and when awake,all he does is cry.The nurse hears that the infant's cries are very high-pitched and shrill.What would 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 of this age.
D)Tell the mother to bring the baby back in a week for a recheck.

Question 36

The nurse is taking the health history of a 78-year-old man.During the history,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,the nurse would do which of the following?

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 37

While the nurse is taking the health 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 humour.
B)uncooperative behaviour.
C)inability to understand the question.
D)a decreased level of consciousness.

Question 38

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.What normal response does the nurse look for?

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

Question 39

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

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

Question 40

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 41

During an assessment of a 62-year-old man the nurse notes stooped posture;shuffling,short steps when walking;a very rigid,flat facial expression;and movement of the fingers as if rolling a pill with them.These findings would be consistent with:

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

Question 42

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 43

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

A)ataxia.
B)astereognosis.
C)the presence of dysdiadochokinesia.
D)a probable abnormality in the cerebellum.

Question 44

The nurse is assessing the neurological status of a patient who has a late-stage brain tumour.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 recognizes this as which of the following?

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

Question 45

During an assessment of a 32-year-old patient with a recent head injury,the nurse notes that the patient responds to pain by extending,adducting,and internally rotating his arms.As well,his palms pronate and his lower extremities extend with plantar flexion.Which of the following statements about these findings is accurate?

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

Question 46

A 32-year-old woman tells the nurse that she has noticed "very sudden,jerky movements," mainly in her hands and arms."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)chorea.
B)athetosis.
C)myoclonus.
D)Parkinson's disease.

Question 47

A man who was found wandering in a park at 2 A.M.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,and 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 suspects which of the following?

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

Question 48

The nurse knows that which of the following scores would indicate that a patient is in a coma based on the Glasgow Coma Scale criteria?

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

Question 49

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

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

Question 50

During an examination,the nurse notes severe nystagmus in both of the patient's eyes.Which of the following conclusions is correct?

A)This is a normal occurrence.
B)This may indicate disease of the cerebellum or brain stem.
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 51

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

A)Hyporeflexia
B)Increased muscle tone
C)A positive Babinski sign
D)The presence of pathological reflexes

Question 52

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

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

Question 53

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

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

Question 54

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