Chapter 23 Flashcards by Brittany Friedberg

The two parts of the nervous system are the:

A) motor and sensory.

B) central and peripheral.

C) peripheral and autonomic.

D) hypothalamus and cerebral.

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The wife of a 65yearold man tells the nurse that she is concerned because she has noticed a change in her husband’s personality and ability to understand. He also cries and becomes angry very easily. The nurse recalls that the cerebral lobe responsible for these behaviors is the _____ lobe.

A) frontal
B) parietal
C) occipital
D) temporal

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Which of these statements concerning areas of the brain is true?

A) The cerebellum is the center for speech and emotions.

B) The hypothalamus controls temperature and regulates sleep.

C) The basal ganglia are responsible for controlling voluntary movements.

D) Motor pathways of the spinal cord and brainstem synapse in the thalamus.

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The area of the nervous system that is responsible for mediating reflexes is the:

A) medulla.

B) cerebellum.

C) spinal cord.

D) cerebral cortex.

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While gathering equipment after an injection, a nurse accidentally received a prick from an improperly capped needle. To interpret this sensation, which of these areas
must be intact?

A) Corticospinal tract, medulla, and basal ganglia

B) Pyramidal tract, hypothalamus, and sensory cortex

C) Lateral spinothalamic tract, thalamus, and sensory cortex

D) Anterior spinothalamic tract, basal ganglia, and sensory cortex

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A patient with lack of oxygen to his heart will have pain in his chest and possibly the shoulder, arms, or jaw. The nurse knows that the statement that best explains why this occurs is which of these?

A) There is a problem with the sensory cortex and its ability to discriminate the location.

B) The lack of oxygen in his heart has resulted in decreased amount of oxygen to the areas experiencing pain.

C) The sensory cortex does not have the ability to localize pain in the heart, so the pain is felt elsewhere.

D) There is a lesion in the dorsal root that is preventing the sensation from being transmitted normally.

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The ability that humans have to perform very skilled movements such as writing

is controlled by the:

A) basal ganglia.

B) corticospinal tract.

C) spinothalamic tract.

D) extrapyramidal tract.

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A 30yearold 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?

A) Thalamus

B) Brainstem

C) Cerebellum

D) Extrapyramidal tract

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Which of these statements about the peripheral nervous system is correct?

A)The cranial nerves enter the brain through the spinal cord.

B) Efferent fibers carry sensory input to the central nervous system through the spinal cord.

C) The peripheral nerves are inside the central nervous system and carry impulses through their motor fibers.

D) The peripheral nerves carry input to the central nervous system by afferent fibers and away by efferent fibers.

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A patient has a severed spinal nerve as a result of trauma. Which of these statements is true in this situation?

A) Because there are 31 pairs of spinal nerves, there is no effect if only one is severed.

B) The dermatome served by this nerve will no longer experience any sensation.

C) The adjacent spinal nerves will continue to carry sensations for the dermatome

served by the severed nerve.

D) This will only affect motor function of the patient because spinal nerves have no

sensory component.

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A 21yearold patient has a head injury resulting from trauma and is unconscious. There are no other injuries. During the assessment what would the nurse
expect to find when testing the patient’s deep tendon reflexes?

A) Reflexes will be normal.

B) Reflexes cannot be elicited.

C) All reflexes would be diminished but present.

D) Some would be present depending on the area of injury.

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During an assessment of an 80yearold patient, the nurse notices the following: inability to identify vibrations at the ankle and to identify position of big toe, slower and
more deliberate gait, and slightly impaired tactile sensation. All other neurologic findings are normal. The nurse should interpret that these findings indicate:

A) cranial nerve dysfunction.

B) lesion in the cerebral cortex.

C) normal changes due to aging.

D) demyelinization of nerves due to a lesion.

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A 70yearold 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:

A) “Have you been extremely tired lately?”

B) “You probably just need to drink more liquids.”

C) “I’ll refer you for a complete neurologic examination.”

D) “You need to get up slowly when you’ve been lying or sitting.”

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During the history, a patient tells the nurse that “it feels like the room is spinning around me.” The nurse would document this as:

A) vertigo.

B) syncope.

C) dizziness.

D) seizure activity.

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When taking the history on a patient with a seizure disorder, the nurse assesses whether the patient has an aura. Which of these would be the best question for obtaining this information?

A) “Does your muscle tone seem tense or limp?”

B) “After the seizure, do you spend a lot of time sleeping?”

C) “Do you have any warning sign before your seizure starts?”

D) “Do you experience any color change or incontinence during the seizure?”

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In obtaining a history on a 74yearold patient the nurse notes that he drinks alcohol daily and that 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?

A) “Does your family know you are drinking every day?”

B) “Does the tremor change when you drink the alcohol?”

C) “We’ll do some tests to see what is causing the tremor.”

D) “You really shouldn’t drink so much alcohol; it may be causing your tremor.”

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A 50yearold woman is in the clinic for weakness in her left arm and leg that she has noticed for the past week. The nurse should perform which type of neurologic
examination?

A) Glasgow Coma Scale

B) Neurologic recheck examination

C) Screening neurologic examination

D) Complete neurologic examination

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During an assessment of the cranial nerves, the nurse finds the following: asymmetry when the patient smiles or frowns, uneven lifting of eyebrows, sagging of the
lower eyelids, and escape of air when the nurse presses against the right puffed cheek. This
would indicate dysfunction of which of these cranial nerves?

A) Motor component of IV

B) Motor component of VII

C) Motor and sensory components of XI

D) Motor component of X and sensory component of VII

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The nurse is testing the function of cranial nerve XI. Which of these best describes the response the nurse should expect if the nerve is intact? The patient:

A) demonstrates ability to hear normal conversation.

B) sticks tongue out midline without tremors or deviation.

C) follows an object with eyes without nystagmus or strabismus.

D) moves the head and shoulders against resistance with equal strength.

During the neurologic assessment of a “healthy” 35yearold patient, the nurse asks him to relax his muscles completely. The nurse then moves each extremity through full range of motion. Which of these results would the nurse expect to find?

A) Firm, rigid resistance to movement

B) Mild, even resistance to movement

C) Hypotonic muscles as a result of total relaxation

D) Slight pain with some directions of movement

When the nurse asks a 68yearold patient to stand with feet together and arms at his side with his eyes closed, he starts to sway and moves his feet farther apart. The nurse would document this finding as a(n):

A) ataxia.

B) lack of coordination.

C) negative Homans’ sign.

D) positive Romberg sign.

The nurse is doing an assessment on a 29yearold 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 should the nurse suspect?

A) Vestibular disease

B) Lesion of cranial nerve IX

C) Dysfunction of the cerebellum

D) Inability to understand directions

During the history of a 78-year-old man, his wife states that he occasionally has problems with short-term memory loss and confusion: “He can’t even remember how to button his shirt.” In doing the assessment of his sensory system, which action by the nurse is most appropriate?
A)
The nurse would not do this part of the examination because results would not be valid.
B)
The nurse would perform the tests, knowing that mental status does not affect sensory ability.
C)
The nurse would proceed with the explanations of each test, making sure the wife understands.
D)
Before testing, the nurse would assess the patient’s mental status and ability to follow directions at this time.

The assessment of a 60-year-old patient has taken longer than anticipated. In testing his pain perception the nurse decides to complete the test as quickly as possible. When the nurse applies the sharp point of the pin on his arm several times, he is only able to identify these as one “very sharp prick.” What would be the most accurate explanation for this?
A)
Patient has hyperesthesia as a result of the aging process.
B)
This is most likely the result of the summation effect.
C)
The nurse was probably not poking hard enough with the pin in the other areas.
D)
The patient most likely has analgesia in some areas of arm and hyperalgesia in others.

``` he 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 notices that the patient is unable to feel vibrations on the great toe or ankle bilaterally, but she is able to feel vibrations on both patellae. Given this information, what would the nurse suspect? A) Hyperalgesia B) Hyperesthesia C) Peripheral neuropathy D) Lesion of sensory cortex ```

``` 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? A) Extinction B) Astereognosis C) Graphesthesia D) Tactile discrimination ```

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: A) ask the patient to lock her fingers and “pull.” B) complete the examination and then test these reflexes again. C) refer the patient to a specialist for further testing. D) document these reflexes as “0” on a scale of 0 to 4+.

``` n assessing a 70-year-old patient who has had a recent cerebrovascular accident, the nurse notices right-sided weakness. What might the nurse expect to find when testing his reflexes on the right side? A) Lack of reflexes B) Normal reflexes C) Diminished reflexes D) Hyperactive reflexes ```

``` hen the nurse is testing the triceps reflex, what is the expected response? A) Flexion of the hand B) Pronation of the hand C) Extension of the forearm D) Flexion of the forearm ```

``` 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 should the nurse document this finding? A) Positive Babinski sign B) Plantar reflex abnormal C) Plantar reflex present D) Plantar reflex “2+” on a scale from “0 to 4+” ```

During the assessment of an 80-year-old patient, the nurse notices 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 these statements is most accurate? A) These are normal findings resulting from aging. B) These could be related to hyperthyroidism. C) These are the result of Parkinson disease. D) This patient should be evaluated for a cerebellar lesion.

``` While the nurse is taking the history of a 68-year-old patient who sustained a head injury 3 days earlier, he tells the nurse that he is on a cruise ship and is 30 years old. The nurse knows that this finding is indicative of: A) a great sense of humor. B) uncooperative behavior. C) inability to understand questions. D) decreased level of consciousness. ```

The nurse is caring for a patient who has just had neurosurgery. To assess for increased intercranial pressure, what would the nurse include in the assessment? A) Cranial nerves, motor function, and sensory function B) Deep tendon reflexes, vital signs, and coordinated movements C) Level of consciousness, motor function, pupillary response, and vital signs D) Mental status, deep tendon reflexes, sensory function, and pupillary response

``` During an assessment of a 22-year-old woman who has a head injury from a car accident 4 hours ago, the nurse notices the following change: pupils were equal, but now the right pupil is fully dilated and nonreactive, left pupil is 4 mm and reacts to light. What does finding this suggest? A) Injury to the right eye B) Increased intracranial pressure C) Test was not performed accurately D) Normal response after a head injury ```

``` A 32-year-old woman tells the nurse that she has noticed “very sudden, jerky movements” mainly in her hands and arms. She says, “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: A) tics. B) athetosis. C) myoclonus. D) chorea. ```

``` ring an assessment of a 62-year-old man the nurse notices the patient has a stooped posture, shuffling walk with short steps, flat facial expression, and pill-rolling finger movements. These findings would be consistent with: A) parkinsonism. B) cerebral palsy. C) cerebellar ataxia. D) muscular dystrophy. ```

During an assessment of a 32-year-old patient with a recent head injury, the nurse notices that the patient responds to pain by extending, adducting, and internally rotating his arms. His palms pronate and his lower extremities extend with plantar flexion. Which of these statements about these findings is accurate? A) This indicates a lesion of the cerebral cortex. B) This indicates a completely nonfunctional brainstem. C) This is a normal response that will go away in 24 to 48 hours. D) This is a very ominous sign and may indicate brainstem injury.

``` alks 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? A) Scissors gait B) Cerebellar ataxia C) Parkinsonian gait D) Spastic hemiparesis ```

``` n a person with an upper motor neuron lesion such as a cerebrovascular accident, which of these physical assessment findings should the nurse expect to see? A) Hyperreflexia B) Fasciculations C) Loss of muscle tone and flaccidity D) Atrophy and wasting of the muscles ```

``` 47. A 59-year-old patient has a herniated intervertebral disk. Which of the following findings should the nurse expect to see on physical assessment of this individual? A) Hyporeflexia B) Increased muscle tone C) A positive Babinski’s sign D) The presence of pathologic reflexes ```

``` patient is not able to perform rapid alternating movements such as patting her knees rapidly. The nurse should document this as: A) ataxia. B) astereognosis. C) the presence of dysdiadochokinesia. D) loss of kinesthesia. ```

``` The nurse knows that determining whether a person is oriented to his or her surroundings will test the functioning of which of these structures? A) Cerebrum B) Cerebellum C) Cranial nerves D) Medulla oblongata ```

During an examination, the nurse notices severe nystagmus in both eyes of a patient. Which of these conclusions by the nurse is correct? A) This is a normal occurrence. B) This may indicate disease of the cerebellum or brainstem. C) This is a sign that the patient is nervous about the examination. D) This indicates a visual problem, and a referral to an ophthalmologist is indicated

``` he nurse knows that testing kinesthesia is a test of a person’s: A) fine touch. B) position sense. C) motor coordination. D) perception of vibration. ```

``` The nurse is reviewing a patient’s medical record and notes that he is in a coma. Using the Glasgow Coma Scale, which number indicates that the patient is in a coma? A) 6 B) 12 C) 15 D) 24 ```

``` A man who was found wandering in a park at 2 AM has been brought to the emergency department for an examination because he said he fell and hit his head. During the examination, the nurse asks him to use his index finger to touch the nurse’s finger, then his own nose, then the nurse’s finger again (which has been moved to a different location). The patient is clumsy, unable to follow the instructions, and overshoots the mark, missing the finger. The nurse should suspect which of the following? A) Cerebral injury B) Cerebrovascular accident C) Acute alcohol intoxication D) Peripheral neuropathy ```

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 interprets this result as: A) a negative Babinski’s sign, which is normal for adults. B) a positive Babinski’s sign, which is abnormal for adults. C) clonus, which is a hyperactive response. D) the Achilles reflex, which is an expected response.