Deck 23: Neurologic System

Question 1

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 notes the following: unable to feel vibrations on the great toe or ankle bilaterally;is able to feel vibrations on both patellae.Given this information,what would the nurse suspect?
1)Hyperalgesia
2)Hyperesthesia
3)Peripheral neuropathy
4)Lesion of sensory cortex

Answer 1

3
Loss of vibration sense occurs with peripheral neuropathy (e.g. ,diabetes and alcoholism).Peripheral neuropathy is worse at the feet and gradually improves as you move up leg,as opposed to a specific nerve lesion,which has a clear zone of deficit for its dermatome.

Question 2

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 the following would the nurse expect to find?
1)Firm,rigid resistance to movement
2)Mild,even resistance to movement
3)Hypotonic muscles as a result of total relaxation
4)Slight pain with some directions of movement

Answer 2

2
Tone is the normal degree of tension (contraction)in voluntarily relaxed muscles.It shows a mild resistance to passive stretch.Normally,you will note a mild,even resistance to movement.

Question 3

During an assessment of an 80-year-old patient,the nurse notes the following: inability to identify vibrations at the ankle and to identify position of big toe;slower and more deliberate gait;slightly impaired tactile sensation.All other neurologic findings are normal.The nurse knows that these findings indicate:
1)cranial nerve dysfunction.
2)lesion in the cerebral cortex.
3)normal changes due to aging.
4)demyelinization of nerves due to a lesion.

Answer 3

3
Some aging adults show a slower response to requests,especially for those calling for coordination of movements.The findings listed are normal in the absence of other significant abnormal findings.

Question 4

A 50-year-old woman is in the clinic for "weakness in my left arm and leg for the past week." The nurse will perform which type of neurologic examination?
1)Glasgow Coma Scale
2)Neurologic recheck examination
3)Screening neurologic examination
4)Complete neurologic examination

Question 5

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 further apart.The nurse would document this finding as a(n):
1)ataxia.
2)lack of coordination.
3)negative Homan's sign.
4)positive Romberg's sign.

Question 6

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?
1)Vestibular disease
2)Lesion of cranial nerve IX
3)Dysfunction of the cerebellum
4)Inability to understand directions

Question 7

Which of the following statements is accurate concerning areas of the brain?
1)The cerebellum is the center for speech and emotions.
2)The hypothalamus controls temperature and regulates sleep.
3)The basal ganglia are responsible for controlling voluntary movements.
4)Motor pathways of the spinal cord and brainstem synapse in the thalamus.

Question 8

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?
1)Extinction
2)Astereognosis
3)Graphesthesia
4)Tactile discrimination

Question 9

A patient with lack of oxygen to his heart will have pain in his chest and also possibly the shoulder,arms,or jaw.Which of the following best explains why this occurs?
1)There is a problem with the sensory cortex and its ability to discriminate the location.
2)The lack of oxygen in his heart has resulted in decreased amount of oxygen to these areas.
3)The sensory cortex does not have the ability to localize pain in the heart,so the pain is felt elsewhere.
4)There is a lesion in the dorsal root that is preventing the sensation from being transmitted normally.

Question 10

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?
1)Corticospinal tract,medulla,and basal ganglia
2)Pyramidal tract,hypothalamus,and sensory cortex
3)Lateral spinothalamic tract,thalamus,and sensory cortex
4)Anterior spinothalamic tract,basal ganglia,and sensory cortex

Question 11

In obtaining a history on a 74-year-old patient the nurse notes the following: he drinks alcohol daily;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?
1)"Does your family know you are drinking every day?"
2)"Does the tremor change when you drink the alcohol?"
3)"We'll do some tests to see what is causing the tremor."
4)"You really shouldn't drink so much alcohol;it may be causing your tremor."

Question 12

During an assessment of the cranial nerves,the nurse finds the following: lack of blink in right eye with corneal reflex;intact ability to sense light touch on face;loss of movement with facial features on right side.This would indicate dysfunction of which of the following cranial nerves?
1)Motor component of IV
2)Motor component of VII
3)Motor and sensory components of XI
4)Motor component of X and sensory component of VII

Question 13

While obtaining a history of a 3-month old infant from the mother,the nurse asks about the baby's ability to suck and grasp the mother's finger.What is the nurse assessing?
1)Reflexes
2)Intelligence
3)Cranial nerves
4)Cerebral cortex function

Question 14

The two parts of the nervous system are the:
1)motor and sensory.
2)central and peripheral.
3)peripheral and autonomic.
4)hypothalamus and cerebral.

Question 15

The nurse is testing the function of cranial nerve XI.Which of the following best describes the response the nurse would expect if the nerve is intact?
1)Demonstrates full range of motion of the neck
2)Sticks tongue out midline without tremors or deviation
3)Follows an object with eyes without nystagmus or strabismus
4)Moves the head and shoulders against resistance with equal strength

Question 16

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?
1)Thalamus
2)Brainstem
3)Cerebellum
4)Extrapyramidal tract

Question 17

The ability that humans have to perform very skilled movements such as writing is controlled by the:
1)basal ganglia.
2)corticospinal tract.
3)spinothalamic tract.
4)extrapyramidal tract.

Question 18

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:
1)"Have you been extremely tired lately?"
2)"You probably just need to drink more liquids."
3)"I'll refer you for a complete neurologic examination."
4)"You need to get up slowly when you've been lying or sitting."

Question 19

During the history,a patient tells the nurse that "it feels like the room is spinning around me." The nurse would document this as:
1)vertigo.
2)syncope.
3)dizziness.
4)seizure activity.

Question 20

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 for obtaining this information?
1)"Does your muscle tone seem tense or limp?"
2)"After the seizure,do you spend a lot of time sleeping?"
3)"Do you have any warning sign before your seizure starts?"
4)"Do you experience any color change or incontinence during the seizure?"

Question 21

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?
1)Cerebrum
2)Cerebellum
3)Cranial nerves
4)Medulla oblongata

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 his head is always nodding.There is no associated rigidity with movement.Which of the following statements is most accurate?
1)These are normal findings resulting from aging.
2)These could be related to hyperthyroidism.
3)These are the result of degenerative arthropathy.
4)This patient should be evaluated for a cerebellar lesion.

Question 23

Which of the following would the nurse use to test the motor coordination of an 11-month old infant?
1)Denver II
2)Stereognosis
3)Deep tendon reflexes
4)Rapid alternating movements

Question 24

A patient is not able to perform rapid alternating movements such as patting her knees rapidly.The nurse would document this as:
1)ataxia.
2)astereognosis.
3)the presence of dysdiadochokinesia.
4)a probable abnormality in the cerebellum.

Question 25

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?
1)Cranial nerves,motor function,and sensory function
2)Deep tendon reflexes,vital signs,and coordinated movements
3)Level of consciousness,motor function,pupillary response,and vital signs
4)Mental status,deep tendon reflexes,sensory function,and pupillary response

Question 26

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?
1)Hyperreflexia
2)Fasciculations
3)Loss of muscle tone and flaccidity
4)Atrophy and wasting of the muscles

Question 27

During an examination,the nurse notes severe nystagmus in both eyes of a patient.Which of the following conclusions is correct?
1)This is a normal occurrence.
2)This may indicate disease of the cerebellum or brainstem.
3)This is a sign that the patient is nervous about the examination.
4)This indicates a visual problem and a referral to an ophthalmologist is indicated.

Question 28

When the nurse is testing the triceps reflex,what is the expected response?
1)Flexion of the hand
2)Pronation of the hand
3)Extension of the forearm
4)Flexion and supination of the forearm

Question 29

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:
1)chorea.
2)athetosis.
3)myoclonus.
4)Parkinson's disease.

Question 30

A 59-year-old patient a herniated intervertebral disk.Which of the following findings would the nurse expect to see on physical assessment of this individual?
1)Hyporeflexia
2)Increased muscle tone
3)A positive Babinski's sign
4)The presence of pathologic reflexes

Question 31

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?
1)Lack of reflexes
2)Normal reflexes
3)Diminished reflexes
4)Hyperactive reflexes

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

Question 33

During an assessment of a 62-year-old man the nurse notes the following: stooped posture;walks with shuffling,short steps;very rigid;flat facial expression;fingers move as if rolling a pill with them.These findings would be consistent with:
1)parkinsonism.
2)cerebral palsy.
3)cerebellar ataxia.
4)muscular dystrophy.

Question 34

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?
1)Scissors gait
2)Cerebellar ataxia
3)Parkinsonian gait
4)Spastic hemiparesis

Question 35

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?
1)Raises head and arches back.
2)Extends arms and drops head down.
3)Flexes knees and elbows with back straight.
4)Holds head at 45 degrees and keeps back straight.

Question 36

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?
1)Positive Babinski sign
2)Plantar reflex abnormal
3)Plantar reflex present
4)Plantar reflex "2+" on a scale from "0 to 4+"

Question 37

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.His palms pronate and his lower extremities extend as well with plantar flexion.Which of the following statements about these findings is accurate?
1)This indicates a lesion of the cerebral cortex.
2)This indicates a completely nonfunctional brainstem.
3)This is a normal response and will go away in 24 to 48 hours.
4)This is a very ominous sign and may indicate brainstem injury.

Question 38

While assessing a 7-month-old infant,the nurse makes a loud noise and notes the following response: abduction and flexion of arms and legs;fanning of fingers,and curling of index and thumb in C position followed by infant bringing in arms and legs to body.What does the nurse know about this response?
1)This could indicate brachial nerve palsy.
2)This is an expected startle response at this age.
3)This reflex should have disappeared between 1 and 4 months of age.
4)It is normal as long as movements are symmetric bilaterally.

Question 39

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 all 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?
1)Refer the infant for further testing.
2)Talk with the mother about eating habits.
3)Nothing;these are expected findings for an infant this age.
4)Tell the mother to bring the baby back in a week for a recheck.

Question 40

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: pupils were equal,but now the right is fully dilated and nonreactive,left is 4 mm and reacts to light.What would finding this suggest?
1)Injury to the right eye
2)Increased intracranial pressure
3)Test was not performed accurately
4)Normal response after a head injury

Question 41

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 recognizes this as which of the following?
1)A negative Babinski's sign,which is normal for adults
2)A positive Babinski's sign,which is abnormal for adults
3)Clonus,a hyperactive response
4)The Achilles reflex,an expected response

Question 42

The nurse knows that testing kinesthesia is a test of a person's:
1)fine touch.
2)position sense.
3)motor coordination.
4)perception of vibration.

Question 43

The nurse knows that which of the following scores would indicate that a patient is in a coma on the basis of the criteria of the Glasgow Coma Scale?
1)6
2)12
3)15
4)24

Question 44

During the assessment of deep tendon reflexes,the nurse finds that a patient's responses are normal bilaterally.Indicate what number is used to indicate "normal" deep tendon reflexes when the documenting this finding.Fill in the blank.
____________ +