Deck 16: Disorders of the Central and Peripheral Nervous Systems and Neuromuscular Junction

Question 1

Which of the following would increase a patient's risk for thrombotic stroke?

A) Hyperthyroidism
B) Hypertension
C) Anemia
D) Dehydration

Answer 1

Dehydration

Question 2

At what level does the majority of intervertebral disc herniations occur?

A) C1-C3
B) T1-T4
C) T12-L3
D) L4-S1

Answer 2

L4-S1

Question 3

A 30-year-old white male recently suffered a cerebrovascular accident. Which of the following is the most likely factor that contributed to his stroke?

A) Age
B) Gender
C) Diabetes
D) Race

Answer 3

Diabetes

Question 4

A nurse is preparing to teach staff about the most common type of traumatic brain injury. Which type of traumatic brain injury should the nurse discuss?

A) Penetrating trauma
B) Diffuse axonal injury
C) Focal brain injury
D) Concussion

Question 5

After falling, a patient's Glasgow Coma Scale (GCS) was 5 initially and 7 after 1 day. The patient remained unconscious for 2 weeks but is now awake, confused, and experiencing anterograde amnesia. This history supports which medical diagnosis?

A) Mild diffuse brain injury
B) Moderate diffuse brain injury
C) Severe diffuse brain injury
D) Postconcussive syndrome

Question 6

A patient is brought to the ER for treatment of injuries received in a motor vehicle accident. An MRI reveals spinal cord injury, and his body temperature fluctuates markedly. What is the reason for the fluctuations in body temperature?

A) He developed pneumonia.
B) His sympathetic nervous system has been damaged.
C) He has a brain injury.
D) He has septicemia from an unknown source.

Question 7

A 69-year-old patient with a history of alcohol abuse presents to the emergency room (ER) after a month-long episode of headaches and increasing confusion. The patient's history and symptomology support which medical diagnosis?

A) Concussion
B) Chronic subdural hematoma
C) Epidural hematoma
D) Subacute subdural hematoma

Question 8

Who is at particular risk for a cerebrovascular accident (CVA)?

A) Someone with hypertension and type 2 diabetes
B) A white person over 65 years of age
C) An athlete engaged in physical contact sports
D) A healthy person of Inuit descent

Question 9

Six weeks ago a patient suffered a T6 spinal cord injury. What complication does the nurse suspect when the patient develops a blood pressure of 200/120, a severe headache, blurred vision, and bradycardia?

A) Extreme spinal shock
B) Acute anxiety
C) Autonomic hyper-reflexia
D) Parasympathetic areflexia

Question 10

Immediately after being struck by a motor vehicle, a patient is unconscious, but the patient regains consciousness before arriving at the hospital and appears alert and oriented. The next morning the patient is confused and demonstrates impaired responsiveness. The patient's history and symptoms support which medical diagnosis?

A) Mild concussion
B) Subdural hematoma
C) Extradural (epidural) hematoma
D) Mild diffuse axonal injury

Question 11

A major contributing factor to the development of a thrombotic stroke is the presence of atherosclerosis. Where does this commonly form?

A) In the larger veins of the brain
B) Near capillary sphincters
C) In cerebral arteries
D) In the venous sinuses

Question 12

What is the main source of bleeding in extradural (epidural) hematomas?

A) Arterial
B) Venous
C) Capillary
D) Sinus

Question 13

A patient diagnosed with a spinal cord injury experienced spinal shock lasting 15 days. The patient is now experiencing an uncompensated cardiovascular response to sympathetic stimulation. What does the nurse suspect caused this condition?

A) Toxic accumulation of free radicals below the level of the injury
B) Pain stimulation above the level of the spinal cord lesion
C) A distended bladder or rectum
D) An abnormal vagal response

Question 14

A coup injury resulting from a blow to the frontal portion of the skull would occur in which region of the brain?

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

Question 15

Which assessment finding by the nurse characterizes a mild concussion?

A) A brief loss of consciousness
B) Significant behavioural changes
C) Retrograde amnesia
D) Permanent confusion

Question 16

A CT scan reveals that a patient has an open basilar skull fracture. Which major complication should the nurse observe for in this patient?

A) Hematoma formation
B) Meningeal infection
C) Increased intracranial pressure (ICP)
D) Cognitive deficits

Question 17

Who is most at risk of spinal cord injury because of pre-existing degenerative disorders?

A) Infants
B) Men
C) Women
D) Older adults

Question 18

A patient diagnosed with a diffuse brain injury (DBI) is at increased risk for which complication?

A) Complete loss of vision
B) Arrhythmia
C) Acute brain swelling
D) Meningitis infection

Question 19

A patient presents with acute low back pain. There is no history of trauma. An MRI reveals that the vertebra at L5 has slipped forward relative to those below it. Which of the following conditions will be documented on the chart?

A) Degenerative disc disease
B) Spondylolysis
C) Spondylolisthesis
D) Spinal stenosis

Question 20

A 72-year-old patient demonstrates left-sided weakness of upper and lower extremities. The symptoms lasted less than an hour and resolved with no evidence of infarction. What did the patient most likely experience?

A) A stroke in evolution
B) An arteriovenous malformation
C) A transient ischemic attack
D) Cerebral hemorrhage

Question 21

What is the most common early symptom of a brain abscess?

A) Neck rigidity
B) Vomiting
C) Drowsiness
D) Headache

Question 22

What is true about the clinical presentation of an aneurysm?

A) A headache is the most common symptom and presents early.
B) Aneurysms are often asymptomatic.
C) Nosebleeds are an early symptom.
D) Epidural hemorrhage occurs in over 80% of patients.

Question 23

What type of encephalitis is the most common?

A) Bacterial
B) Viral
C) Fungal
D) Toxoid

Question 24

A 48-year-old patient presents at the ER reporting an acute severe headache, nausea, photophobia, and nuchal rigidity. Which medical diagnosis is supported by these signs and symptoms?

A) Diffuse brain injury
B) Subarachnoid hemorrhage
C) Epidural hematoma
D) Classic concussion

Question 25

A patient presents with seizures. An MRI reveals a meningioma. Where do these tumours usually arise?

A) The dura mater and arachnoid membrane
B) From astrocytes
C) In the pia mater
D) From CNS neurons

Question 26

Upon autopsy of a 25-year-old, abnormalities in the media of the arterial wall and degenerative changes were detected. Which of the following would most likely accompany this finding?

A) Fusiform aneurysm
B) Saccular aneurysm
C) Arteriovenous malformation
D) Thrombotic stroke

Question 27

A patient is newly diagnosed with multiple sclerosis (MS). What physiological change is causing the patient's symptoms?

A) Depletion of dopamine in the central nervous system (CNS)
B) Demyelination of nerve fibres in the CNS
C) The development of neurofibril webs in the CNS
D) Reduced amounts of acetylcholine at the neuromuscular junction

Question 28

The patient reports generalized muscle weakness. The health care provider orders administration of the medication edrophonium chloride (Tensilon). This medication is used in the diagnosis of:

A) amyotrophic lateral sclerosis (ALS).
B) myasthenia gravis.
C) multiple sclerosis (MS).
D) autonomic hyper-reflexia.

Question 29

What is the cause of myasthenia gravis?

A) A viral infection of skeletal muscle
B) Atrophy of motor neurons in the spinal cord
C) Demyelination of skeletal motor neurons
D) An autoimmune injury at the neuromuscular junction

Question 30

A 65-year-old patient diagnosed with a subarachnoid hemorrhage secondary to uncontrolled hypertension appears drowsy and confused with pronounced focal neurological deficits. This symptomology would place this hemorrhage at which grade?

A) I
B) II
C) III
D) IV

Question 31

A 75-year-old patient experienced a lacunar stroke. When looking through the patient's chart, which of the following would the nurse expect to find?

A) A diagnosis of increased intracranial pressure
B) An image of an ischemic lesion near the basal ganglia
C) A report of a subdural hemorrhage
D) A history of pulmonary embolism

Question 32

A 60-year-old patient with a recent history of head trauma and a long-term history of hypertension presents to the ER for changes in mental status. MRI reveals that the patient has experienced a subarachnoid hemorrhage. What does the nurse suspect caused this type of stroke?

A) Rheumatic heart disease
B) Thrombi
C) Aneurysm
D) Hypotension

Question 33

A 15-month-old child from Nova Scotia was brought to the ER with symptomology that includes fever, seizure activity, cranial palsies, and paralysis. Which form of encephalitis is best supported by the available assessment data?

A) Eastern equine encephalitis
B) Venezuelan encephalitis
C) St. Louis encephalitis
D) West Nile encephalitis

Question 34

Patients diagnosed with myasthenia gravis often have tumours or pathological changes in which area of the body?

A) Brain
B) Pancreas
C) Thymus
D) Lungs

Question 35

When a patient asks, "What is the cause of multiple sclerosis", how might the nurse answer?

A) There are vascular and metabolic factors.
B) It is caused by bacterial infection and the inflammatory response.
C) It is an autoimmune disorder in those with a genetic susceptibility.
D) It involves neurotransmitters and inherited genes.

Question 36

What are the most common primary central nervous system (CNS) tumours in adults?

A) Meningiomas
B) Oligodendrogliomas
C) Astrocytomas
D) Ependymomas

Question 37

A patient presents to a primary care provider reporting fever, headache, nuchal rigidity, and decreased consciousness. History includes a previously treated sinusitis. Which medical diagnosis is best supported by this assessment data?

A) Aseptic meningitis
B) Bacterial meningitis
C) Fungal meningitis
D) Nonpurulent meningitis