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

The majority of intervertebral disk herniations occur between which vertebral levels (cervical, C; thoracic, T; lumbar, L; sacral, S)?

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

Answer 2

L4-S1

Question 3

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

Answer 3

Meningeal infection

Question 4

Of the following groups, who are at highest risk for a cerebrovascular accident (CVA)?

A) Blacks over 65 years of age
B) Whites over 65 years of age
C) Blacks under 65 years of age
D) Whites under 65 years of age

Question 5

A major contributing process in CVAs is the development of atheromatous plaques in cerebral circulation.Where do these plaques most commonly form?

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

Question 6

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 disk disease
B) Spondylolysis
C) Spondylolisthesis
D) Spinal stenosis

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 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

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 9

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

Question 10

Who is most at risk of spinal cord injury because of preexisting degenerative disorders?

A) Infants
B) Men
C) Women
D) The elderly

Question 11

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 12

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.The patient most likely experienced a(n):

A) stroke in evolution.
B) arteriovenous malformation.
C) transient ischemic attack.
D) cerebral hemorrhage.

Question 13

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.The most accurate explanation of this phenomenon is that:

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 14

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 15

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

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

Question 16

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 17

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 18

Which assessment finding by the nurse characterizes a mild concussion?

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

Question 19

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 20

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 hyperreflexia
D) Parasympathetic areflexia

Question 21

Which information is basic to the assessment findings associated with a patient diagnosed with an aneurysm?

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

Question 22

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 hyperreflexia.

Question 23

A patient presents with seizures.An MRI reveals a meningioma most likely originating from the:

A) dura mater and arachnoid membrane.
B) astrocytes.
C) pia mater.
D) CNS neurons.

Question 24

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

A) An embolus
B) An ischemic lesion
C) A hemorrhage
D) An aneurysm

Question 25

Patient teaching is considered successful regarding myasthenia gravis when the patient identifies its cause as being:

A) viral infection of skeletal muscle.
B) atrophy of motor neurons in the spinal cord.
C) demyelination of skeletal motor neurons.
D) autoimmune injury at the neuromuscular junction.

Question 26

When a patient asks, "What is the cause of multiple sclerosis?" the nurse bases the answer on the interaction between:

A) vascular and metabolic factors.
B) bacterial infection and the inflammatory response.
C) autoimmunity and genetic susceptibility.
D) neurotransmitters and inherited genes.

Question 27

Patients diagnosed with myasthenia gravis often have tumors or pathologic changes in the:

A) brain.
B) pancreas.
C) thymus.
D) lungs.

Question 28

Most causes of encephalitis are which of the following?

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

Question 29

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 fibers in the CNS
C) The development of neurofibril webs in the CNS
D) Reduced amounts of acetylcholine at the neuromuscular junction

Question 30

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 31

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

Question 32

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

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

Question 33

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

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

Question 34

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

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

Question 35

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 36

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 37

A 15-month-old child from Pennsylvania 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