Question 1

A 22-year-old female college student is shocked to receive a diagnosis of myasthenia gravis. What are the etiology and most likely treatment for her health problem?

Accepted Answer

A)  Autoimmune destruction of skeletal muscle cells; treatment with intensive physical therapy and anabolic steroids
B)  A decline in functioning acetylcholine receptors; treatment with corticosteroids and intravenous immunoglobulins
C)  Cerebellar lesions; surgical and immunosuppressive treatment
D)  Excess acetylcholinesterase production; treatment with thymectomy B

Question 2

A toddler is displaying signs and symptoms of weakness and muscle atrophy. The pediatric neurologist suspects it may be a lower motor neuron disease called spinal muscular atrophy (SMA). The patient's family asks how he got this. The nurse will respond

Accepted Answer

A)  "This could result from playing in soil and then ingesting bacteria that are now attacking his motor neurons."
B)  "No one really knows how this disease is formed. We just know that in time, he may grow out of it."
C)  "This is a degenerative disorder that tends to be inherited as an autosomalrecessive trait."
D)  "This is a segmental demyelination disorder that affects all nerve roots and eventually all muscle groups as well." C

Question 3

After being thrown off the back of a bull, the bull rider can move his arms but has loss of motor function in the lumbar and sacral segments of the spinal cord. This is usually referred to as

Accepted Answer

A)  tetraplegia.
B)  quadriplegia.
C)  paraplegia.
D)  anterior cord syndrome. C

Question 4

Several months ago, a 20-year-old male suffered a spinal cord injury brought about by a snowboard trick gone wrong. The lasting effects of his injury include a flaccid bowel and bladder and the inability to obtain an erection. While sensation has been completely preserved in his legs and feet, his motor function is significantly impaired. What type of incomplete spinal cord injury has the man most likely experienced?

Accepted Answer

A)  Anterior cord syndrome
B)  Brown-Séquard syndrome
C)  Central cord syndrome
D)  Conus medullaris syndrome

Question 5

If the nurse suspects a spinal cord injury, the patient has developed autonomic dysreflexia. Which of the following assessments would confirm this complication? Select all that apply.

Accepted Answer

A)  BP180/98 
B)  Skin covered with macular rash 
C)  Pulse rate 49 
D)  Complains of a pounding headache
E)  Cold, cyanotic lower legs

Question 6

Which of the following individuals is likely to have the best prognosis for recovery from his or her insult to the peripheral nervous system? An adult

Accepted Answer

A)  who developed rhabdomyolysis and ischemic injury after a tourniquet application.
B)  who suffered a bone-depth laceration to the shoulder during a knife attack.
C)  who had his forearm partially crushed by gears during an industrial accident.
D)  who had nerves transected during surgery to remove a tumor from the mandible.

Question 7

The geriatrician providing care for a 74-year-old man with diagnosis of Parkinson disease has recently changed the client's medication regimen. What is the most likely focus of the pharmacologic treatment of the man's health problem?

Accepted Answer

A)  Maximizing acetylcholine release from synaptic vesicles at neuromuscular junctions
B)  Preventing demyelination of the efferent cerebellar pathways
C)  Increasing the functional ability of the underactive dopaminergic system
D)  Preventing axonal degradation of motor neurons

Question 8

The nurse should anticipate she will need to teach the newly diagnosed multiple sclerosis patient how to give injections if he is prescribed which medication to modify the course of the disease by reducing exacerbations?

Accepted Answer

A)  Corticosteroids
B)  Plasmapheresis
C)  Interferon beta
D)  Mitoxantrone

Question 9

The parents of a 3-year-old boy have brought him to a pediatrician for assessment of the boy's late ambulation and frequent falls. Subsequent muscle biopsy has confirmed a diagnosis of Duchenne muscular dystrophy. Which of the following teaching points should the physician include when explaining the child's diagnosis to his parents?

Accepted Answer

A)  "Your son's muscular dystrophy is a result of faulty connections between muscles and the nerves that normally control them."
B)  "He'll require intensive physical therapy as he grows up, and there's a good chance that he will outgrow this problem as he develops."
C)  "Your son will be prone to heart problems and decreased lung function because of this."
D)  "His muscles will weaken and will visibly decrease in size relative to his body size throughout his childhood."

Question 10

A 41-year-old woman was diagnosed with multiple sclerosis (MS) 7 years ago and is sharing her story with members of an MS support group, many of whom have been diagnosed recently. Which of the following aspects of her health problem should the woman warn others to expect at some point in the progression of the disease? Select all that apply.

Accepted Answer

A)  Debilitating fatigue
B)  Progressive loss of visual acuity
C)  Gradual development of a resting tremor 
D)  Loss of mental acuity 
E)  Shuffling gait

Question 11

During a flu shot clinic, one of the questions the student nurse asks relates to whether the patient has had Guillain-Barré syndrome in his medical history. The patient asks, "What is that?" How should the nursing student reply?

Accepted Answer

A)  "A type of paralysis that affects movement on both sides of the body that mayeven involve the respiratory muscles" 
B)  "Swelling of your arm where you got your flu shot, and maybe your eyes and lips had some swelling as well"
C)  "A degenerative disease where you have trouble walking without the help of a cane or walker"
D)  "Influenza-like illness where you had fever and chills for 2 to 3 days after your last flu shot"

Question 12

A 47-year-old woman was diagnosed with amyotrophic lateral sclerosis 3 years ago and has experienced a progressive onset and severity of complications. She has been admitted to a palliative care unit due to her poor prognosis? What assessments and interventions should the nursing staff of the unit prioritize in their care?

Accepted Answer

A)  Assessment and documentation of cognitive changes, including confusion and restlessness
B)  Regular pain assessment and administration of opioid analgesics as needed
C)  Assessment of swallowing ability and respiratory status
D)  Cardiac monitoring and administration of inotropic medications

Question 13

A nurse working in a busy orthopedic clinic is asked to perform the Tinel sign on a patient having problems in his hand/wrist. In order to test Tinel sign, the nurse should give the patient which of the following directions?

Accepted Answer

A)  "Stand tall, arms at your side, shut your eyes; place the tip of your index finger to your nose."
B)  "Hold your wrist in complete flexion; keep it in this position for 60 seconds; howdoes your hand feel after placing it in a neutral position?"
C)  "I'm going to tap (percuss)  over the median nerve in your wrist; tell me what sensation you feel while I am doing this. Does the sensation stay in the wrist or go anywhere else?"
D)  "I'm going to tap this tuning fork and place it on the side of your thumb; then tell me what you are feeling in your hand and wrist."

Question 14

The unique clinical presentation of a 3-month-old infant in the emergency department leads the care team to suspect botulism. Which of the following assessment questions posed to the parents is likely to be most useful in the differential diagnosis?

Accepted Answer

A)  "Have you ever given your child any honey or honey-containing products?"
B)  "Is there any family history of neuromuscular diseases?"
C)  "Has your baby ever been directly exposed to any chemical cleaning products?"
D)  "Is there any mold in your home that you know of?"

Question 15

A middle-aged woman is brought to the emergency room after a minor auto accident. Her gait is staggering and unsteady; her speech is slurred; and she displays slight nystagmus. The police officer who brought her in says she has not been drinking. Her blood pressure is very high. which of the following health problems most likely underlies her present state?

Accepted Answer

A)  Multiple sclerosis
B)  Guillain-Barré syndrome
C)  Myasthenia crisis
D)  Cerebellar damage caused by a cerebrovascular accident

Question 16

A 70-year-old male has been diagnosed with a stroke that resulted in an infarct to his cerebellum. Which of the following clinical findings would be most closely associated with cerebellar insult?

Accepted Answer

A)  Flaccid loss of muscle tone
B)  Difficulty in starting movement, stopping movement, and maintaining rhythmic movements.
C)  Tremor, rigidity, and bradykinesia
D)  Unsteady gait and difficulty in speaking and swallowing

Question 17

A clinician is conducting an assessment of a male client suspected of having a disorder of motor function. Which of the following assessment findings would suggest a possible upper motor neuron (UMN) lesion?

Accepted Answer

A)  The client has decreased deep tendon reflexes.
B)  The client displays increased muscle tone.
C)  The client's muscles appear atrophied.
D)  The client displays weakness in the distal portions of his limbs.

Question 18

A 60-year-old male office worker presents to a clinic complaining of new onset of lower back pain that has been worsening over the last 6 weeks. The nurse knows which of the following components of his physical assessment and history is most indicative of a serious pathological process (like aortic aneurysm or cancer)?

Accepted Answer

A)  His pain is relieved by extended bed rest.
B)  When supine, passive rising of his leg to 90 degrees results in hamstring pain.
C)  He has needed regular nonsteroidal anti-inflammatory drugs to control the pain in recent weeks.
D)  His onset of pain has been gradual, and he has no prior history of lower back problems.

Question 19

During a late night study session, a pathophysiology student reaches out to turn the page of her textbook. Which of the following components of her nervous system contains the highest level of control of her arm and hand action?

Accepted Answer

A)  Cerebellum
B)  Thalamus
C)  Basal ganglia
D)  Frontal lobe

Question 20

A patient is asked to stand with feet together, eyes open, and hands by the sides. Then the patient is asked to close his eyes while the nurse observes for a full minute. What assessment is the nurse performing?

Accepted Answer

A)  Segmental reflex
B)  Posture
C)  Proprioception
D)  Crossed-extensor reflex

Exam 18: Disorders of Thought, Emotion, and Memory