ch35 neuro ch 41 iggy

Question 1

During a client’s neurologic assessment, the nurse finds that he is arousable after light touch combined
with a loud voice. How does the nurse document this client’s level of consciousness?
A. “Stuporous”
B. “Lethargic”
C. “Comatose”
D. “Drowsy”

Answer 1

Answer: B
Rationale: Coma means unarousable, and alert is a normal response. Drowsy generally indicates arousal
by voice. Lethargy indicates that voice and light touch are used to obtain a client response. Stuporous is a
deeper level of unresponsiveness that responds to more vigorous touch or tactile stimulation. Comatose
indicates no response to painful or noxious stimuli.

Question 2

A client with possible Parkinson’s disease is scheduled to have magnetic resonance imaging (MRI). The
daughter asks the nurse how this test is different from a computed tomography (CT) scan. What is the
nurse’s best response?

A. “The MRI scan provides better contrast between normal tissue and pathologic tissue.”
B. “They are not different; both use ionizing radiation.”
C. “The MRI will not require contrast material.”
D. “The CT scan does not provide a view of deep brain structures like the region where Parkinson’s
originates.

Answer 2

Answer: A
Rationale: MRI is based on how hydrogen atoms behave in a magnetic field. These atoms differ in normal
versus diseased tissue, providing better visualization of small or deep structures in the body. Although
both CT and MRI images can be enhanced with contrast material and both provide views of deep brain
structures, only CT uses ionizing radiation.

Question 3

The nurse is caring for a client with a glioma. Which part of the brain is affected in this client?

1. Cerebrum
2. Meninges
3. Pituitary lobe
4. Cranial Nerve XIII

Answer 3

1

Option 1:
Gliomas generally originate in the cerebrum. The glia provides the physical structure of the brain and supports endothelial cells of the blood–brain barrier.
Option 2:
Meningiomas arise from the meninges or layers of the brain. They are space-occupying lesions that can cause devastating damage based on size and location.
Option 3:
Pituitary tumors are generally found in the anterior lobe of the pituitary.
Option 4:
Acoustic neuromas or Schwannomas originate from the protective covering around nerve fibers of Cranial Nerve XIII.

Question 4

A client is diagnosed with a tumor in the left inferior frontal lobe (Broca’s Area). Which symptom is the client likely to exhibit?

1. Loss of vision in one eye
2. Loss of upward gaze
3. Motor weakness
4. Difficulty with speech

Answer 4

4

Option 1:
A tumor affecting the optic nerve will result in the loss of vision in one eye.
Option 2:
The client will experience loss of upward gaze and light reflex when there is a tumor in the pineal gland.
Option 3:
A tumor located in the frontal motor cortex causes motor weakness.
Option 4:
The client with a tumor in the Broca’s Area has difficulty with speech.

Question 5

Which is true of atonic seizures?

1. The client experiences brief contracture of muscles or muscle groups.
2. The client develops shallow breathing and periods of apnea.
3. The client has rhythmic jerking of all extremities.
4. The client may experience a severe fall to the ground with loss of consciousness.

Answer 5

4

Option 1:
The client experiences brief contracture of muscles or muscle groups during myoclonic seizures. The client does not lose consciousness.
Option 2:
Tonic-clonic seizures affect both the cerebral hemispheres. The client experiences shallow breathing and periods of apnea.
Option 3:
In a tonic-clonic seizure, the client experiences rigidity during the tonic phase and rhythmic jerking of all extremities during the clonic phase.
Option 4:
The client experiencing an atonic seizure has sudden momentary loss of motor tone. This client is at high-risk of injury. The client may have a head drop or a severe fall to the ground accompanied by a brief loss of consciousness.

Question 6

The nurse observes a client experiencing a partial seizure. Which behavior does the nurse document as automatism?

1. Unilateral, rhythmic muscle movements
2. Rhythmic jerkiness of all extremities
3. Repetitive unconscious movements
4. Visualizations or hallucinations

Answer 6

3

Option 1:
A client experiencing partial seizure may have rhythmic muscle movements on one side of the body.
Option 2:
During a tonic-clonic seizure, the client experiences rhythmic jerkiness of all extremities in the clonic phase.
Option 3:
Automatism involves repetitive unconscious movements such as lip smacking, chewing, or swallowing.
Option 4:
Seizures can be preceded by a preictal phase during which the client may experience auras. Auras include visualizations or hallucinations.

Question 7

What is a likely cause of viral meningitis?

1. Lumbar puncture
2. Intraventricular catheter
3. Traumatic injury
4. Lack of immunization against mumps

Answer 7

4

Option 1:
Bacteria responsible for meningitis may enter the body secondary to a lumbar puncture. This can lead to acute meningitis with the presence of symptoms occurring in hours to days.
Option 2:
A client may develop bacterial meningitis secondary to the use of monitoring devices such as intraventricular catheter.
Option 3:
Direct inoculation of the organisms responsible for bacterial or fungal meningitis may occur secondary to traumatic injury.
Option 4:
Viral meningitis may be caused by mumps and measles. In populations not immunized against mumps, 30% of those who contract mumps develop meningitis.

Question 8

Question 6. Which surgical procedure is used to treat the client with Parkinson’s disease (PD)?

1. Vagal nerve stimulator (VNS)
2. Stereotactic pallidotomy
3. Deep brain stimulation
4. Partial corpus callosectomy

Answer 8

2

Option 1:
VNS works like a cardiac pace maker. It is used to stimulate the vagus nerve (10th Cranial Nerve) to effectively control seizure activity.
Option 2:
Stereotactic pallidotomy involves the opening of the pallidum within the corpus striatum. A cylindrical rod or electrode is implanted allowing the targeted area to receive mild electrical stimulation to reduce tremors and the rigidity associated with PD.
Option 3:
Deep brain stimulation is used to treat uncontrolled seizure activity. Electrodes are placed in deep brain structures and programmed to activate when a seizure activity is sensed.
Option 4:
Partial corpus callosectomy is utilized for clients with intractable tonic-clonic or atonic seizures. The procedure involves a craniotomy, and the connection between the right and left hemispheres of the brain is either disrupted or partially or totally severed.

Question 9

Which part of the cerebrum is the primary regulator of the autonomic nervous system?

1. Thalamus
2. Basal ganglia
3. Hypothalamus
4. Limbic system

Answer 9

3

Option 1:
The thalamus is the center for sensory impulses to the cerebral cortex and also helps regulate motor functions.
Option 2:
The basal ganglia coordinate with the cerebellum and regulate impulse movement back and forth through the thalamus to the cerebral cortex.
Option 3:
The hypothalamus is the main regulator for the autonomic nervous system, which regulates heart rate and blood pressure by sending signals to the brain stem.
Option 4:
The limbic system is the primary center for memory and emotions.

Question 10

Which are primary functions of the limbic system? Select all that apply.

1. Regulating memory
2. Maintaining equilibrium
3. Regulating pain and senses
4. Regulating the feelings of pleasure and grief
5. Regulating food and water intake

Answer 10

1, 4

Option 1:
The limbic system consists of the cingulate gyrus, the hippocampus, and the amygdala, which play a primary role in regulating the memory.
Option 2:
The thalamus regulates motor control that maintains equilibrium.
Option 3:
The thalamus is the center for sensory impulses that regulate pain and senses, such as hearing, touch, smell, and vision.
Option 4:
The limbic system of the cerebrum has a center for gratification and aversion that controls emotions, such as pleasure and grief.
Option 5:
The hypothalamus is a regulator of the autonomic nervous system that maintains food and water intake control.

Question 11

The nurse notes a client with Parkinson’s disease has uncoordinated body movements. Which brain system coordination failure is responsible for the client’s condition?

1. Basal ganglia and cerebellum
2. Thalamus and cerebral cortex
3. Limbic system and aversion center
4. Hypothalamus and anterior pituitary gland

Answer 11

1

Option 1:
The basal ganglia in coordination with the cerebellum regulate body movements. A client with Parkinson’s disease may have uncoordinated body movements due to the failure of both of these operating systems.
Option 2:
The thalamus, along with the cerebral cortex, regulates sensory impulses, such as pain, temperature, taste, smell, hearing, equilibrium, vision, and touch.
Option 3:
The coordination between the limbic system and the aversion center produces objectionable feelings, such as grief and dread.
Option 4:
The hypothalamus, along with the anterior pituitary gland, controls the secretion of hormones that regulate metabolism, reproduction, growth, and stress.

Question 12

Which cranial nerve originating from the medulla oblongata is the vagus nerve?

1. XII
2. XI
3. X
4. IX

Answer 12

3

Option 1:
Cranial nerve XII, which originates from the medulla oblongata, is the hypoglossal nerve.
Option 2:
Cranial nerve XI, which originates from the medulla oblongata, is the spinal accessory.
Option 3:
Cranial nerve X, which originates from the medulla oblongata, is the vagus nerve.
Option 4:
Cranial nerve IX, which originates from the medulla oblongata, is the glossopharyngeal nerve.

Question 13

Which originates in the pons as cranial nerve VI?

1. Facial nerve
2. Acoustic nerve
3. Abducens nerve
4. Trigeminal nerve

Answer 13

3

Option 1:
Cranial nerve VII, originating from the pons, is the facial nerve.
Option 2:
Cranial nerve VIII, originating from the pons, is the acoustic nerve.
Option 3:
Cranial nerve VI, originating from the pons, is the abducens nerve.
Option 4:
Cranial nerve V, originating from the pons, is the trigeminal nerve.

Question 14

Which is associated with Cushing’s triad? Select all that apply.

1. Decreased heart rate
2. Increased urinary output
3. Irregular respiratory rate
4. Increased systolic blood pressure
5. Increased serum sodium concentration

Answer 14

1, 3, 4

Option 1:
Cushing’s triad is a physiological nervous system response to increased intracranial pressure, which includes a decreased heart rate.
Option 2:
Increased urinary output may compromise cerebral perfusion pressure.
Option 3:
Cushing’s triad includes an irregular respiratory rate.
Option 4:
Cushing’s triad includes increased systolic blood pressure.
Option 5:
Increased serum sodium concentration greater than 145 milliequivalents/liter is not included in Cushing’s triad.

Question 15

Which is a first-line medication used in the immediate treatment of seizures and status epilepticus? Select all that apply.

1. Propofol
2. Phenytoin
3. Lorazepam
4. Midazolam
5. Levetiracetam

Answer 15

3, 4

Option 1:
Propofol is used in high doses to treat the refractory seizure.
Option 2:
A loading dose of phenytoin is given around the clock to stabilize the client with seizures.
Option 3:
Lorazepam is a benzodiazepine that is used as a first-line medication in the treatment of seizures and status epilepticus.
Option 4:
Midazolam is a benzodiazepine that is used as a first-line medication in the treatment of seizures and status epilepticus.
Option 5:
A loading dose of levetiracetam is given around the clock to stabilize the client with seizures.

Question 16

In which state of a seizure is a client most likely to have compromised airway and decreased level of consciousness?

1. After a seizure episode
2. During the preictal state
3. During the postictal state
4. Between seizure episodes

Answer 16

3

Option 1:
A client may have an unstable airway after the seizure activity and may require an immediate suctioning of the oral airway.
Option 2:
The preictal state is a state immediately before a seizure that is associated with alterations of the vital signs.
Option 3:
A client may have a compromised airway secondary to a decreased level of consciousness either during the seizure or in the postictal state.
Option 4:
Vital signs, such as blood pressure, heart rate, and oxygen saturation, may not vary between seizure episodes.

Question 17

The RN is caring for a client with tonic-clonic seizures. Which action of the RN is most likely to benefit the client?

1. Encouraging the client to eat finger foods
2. Placing the client in a left recumbent position
3. Placing a clock and calendar in the client’s room
4. Encouraging the client to participate in self-care activities

Answer 17

2

Option 1:
The nursing student should encourage a client with Alzheimer’s disease to eat finger foods as it may increase caloric diet intake.
Option 2:
Encouraging the client with tonic-clonic seizures to turn to the left side reduces the risk of aspiration.
Option 3:
While caring for a client with Alzheimer’s disease, the nursing student should place a clock and a calendar in the client’s room. This nursing action helps provide orientation to time and date for the client as cognition declines.
Option 4:
A client with Parkinson’s disease should participate in self-care activities to maintain independence and safety.

Question 18

A client with a body temperature of 102°F reports headaches, sensitivity to light and sound, and neck stiffness but denies vomiting and stomach upset. With which condition do these symptoms most likely correspond?

1. Meningitis
2. Encephalitis
3. Cerebral edema
4. Pituitary tumor

Answer 18

2

Option 1:
A client with meningitis may have a headache, fever, photophobia, nausea, vomiting, altered level of consciousness, rhinorrhea, and nuchal rigidity.
Option 2:
A client with encephalitis may have a headache, photophobia (sensitivity to light), phonophobia (sensitivity to sound), and nuchal rigidity (neck stiffness).
Option 3:
Cerebral edema occurs secondary to inflammation of the blood-brain barrier, which may be manifested by nausea, vomiting, seizures and coma.
Option 4:
A client with a pituitary tumor may have hypersecretion of hormones, such as growth hormone, prolactin, and adrenocorticotropic hormone.

Question 19

Which clinical finding may indicate that a client has meningitis? Select all that apply.

1. Akinesia
2. Photophobia
3. Phonophobia
4. Nuchal rigidity
5. Brudzinski’s sign

Answer 19

2, 4, 5

Option 1:
Loss of movement, or akinesia, is a sign of Parkinson’s disease.
Option 2:
Photophobia, or sensitivity to light, is a sign of meningitis.
Option 3:
Phonophobia is a manifestation of encephalitis.
Option 4:
Meningeal irritation may include nuchal rigidity, or neck stiffness.
Option 5:
Brudzinski”s sign is an indication of meningitis in which passive flexion of the leg on one side causes a similar movement of the opposite leg.

Question 20

The echocardiogram of a client shows myocarditis. Upon auscultation, the nurse hears heart murmurs. For which brain disease is the client most at risk?

1. Meningitis
2. Hydrocephalus
3. Encephalomyelitis
4. Cognitive dysfunction

Answer 20

1

Option 1:
A client who has myocarditis associated with the presence of heart murmurs may be at risk for meningitis.
Option 2:
Ineffective cerebral tissue perfusion may lead to hydrocephalus.
Option 3:
Inflammation of both the brain and spinal cord due to a pathogen may lead to encephalomyelitis.
Option 4:
Myocardial infarction, congestive heart failure, arrhythmias, and anemia can cause cognitive dysfunction.

Question 21

The RN is caring for a client who has been admitted to the hospital with right-sided weakness. Upon assessment, the nurse finds that the client has decreased sensation on the right side and an inability to process speech. Which condition is the client most likely experiencing?

1. Basilar artery syndrome
2. Cerebral amyloid angiopathy (CAA)
3. Left middle cerebral artery syndrome
4. Right middle cerebral artery syndrome

Answer 21

3

Option 1:
A client with basilar artery syndrome may have dizziness, ataxia, tinnitus, weakness on one side of the body, nausea, and vomiting.
Option 2:
A client with cerebral amyloid angiopathy may have fragile blood vessels that indicate ischemic heart disease.
Option 3:
A client with right-sided weakness associated with decreased sensation on the right side, inability to process speech, and dysphasia may have left middle cerebral artery syndrome.
Option 4:
A client with weakness on the left side of the face and left homonymous hemianopia may have right middle cerebral artery syndrome.

Question 22

While assessing a client with warm and dry skin, the primary health-care provider finds that the client has hypotension, bradycardia, metabolic acidosis, and peripheral vasodilation. Which disease condition is responsible for these symptoms?

1. Neurogenic shock
2. Hemorrhagic stroke
3. Traumatic brain injury
4. Basilar artery syndrome

Answer 22

1

Option 1:
A client with neurogenic shock may have warm and dry skin associated with hypotension, bradycardia, metabolic acidosis, and peripheral vasodilation due to the disruption of the sympathetic fibers and vasomotor fibers.
Option 2:
A client with hemorrhagic stroke may have cerebral hypoperfusion, atrial fibrillation, hyponatremia, cerebral edema, and neurologic deterioration.
Option 3:
A client with traumatic brain injury may have hypotension, hypoxemia, ischemic brain injury, inflammation, fractures, and cerebral contusions.
Option 4:
A client with basilar artery syndrome may have dizziness, ataxia, tinnitus, weakness on one side of the body, nausea, and vomiting.

Question 23

The RN is teaching a group of LPNs about autonomic dysreflexia. Which statements made by the LPN indicate the need for further teaching? Select all that apply.

1. “It is a syndrome of massive imbalanced reflex sympathetic discharge occurring in most patients with spinal cord injury.”
2. “It occurs in the first week of the spinal injury.”
3. “Nasal congestion, anxiety, blurred vision, and a sense of impending doom is a clinical manifestation of the syndrome.”
4. “The syndrome occurs simultaneously with the spinal shock in the client.”
5. “A client might suffer myocardial infarction if the syndrome is not treated.”

Answer 23

2, 4

Option 1:
Autonomic dysreflexia is a syndrome of massive imbalanced reflex sympathetic discharge occurring in most patients with spinal cord injury.
Option 2:
Autonomic dysreflexia occurs in the first year of the spinal injury, not the first week of the injury.
Option 3:
Nasal congestion, anxiety, blurred vision and a sense of impending doom is a clinical manifestation of autonomic dysreflexia.
Option 4:
Autonomic dysreflexia occurs after spinal shock in the client, not simultaneously.
Option 5:
A client might suffer myocardial infarction if the syndrome is not treated.

Question 24

Which condition refers to the constriction of the spinal foramina and canals?

1. Axial loading
2. Herniation
3. Spinal stenosis
4. Spinal degeneration

Answer 24

3

Option 1:
Axial loading involves every mechanism of hyperextension, hyperflexion, rotation and vertical compression.
Option 2:
Herniation is called the leaking of interior disc contents into the vertebral areas.
Option 3:
Spinal stenosis refers to constriction of the spinal foramina and canals.
Option 4:
Spinal degeneration is characterized by decreasing water content from the disk nucleus. For this reason, the fibers of the annulus begin to wear out

Question 25

Which diagnostic test is optimal for detecting soft tissue damage of the discs between the vertebrae and ligaments?

1. Magnetic resonance imaging (MRI)
2. Electromyography
3. Discogram
4. Computed tomography

Answer 25

1

Option 1:
MRI is optimal for detecting soft tissue damage of the discs between vertebrae and ligaments.
Option 2:
Electromyography is a test that indicates if there is old nerve damage that is healing.
Option 3:
Discogram helps determine the disc status in the client.
Option 4:
Computed tomography, or CT scan, is a diagnostic test that is optimal for visualizing bony structures.

Question 26

Which NSAID is used for treating lower-back pain?

1. Prednisone
2. Cardisoprodol
3. Codeine
4. Ketolorac tromethamine

Answer 26

4

Option 1:
Prednisone falls under the corticosteroids class of medication. This medication is used for treating lower-back pain.
Option 2:
Cardisoprodol is a muscle relaxant used for treating lower-back pain.
Option 3:
Codeine belongs to the opioid class of medication, which is used for treating lower-back pain.
Option 4:
Ketolorac tromethamine is an NSAID that treats lower-back pain.

Question 27

Which medication belongs to the opioid class?

1. Cardisoprodol
2. Metazalone
3. Codeine
4. Diazepam

Answer 27

3

Option 1:
Cardisoprodol belongs to the class of muscle relaxants.
Option 2:
Metazalone is a muscle relaxant, required to depress the central nervous system.
Option 3:
Codeine belongs to the opioid class of medication.
Option 4:
Diazepam belongs to the class of muscle relaxants.

Question 28

Which are clinical manifestations of amyotrophic lateral sclerosis (ALS)? Select all that apply.

1. Double or blurred vision
2. Difficulty swallowing
3. Fasciculation
4. Tremor
5. Memory loss

Answer 28

2, 3

Option 1:
Double or blurred vision is a clinical manifestation of multiple sclerosis.
Option 2:
Difficulty swallowing is a clinical manifestation of ALS.
Option 3:
Fasciculation is a clinical manifestation of ALS.
Option 4:
Tremor or unsteady gait is the clinical manifestation of multiple sclerosis.
Option 5:
Memory loss is a complication related to multiple sclerosis.

Question 29

Which is the outermost layer of the spinal meninges called?

1. Pia mater
2. Axons
3. Arachnoid
4. Dura mater

Answer 29

Option 1:
The pia mater comprises the innermost layer of the spinal meninges.
Option 2:
Axons are the long, thin nerve cell extensions that carry impulses away from the cell body.
Option 3:
The arachnoid forms the middle layer of the spinal meninges.
Option 4:
The outermost layer of the spinal meninges is called the dura mater.

Question 30

Which are the largest avascular structures in the body?

1. Coccyx
2. Nucleus pulposus
3. Annulus fibrosus
4. Intervertebral discs

Answer 30

4

Option 1:
The coccyx is one of the five sections of vertebrae.
Option 2:
The central or inner portion of the intervertebral discs is called the nucleus pulposus. This portion is made of softer, spongier material.
Option 3:
The outer layer of the intervertebral discs is called the annulus fibrosus. The annulus fibrosus are concentric rings of tough fibrous tissue.
Option 4:
The intervertebral discs are the largest avascular structures in the body.

Question 31

A paralytic ileus is a complication related to which kind of spinal cord injury?

1. Cardiovascular
2. Gastrointestinal
3. Neurologic
4. Musculoskeletal

Answer 31

2

Option 1:
Hypotension, bradycardia, and decreased cardiac output are complications related to the cardiovascular system, but not paralytic ileus.
Option 2:
Paralytic ileus is a spinal cord injury complication related to the gastrointestinal system.
Option 3:
Paralysis, contracture, and spasticity are neurologic complications, but not paralytic ileus.
Option 4:
Musculoskeletal complications include muscle atrophy, but not paralytic ileus.

Question 32

Which is considered to be a malignant central nervous system (CNS) tumor?

1. Ependymoma
2. Schwannoma
3. Sarcoma
4. Neurofibroma

Answer 32

Option 1:
An ependymoma is considered the most benign CNS tumor.
Option 2:
A schwannoma is a benign tumor.
Option 3:
A sarcoma is considered a malignant CNS tumor.
Option 4:
A neurofibroma is usually a benign tumor in nature.