Deck 25: Neurological System

Question 1

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

Answer 1

Reflexes

Question 2

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 neurological examination?

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

Answer 2

Complete neurological examination

Question 3

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

Answer 3

Lateral spinothalamic tract, thalamus, and sensory cortex

Question 4

During an assessment of an 80-year-old patient, the nurse notices the following: the patient's 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.The nurse should interpret that these findings indicate:

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

Question 5

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 6

Which of these 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 from the central nervous system by efferent fibres.

Question 7

A 70-year-old woman tells the nurse that every time she gets up in the morning or after she has 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 down or sitting."

Question 8

A 30-year-old woman tells the nurse that she has been very unsteady and has had difficulty maintaining her balance.Which area of the brain that is related to these findings would concern the nurse?

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

Question 9

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.The nurse recalls that the cerebral lobe responsible for these behaviours is the __________ lobe.

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

Question 10

During an assessment of the cranial nerves, 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.This would indicate dysfunction of which of these cranial nerves?

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

Question 11

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

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 12

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

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

Question 13

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 14

Which statement concerning the areas of the brain is true?

A)The cerebellum is the centre 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 15

When taking the health history on a patient with a seizure disorder, the nurse is trying to determine 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 16

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 your family know you are drinking every day?"
B)"Does the tremor change when you drink 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 17

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:

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

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

Question 19

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 (DTRs)?

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 20

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 21

The nurse is performing an assessment on a 29-year-old woman who is at 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 of her knees.Her response is extremely slow and she frequently misses.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 22

After a spinal cord injury in a 40-year-old patient, the nurse is testing the intactness of the patient's reflex arcs.The nurse tests the triceps reflex to elicit what response for which spinal level?

A)Flexion of the hand for C5 to C6
B)Pronation of the hand for C5 to C6
C)Extension of the forearm for C7 to C8
D)Flexion of the forearm for C7 to C8

Question 23

The nurse is performing a neurological 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 24

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 that the toes curl down and away from the shin.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 25

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

A)Hop on one foot
B)Stand on his head
C)Touch his finger to his nose
D)Make "funny" faces at the nurse

Question 26

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 related to hyperthyroidism.
C)These findings are the result of Parkinson's disease.
D)This patient should be evaluated for a cerebellar lesion.

Question 27

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)DTRs, vital signs, and coordinated movements
C)Level of consciousness, motor function, pupillary response, and vital signs
D)Mental status, DTRs, sensory function, and pupillary response

Question 28

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

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

Question 29

As part of a neurological examination, the nurse is testing the DTRs of a 30-year-old woman.When striking the Achilles heel and quadriceps muscle, 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 30

During the neurological assessment of an apparently 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 31

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 that he is 30 years of age.The nurse knows that this finding is indicative of a(n):

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

Question 32

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 33

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 know 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 symmetrical.

Question 34

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

A)Nipissing District Developmental Screen (NDDS)
B)Stereognosis
C)DTRs
D)Rapid alternating movements

Question 35

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 36

In the assessment of a 1-month-old infant, the nurse notices lack of response to noise or stimulation.The mother reports that in the past 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)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

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? The infant:

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

Question 38

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 39

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

A)Demonstrates the ability to hear normal conversation
B)Sticks out the tongue midline without tremors or deviation
C)Follows an object with his or her eyes without nystagmus or strabismus
D)Moves the head and shoulders against resistance with equal strength

Question 40

During the health history interview with 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 not test the sensory system as part of the examination because the 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 an explanation of each test, making certain that the wife understands.
D)Before testing, the nurse would assess the patient's mental status and ability to follow directions.

Question 41

The nurse is providing an informational session on stroke at a community health centre and includes the following risk factors that should be modified to decrease risk for stroke: (Select all that apply.)

A)Obesity
B)Sedentary lifestyle
C)Cigarette smoking
D)Hypoglycemia
E)High levels of low-density lipoprotein (LDL) cholesterol
F)Normotensive

Question 42

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 43

To encourage quick response when observing someone experiencing symptoms of a stroke, the nurse uses the mnemonic:

A)BUBBLE
B)FAST
C)PERRLA
D)PQRST

Question 44

A 59-year-old patient has a herniated intervertebral disc.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 pathological reflexes

Question 45

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

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

Question 46

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 47

During examination, the nurse notices severe back and forth oscillations in both eyes of the patient.Which conclusion by the nurse is correct regarding the findings? This:

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

Question 48

During the assessment of DTRs, the nurse finds that a patient's responses are bilaterally normal.What number is used to indicate normal DTRs when the documenting this finding? __________+

Question 49

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? This patient's response:

A)Indicates a lesion of the cerebral cortex
B)Indicates a completely nonfunctional brainstem
C)Is normal and will go away in 24 to 48 hours
D)Indicates decerebrate rigidity

Question 50

The nurse is working at a blood pressure clinic with a multicultural community.The nurse ensures to provide health education resources on stroke, especially to certain individuals who are from the following ethnocultural backgrounds and have a greater risk for stroke: (Select all that apply.)

A)Middle Eastern
B)Indigenous
C)European
D)African
E)South Asian

Question 51

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 52

During an assessment of a 62-year-old man, the nurse notices that 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 multiple sclerosis patient is unable to perform rapid alternating movements, such as rapid patting of her knees.The nurse should document this inability as:

A)Ataxia
B)Astereognosis
C)Dysdiadochokinesia
D)Loss of kinesthesia

Question 54

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, 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 should suspect which of the following?

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

Question 55

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 interprets this result as:

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

Question 56

During an assessment of a 22-year-old woman who sustained a head injury from a motor vehicle 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 right eye
B)Increased intracranial pressure
C)Test inaccurately performed
D)Normal response after a head injury

Question 57

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 he drags the toe in a semicircle 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 58

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

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