Patho Module 8 Exam 3

Most reflexes are?, meaning that they involve one or more interposed interneurons

polysynaptic

Involuntary motor responses is called?

reflex

The ? serves as a synapse between a motor neuron and a skeletal muscle fiber

neuromuscular junction

The chart of a client admitted because of seizures notes that the seizure activity began simultaneously in both cerebral hemispheres. The nurse should interpret this to mean that the client experienced:

generalized seizure.

The signs and symptoms of a ? are localized to the area of the body innervated by the nerve roots and include both motor and sensory manifestations

herniated disk

Sudden complete transection of the spinal cord results in complete ? of motor, sensory, reflex, and autonomic function below the level of injury

loss

A nurse caring for a patient in myasthenic crisis identifies a priority concern as:

maintenance of airway and respiration.

? usually are caused by localized conditions such as trauma, compression, or infections that affect a single spinal nerve, plexus, or peripheral nerve trunk

mononeuropathies

Abnormalities in any part of the ? pathway can produce muscle weakness

motor

The primary ? cortex is located on the rostral surface and adjacent portions of the central sulcus

motor

? is characterized by inflammation and selective destruction of CNS myelin

multiple sclerosis

The ?, which are distributed throughout the belly of a muscle, relay information about muscle length and rate of stretch

muscle spindles

Any interruption of the myotatic or stretch reflex circuitry by peripheral nerve injury, pathology of the neuromuscular junction, injury to the spinal cord, or damage to the corticospinal system can result in disturbances of ?

muscle tone

? hypotension usually occurs in person with injuries at T4 to T6 and above and related to the interruption of descending control of sympathetic outflow to blood vessels in the extremities and abdomen

orthostatic

? refers to impairment or loss of motor or sensory function (or both) in the thoracic, lumbar, and sacral segments of the spinal cord from damage of neural elements in the spinal canal and the brain

paraplegia

? disease is a degenerative disorder of basal ganglia function that results in variable combinations of tremor, rigidity, and bradykinesia

parkinson

Stretch reflexes tend to be hypoactive or absent in cases of ? nerve damage or ventral horn injury involving the test area

peripheral

There are two main types of ? injury based on the target of the insult; segmental demyelination involving the Schwann cell and axonal degeneration involving the neuronal cell body and /or its axon

peripheral nerve

? involve demyelination or axonal degeneration of multiple peripheral nerves that leads to symmetric sensory, motor, or mixed sensorimotor deficits

polyneuropathies

The medial descending system of the brain stem contribute to the control of ? by integrating visual, vestibular, and somatosensory information

posture

The nurse observes a new nurse performing the test for Kernig sign on a client. The new nurse performs the test by providing resistance to flexion of the knees while the client is lying with the hip flexed at a right angle. The nurse should explain to the new nurse that:

resistance should be provided with the knee in a flexed position.

The nurse is assessing a client and notes the client is now displaying decerebrate posturing. The position would be documented as:

rigidity of the arms with palms of the hands turned away from the body and with stiffly extended legs and plantar flexion of the feet.

The ? contains the neuronal circuits that mediate a variety of reflexes and automatic rhythmic movements

spinal cord

The most common cause of ? is motor vehicle accidents, followed by falls, violence (primarily gunshot wounds), and recreational sporting activities

spinal cord injury

Lower motor neuron diseases are progressive neurologic illnesses that selectively affect the anterior horn cells of the ? and ? motor neurons

spinal cord, cranial nerve

? is the impairment or loss of motor or sensory function (or both) after damage to neural structures in the cervical segments of the spinal cord

tetraplegia

The most common cause of ischemic stroke is:

thrombosis.

Disorders of the basal ganglia comprise a complex group of motor disturbances characterized by ? and other involuntary movements, changes in posture and muscle tone, and poverty and slowness of movement

tremor

Hyperactive reflexes are suggestive of a(n) ? disorder

upper motor neuron

Vagal stimulation that causes a marked bradycardia is called the ? response

vasovagal

Visible squirming and twitching movements of muscle is called?

Fasciculations

Which of the following clients may be experiencing the effects of neuropathic pain?

A man with pain secondary to his poorly controlled diabetes

The nurse is caring for a client with a brain tumor when the client begins to vomit. Which intervention should the nurse do first?

Assess for other signs/symptoms of increased intracranial pressure.

A wide-based unsteady gait is called?

Ataxia

The nurse assessing a client with a traumatic brain injury assesses for changes in which neurologic component? Select all that apply.

Cognition Level of consciousness Motor function Sensory function

Following a collision while mountain biking, the diagnostic work up of a 22 year-old male has indicated the presence of an acute subdural hematoma. Which of the following pathophysiological processes most likely underlies his diagnosis?

Blood has accumulated between the man's dura and subarachnoid space.

Slowness of movement is called?

Bradykinesia

A client has sustained a severe, diffuse brain injury that resulted in seriously compromised brain function. The client is at greatest risk for:

Brain death

The nurse is caring for a client with Guillain Barre' syndrome. Which of the following are expected clinical manifestations? Select all that apply. a. Flaccid paralysis of extremities b. Asymmetrical limb weakness c. Pain d. Muscular hypertrophy e. Loss of tendon reflexes

Correct response: a. Flaccid paralysis of extremities c. Pain e. Loss of tendon reflexes Explanation: Flaccid paralysis of extremities occurs, often preceded by parasthesias. Limbs become weakened, symmetrically due to the nature of the demyelination. Pain and loss of tendon reflexes are expected. Muscle hypertrophy is not expected.

The nurse knows that which treatment plan listed below is most likely to be prescribed after a computerized tomography (CT) scan of the head reveals a new-onset aneurysmal subarachnoid hemorrhage?

Craniotomy and clipping of the affected vessel

At what level of the cervical spine would a complete cord injury prevent flexion and extension of the fingers? A. C5 B. C6 C. C7 D. C8

D. C8

The emergency department physician explains to the nurse that the trauma client has a subluxation injury of the shoulder. The nurse understands this injury is a type of which of the following?

Dislocation

Which of the following substances provides the majority of the fuel needs of the neurologic system?

Glucose

While lecturing to a group of physiology students, the instructor asks, "What metabolic factors cause vasodilation of cerebral vessels, thereby increasing cerebral blood flow to the brain?" The best student response would be:

Increased carbon dioxide level

As a client explains to the nurse what occurred prior to the onset of seizure activity, the client describes perceiving a feeling or warning that the seizure would occur. The nurse documents the perceived warning as which of the following?

Prodrome

Sense of body movement and position is called?

Proprioception

Which of the following clinical manifestations would lead the health care provider to diagnose the sunburn as severe?

There is blistering of the skin and associated fever and chills.

If the lower motor neuron dies or its axon is destroyed, the skeletal muscle cell beings to have temporary spontaneous contractions called ?

fasciculations

Which intracranial pressure (ICP) would the nurse consider a normal reading?

0 to 15 mm Hg

For seizure disorders that do not respond to anticonvulsant medications, the option for surgical treatment exists. What is removed in the most common surgery for seizure disorders?

Amygdala

Which intracranial volume is most capable of compensating for increasing intracranial pressure?

Cerebrospinal fluid

Abnormal writhing movements is called?

Chorea

Somatotopic array of the body representing motor areas is called?

Motor homunculus

Rhythmic movements of particular body part is called?

Tremor

Muscular ? usually results from LMN lesions as well as diseases of the muscle themselves

atrophy

The nurse is caring for an older adult client with hemiplegia following a stroke. While planning the client's care, the nurse knows the client is at risk for developing which condition?

Muscle atrophy

A client is admitted to the emergency department with a muscle strain to the back. What is an appropriate statement for the nurse to make to this client?

"A strain is a stretching injury. You need to rest your back."

The parent of an infant who developed hydrocephalus while in utero is very concerned that the child will have significant intellectual dysfunction. The best response to the parent would be:

"Because the skull sutures are not fused there may be no brain damage."

The nurse is caring for a female client with cholelithiasis. When teaching the client about the disease, the nurse includes which of these points?

"Gallstones have developed, which are typically composed of cholesterol."

The nurse is educating parents of a child with arteriovenous malformation. The nurse determines that the parents need additional education when the parents state:

"It is a rare complication of concussions."

A nurse is teaching a patient diagnosed with osteoarthritis about the joint capsule. Which of the following statements made by the patient indicates that teaching was successful?

"The synovial fluid in my joint capsule acts as a lubricant and helps the movement of the joint's articulating surfaces."

? is a disorder of transmission at the neuromuscular junction that affects communication between the motor neuron and the innervated muscle cell

Myasthenia gravis

What is the route of synaptic transmission?

1. action potential arrives at synaptic terminal 2. Influx of Ca+ 3. Release of acetylcholine into synapse 4. Depolarization of motor-end plate 5. Inactivation by acetylcholinesterase

According to the Glasgow Coma Scale, opening one's eyes to only painful stimuli would receive which score?

2. Only opening eyes to painful stimulation is scored as a 2. Spontaneously opening eyes is scored as a 4; opening eyes to speech is scored as a 3; no opening is scored as a 1.

A 26 year-old female is resting after a one-minute episode during which she lost consciousness while her muscles contracted and extremities extended. This was followed by rhythmic contraction and relaxation of her extremities. On regaining consciousness, she found herself to have been incontinent of urine. What has the woman most likely experienced

A tonic-clonic seizure.

A client presents to a health clinic complaining of several vague symptoms. As the history/physical continues, the health care provider clearly thinks the client may have myasthenia gravis. Which statements by the client would correlate with this diagnosis? Select all that apply. A) "Sometimes I have double vision." B) "I have more energy in the morning but get worse as the day goes by." C) "Sometimes I have numbness/tingling on my face." D) "I had what felt like an electric shock race down the back of my leg when I bend my neck." E) "I feel like I don't have enough energy to chew my food sometimes."

A) "Sometimes I have double vision." B) "I have more energy in the morning but get worse as the day goes by." E) "I feel like I don't have enough energy to chew my food sometimes." Now recognized as an autoimmune disease, myasthenia gravis is caused by an antibody-mediated destruction of acetylcholine receptors in the neuromuscular junction. This results in both muscle weakness and fatigability with sustained effort. Most commonly affected are the eye and periorbital muscles, with ptosis (drooping of eyelids) or diplopia (double vision) due to weakness of the extraocular muscles as an initial symptom. The disease may progress from ocular muscle weakness to generalized weakness. Chewing and swallowing may be difficult. In most persons, symptoms are least evident when arising in the morning, but grow worse with effort and as the day proceeds. Multiple sclerosis clients have paresthesias exhibited as numbness, tingling, burning sensations, or pressure on the face or involved extremities. The Lhermitte sign is an electric shock-like tingling down the back and onto the legs that is produced by flexion of the neck.

A client with a spinal cord injury at T8 would likely retain normal motor and somatosensory function of her: A) Arms B) Bowels C) Bladder D) Perineal musculature

A) Arms A spinal cord injury at T8 would likely allow the client to retain normal function of the upper extremities, while innervations governing the function of the bowels, bladder, and perineum would be severed.

The family of a multiple sclerosis client asks, "What psychological manifestations may we expect to see in our mother?" The health care provider informs them to expect which of the following? Select all that apply. A) Depression B) Hallucinations C) Delirium D) Inattentiveness E) Forgetfulness

A) Depression D) Inattentiveness E) Forgetfulness Psychological manifestations, such as mood swings, may represent an emotional reaction to the nature of the disease or, more likely, involvement of the white matter of the cerebral cortex. Depression, euphoria, inattentiveness, apathy, forgetfulness, and loss of memory may occur. Hallucinations and delirium are not usually associated as a manifestation of MS.

A client works as a data entry worker for a large company. The client goes to employee health with pain in the wrist/hand. The nurse suspects that it is carpal tunnel syndrome based on which of the following assessment findings? Select all that apply. A) Describes numbness/tingling in the thumb and first digit B) States his forearm feels funny (paresthesia) C) Loss of tendon reflexes on the affected extremity D) Precision grip weakness in the affected hand E) Pain interferes with sleeping

A) Describes numbness/tingling in the thumb and first digit D) Precision grip weakness in the affected hand E) Pain interferes with sleeping Carpal tunnel syndrome is a mononeuropathy with compression of the median nerve as it travels with the flexor tendons through a canal made by the carpal bones and transverse carpal ligament. The condition can be caused by a variety of conditions that produce a reduction in the capacity of the carpal tunnel or an increase in the volume of the tunnel contents. Carpal tunnel syndrome is characterized by hand and wrist pain, hand or finger paresthesia, and numbness of the thumb and first two and one half digits of the hand; atrophy of abductor pollicis muscle; pain interferes with sleep; and weakness in precision grip. Guillain-Barré syndrome is characterized by rapidly progressive limb weakness and loss of tendon reflexes.

A client's recent diagnosis of Parkinson disease has prompted his care provider to promptly begin pharmacologic therapy. The drugs that are selected will likely influence the client's levels of: A) Dopamine B) Acetylcholine C) Serotonin D) Adenosine

A) Dopamine Although some antiparkinsonian drugs act by reducing the excessive influence of excitatory cholinergic neurons, most act by improving the function of the dopaminergic system. Serotonin and adenosine are not known to participate directly in the pathophysiology of Parkinson disease.

A sudden traumatic complete transection of the spinal cord results in what type of injury below the site? A) Flaccid paralysis B) Vasoconstriction C) Deep visceral pain D) 3+ tendon reflexes

A) Flaccid paralysis Sudden complete transection of the spinal cord results in complete loss of motor, sensory, reflex, and autonomic function below the level of injury. This immediate response to spinal cord injury, spinal cord shock, is characterized by flaccid paralysis with loss of tendon reflexes below the level of injury, absence of somatic and visceral sensations below the level of injury, and loss of bowel and bladder function. Loss of systemic sympathetic vasomotor tone may result in vasodilation, increased venous capacity, and hypotension. These manifestations occur regardless of whether the level of the lesion eventually will produce spastic or flaccid paralysis. In persons in whom the loss of reflexes persists, hypotension and bradycardia may become critical but manageable problems. In general, the higher the level of injury, the greater is the effect.

A clinician is assessing the muscle tone of a client who has been diagnosed with a lower motor neuron (LMN) lesion. Which of the following assessment findings is congruent with the client's diagnosis? A) Hypotonia B) Spasticity C) Tetany D) Rigidity

A) Hypotonia Typically, UMN lesions produce increased tone (e.g., spasticity, tetany, and rigidity), whereas LMN lesions produce decreased tone (hypotonia).

Which of the following peripheral nerve injuries will likely result in cellular death with little chance of regeneration? A) Nerve fibers destroyed close to the neuronal cell body B) Crushing injury where the nerve is traumatized but not severed C) Cutting injury where slow-regeneration axonal branches are located D) Incomplete amputation where tubular implants are used to fill in the gaps of nerves

A) Nerve fibers destroyed close to the neuronal cell body The successful regeneration of a nerve fiber in the PNS depends on many factors. If a nerve fiber is destroyed relatively close to the neuronal cell body, the chances are that the nerve cell will die; if it does, it will not be replaced. If a crushing type of injury has occurred, partial or often full recovery of function occurs. Cutting-type trauma to a nerve is an entirely different matter. A number of scar-inhibiting agents have been used in an effort to reduce this hazard, but have met with only moderate success. Various types of tubular implants have been used to fill longer gaps in the endoneurial tube but again only with moderate success.

Disorders of the pyramidal tracts, such as a stroke, are characterized by: A) Paralysis B) Hypotonia C) Muscle rigidity D) Involuntary movements

A) Paralysis Disorders of the pyramidal tracts (e.g., stroke) are characterized by spasticity and paralysis, whereas those affecting the extrapyramidal tracts (e.g., Parkinson disease) by involuntary movements, muscle rigidity, and immobility without paralysis. Hypotonia is a condition of less than normal muscle tone, hypertonia or spasticity is a condition of excessive tone, and paralysis refers to a loss of muscle movement. Upper motor neuron (UMN) lesions produce spastic paralysis and lower motor neuron (LMN) lesions flaccid paralysis.

More complex patterns of movements, such as throwing a ball or picking up a fork, are controlled by which portion of the frontal lobe? A) Premotor cortex B) Primary motor cortex C) Reflexive circuitry D) Supplementary motor cortex

A) Premotor cortex Nerve signals generated by the premotor cortex produce much more complex "patterns" of movement; the movement pattern to accomplish a particular objective, such as throwing a ball or picking up a fork, is programmed by the prefrontal association cortex and associated thalamic nuclei. The primary motor cortex is concerned with the purpose and planning of the motor movement and controls specific muscle movement sequences. The lowest level of the hierarchy occurs at the spinal cord, which contains the basic reflex circuitry needed to coordinate the function of the motor units involved in the planned movement. The supplementary motor cortex, which contains representations of all parts of the body, is involved in the performance of complex, skillful movements that require coordination of both sides of the body.

Following his annual influenza vaccination, a client begins to feel achy, like he has developed the flu. An hour later, the client is rushed to the emergency department. Diagnosis of Guillain-Barré syndrome was made based on which of the following assessment findings? Select all that apply. A) Rapid deterioration of respiratory status B) Lack of any physical pain C) Flaccid paralysis of limbs D) BP 90/62 E) Pale, cool, dry skin

A) Rapid deterioration of respiratory status C) Flaccid paralysis of limbs D) BP 90/62 Guillain-Barré syndrome usually is a medical emergency. There may be a rapid development of ventilatory failure and autonomic disturbances that threaten circulatory function. The disorder is characterized by progressive ascending muscle weakness of the limbs, producing a symmetric flaccid paralysis. Paralysis may progress to involve the respiratory muscles. Autonomic nervous system involvement that causes postural hypotension, arrhythmias, facial flushing, abnormalities of sweating, and urinary retention is common. Pain is another common feature of Guillain-Barré syndrome.

A family brings their father to his primary care physician for a checkup. Since their last visit, they note their dad has developed a tremor in his hands and feet. He also rolls his fingers like he has a marble in his hand. The primary physician suspects the onset of Parkinson disease when he notes which of the following abnormalities in the client's gait? A) Slow to start walking and has difficulty when asked to "stop" suddenly B) Difficulty putting weight on soles of feet and tends to walk on tiptoes C) Hyperactive leg motions like he just can't stand still D) Takes large, exaggerated strides and swings arms/hands wildly

A) Slow to start walking and has difficulty when asked to "stop" suddenly The cardinal symptoms of Parkinson disease (PD) are tremor, rigidity (hypertonicity), and bradykinesia or slowness of movement. Bradykinesia is characterized by slowness in initiating and performing movements and difficulty in sudden, unexpected stopping of voluntary movements. Persons with the disease have difficulty initiating walking and difficulty turning. While walking, they may freeze in place and feel as if their feet are glued to the floor, especially when moving through a doorway or preparing to turn. When they walk, they lean forward to maintain their center of gravity and take small, shuffling steps without swinging their arms.

During physiology class, the instructor asks students to explain the pathology behind development of multiple sclerosis. Which student gave the most accurate description? A) The demyelination and subsequent degeneration of nerve fibers and decreased oligodendrocytes, which interfere with nerve conduction B) Muscle necrosis with resultant increase in fat/connective tissue replacing the muscle fibers C) Atherosclerotic destruction of circulation to the brain resulting in lactic acid buildup that affects nerve transmission D) Autoimmune disease where antibody loss of acetylcholine receptors at the neuromuscular junction causes decrease motor response

A) The demyelination and subsequent degeneration of nerve fibers and decreased oligodendrocytes, which interfere with nerve conduction Multiple sclerosis (MS) is an immune-mediated disorder that occurs in genetically susceptible individuals. The pathophysiology of MS involves demyelination and subsequent degeneration of nerve fibers in the central nervous system (CNS), marked by prominent lymphocytic invasion in the lesion. The infiltrate in nerve fiber (rather than vascular) sclerotic plaques contains CD8+ and CD4+ T cells as well as macrophages, which are thought to induce oligodendrocyte injury. With muscular dystrophy, the muscle undergoes necrosis, and fat and connective tissue replace the muscle fibers, which increases muscle size and results in muscle weakness. Now recognized as an autoimmune disease, myasthenia gravis is caused by an antibody-mediated loss of acetylcholine receptors in the neuromuscular junction.

Unlike disorders of the motor cortex and corticospinal (pyramidal) tract, lesions of the basal ganglia disrupt movement: A) Without causing paralysis B) Posture and muscle tone C) And cortical responses D) Of upper motor neurons

A) Without causing paralysis Disorders of the basal ganglia comprise a complex group of motor disturbances characterized by tremor and other involuntary movements, changes in posture and muscle tone, and poverty and slowness of movement. They include tremors and tics, spasticity, hypokinetic disorders, and hyperkinetic disorders. Unlike disorders of the motor cortex and corticospinal (pyramidal) tract, lesions of the basal ganglia disrupt movement but do not cause paralysis. Disorders of the upper motor neuron pyramidal tracts are characterized by spasticity and paralysis.

A 14 year old girl has been thrown from the back of a pick up truck. MRI shows complete cord injury at the level of C2. What is the main significance of an injury at this level of the spinal column? A. Cannot breathe on own, needs ventilator assistance B. Partial or full diaphragmatic function; ventilation is diminished because of the loss of intercostal muscle function, resulting in shallow breaths and a weak cough C. Intercostal and abdominal musculature is affected; the ability to take a deep breath and cough is less impaired D. Needs maintenance therapy to strengthen existing muscles for endurance and mobilization of secretions

A. Cannot breathe on own, needs ventilator assistance

The spinal cord contains the basic factors necessary to coordinate function when a movement is planned. It is the lowest level of function. What is the highest level of function in planning movement? A. Frontal cortex B. Cerebral cortex C. Pons D. Cerebellum

A. Frontal Cortex

Approximately 6 months after a spinal cord injury, a 29 year old man has an episode of autonomic dysreflexia. What are the characteristics of autonomic dysreflexia? (select all) A. HTN B. Fever C. Skin pallor D. Vasoconstriction E. Piloreceptor response

A. HTN C. Skin pallor E. Piloreceptor response

What disease results from the degeneration of the dopamine nigrostriatal system of the basal ganglia? A. Parkinson disease B. Huntington disease C. Guillain-barre syndrome D. Myasthenia gravis

A. Parkinson disease

The signs and symptoms produced by disorders of the motor system are useful in finding the disorder. What signs and symptoms would the nurse assess when looking for a disorder of the motor system? (Select all) A. Spinal reflex activity B. Bulk C. Motor coordination D. Muscle innervation E. Tone

A. Spinal reflex activity B. Bulk C. Motor coordination E. Tone

In Myasthenia gravis, periods of stress can produce myasthenia crisis. When does myasthenia crisis occur? A. When muscle weakness becomes severe enough to compromise B. When the client is too weak to hold the head up C. When the client is so weak he/she cannot lift arms D. When the client can no longer walk

A. when muscle weakness becomes severe enough to compromise

The nurse is caring for a client admitted to the emergency room with suspected meningitis. The nurse prepares to perform which nursing intervention upon physician orders, while diagnostic testing is being completed?

Administration of antibiotics

When assessing the client with acute pancreatitis, which of these diagnostic tests, consistent with the disease, does the nurse anticipate will be altered?

Amylase and lipase

A client has just been diagnosed with multiple sclerosis (MS). The nurse recognizes that the client's condition is a result of:

An immune-mediated response that is caused by the demyelinization of the myelin sheath of the white matter of the brain, spinal cord, and optic nerve

What medication teaching should be done for a woman of childbearing age with a seizure disorder?

Antiseizure drugs increase the risk for congenital abnormalities.

A client's emergency room report includes the presence of a contrecoup injury. The nurse plans care for a client with which of the following?

Closed head injury opposite the area of impact

The nurse is caring for a spinal cord injury client. Assessment reveals shallow breath sounds with a very weak cough effort. The nurse correlates this with which level of injury on the spinal column? A) C2 B) C5 C) T1 D) T10

B) C5 Although a C3-to-C5 injury allows partial or full diaphragmatic function, ventilation is diminished because of the loss of intercostal muscle function, resulting in shallow breaths and a weak cough. Cord injuries involving C1 to C3 result in a lack of respiratory effort, and affected clients require assisted ventilation. The intercostal muscles, which function in elevating the rib cage and are needed for coughing and deep breathing, are innervated by spinal segments T1 through T7. The major muscles of expiration are the abdominal muscles, which receive their innervation from levels T6 to T12.

An elderly client has been brought to his primary care provider by his wife, who is concerned about his recent decrease in coordination. Upon assessment, his primary care provider notes that the client's gait is wide-based, unsteady, and lacking in fluidity, although his muscle tone appears normal. This client requires further assessment for which of the following health problems? A) Muscle atrophy B) Cerebellar disorders C) Impaired spinal reflexes D) Lower motor neuron lesions

B) Cerebellar disorders An ataxic gait is characteristic of cerebellar and/or vestibular disorders. An LMN lesion typically results in decreased muscle tone. Impaired spinal reflexes would not normally manifest as ataxia, and muscle atrophy would cause weakness and decreased muscle tone.

A client with laryngeal dystonia has gotten to the point that people on the telephone cannot understand her. She has heard about getting Botox injections into her vocal cords. The nurse will teach about the actions of Botox. Which is the most accurate description? This drug: A) Will slow the decline in muscle strength and function B) Produces paralysis of the larynx muscles by blocking acetylcholine release C) Prevents the depolarizing effect of the neurotransmitters D) Inhibits the peripheral metabolism of dopamine

B) Produces paralysis of the larynx muscles by blocking acetylcholine release Pharmacologic preparations of the botulinum toxin (botulinum type A toxin [Botox] and botulinum type B toxin [Myobloc]) produce paralysis by blocking acetylcholine release. Glucocorticoids are the only medication currently available to slow the decline in muscle strength and function in DMD. Curare acts on the postjunctional membrane of the motor endplate to prevent the depolarizing effect of the neurotransmitter. Neuromuscular transmission is blocked by curare-type drugs during many types of surgical procedures to facilitate relaxation of involved musculature. Levodopa, a dopamine agonist used in Parkinson disease, is administered with carbidopa, which inhibits its peripheral metabolism, allowing therapeutic concentrations of the drug to enter the brain without disabling adverse effects.

Peripheral nerve disorders are not uncommon. What is an example of a fairly common mononeuropathy? A. Guillain-Barre syndrome B. Carpal tunnel syndrome C. Myasthenia gravis D. Phalen syndrome

B. Carpal tunnel syndrome

Bowel dysfunction is one of the most difficult problems to deal with after a spinal cord injury. After a spinal cord injury, most people experience constipation. Why does this occur? A. Innervation of the bowel is absent B. Defecation reflex is lost C. Internal anal sphincter will not relax D. Peristaltic movements are not strong enough to move stool through the colon

B. Defecation reflex is lost

Reflexes are basically "hard-wired" into the CNS. Anatomically, the basis of a reflex is an afferent neuron that synapses directly with an effector neuron that causes muscle movement. Sometimes the afferent neuron synapses with what intermediary between the afferent and effector neurons? A. Neurotransmitter B. Interneuron C. Intersegmental effectors D. Suprasegmental effectors

B. Interneuron

Amyotrophic lateral sclerosis is considered a disease of the upper motor neurons. What is the most common clinical presentation of amyotrophic lateral sclerosis? A. Rapidly progressive weakness and atrophy in distal muscles of both upper extremities B. Slowly progressive weakness and atrophy in distal muscles of one upper extremity C. Rapidly progressive weakness and atrophy in distal muscles of both lower extremities D. Slowly progressive weakness and atrophy in distal muscles of one lower extremity

B. Slowly progressive weakness and atrophy in distal muscles of one upper extremity

A teenager has been in a car accident and experienced acceleration-deceleration head injury. Initially, the client was stable but then started to develop neurological signs/symptoms. The nurse caring for this client should be assessing for which type of possible complication?

Brain contusions and hematomas

A teenager has been in a car accident and experienced an acceleration-deceleration head injury. Initially, the client was stable but then started to develop neurological signs/symptoms. The nurse caring for this client should be assessing for which type of possible complication?

Brain contusions and hematomas

Manifestations of brain tumors are focal disturbances in brain function and increased ICP. What causes the focal disturbances manifested by brain tumors?

Brain edema and disturbances in blood flow

When the suspected diagnosis is bacterial meningitis, what assessment techniques can assist in determining if meningeal irritation is present?

Brudzinski sign and Kernig sign

The client has a traumatic complete spinal cord transection at the C5 level. Based on this injury, the health care worker can expect the client to have control of which body function/part? A) Bladder B) Finger flexion C) Diaphragm D) Trunk muscle

C) Diaphragm The functional levels of cervical injury are related to C5, C6, C7, or C8 innervation. All motor and sensory function is absent below the level of cord transection. At the C5 level, deltoid and biceps function is spared, allowing full head, neck, and diaphragm control with good shoulder strength and full elbow flexion. At the C8 level, finger flexion is added. Thoracic cord injuries (T1 to T12) allow full upper extremity control with limited to full control of intercostal and trunk muscles and balance. Sacral (S1 to S5) innervation allows for full leg, foot, and ankle control and innervation of perineal musculature for bowel, bladder, and sexual function.

Among the treatments for multiple sclerosis (MS), which medication will reduce the exacerbation of relapsing-remitting MS? A) Long-term corticosteroid administration B) Mitoxantrone, an antineoplastic agent C) Interferon-β, a cytokine injection D) Baclofen, a muscle relaxer

C) Interferon-β, a cytokine injection Disease-modifying agents include interferon-b and glatiramer acetate. These agents have shown some benefit in reducing exacerbations in persons with relapsing-remitting MS. Interferon-β is a cytokine that acts as an immune enhancer. Corticosteroids are the mainstay of treatment for acute attacks of MS. These agents are thought to reduce the inflammation, improve nerve conduction, and have important immunologic effects. Long-term administration does not, however, appear to alter the course of the disease and can have harmful side effects. Mitoxantrone, an anticancer drug, is recommended for persons with worsening forms of the disease. Baclofen is a muscle relaxer for helping with symptom relief.

A client with a diagnosis of myasthenia gravis has required a mastectomy for the treatment of breast cancer. The surgery has been deemed a success, but the client has gone into a myasthenic crisis on postoperative day 1. Which of the following measures should the care team prioritize in this client's immediate care? A) Positioning the client to minimize hypertonia and muscle rigidity B) Seizure precautions with padded side rails and bed in lowest height C) Respiratory support and protection of the client's airway D) Monitoring the client for painful dyskinesias

C) Respiratory support and protection of the client's airway Myasthenic crisis occurs when muscle weakness becomes severe enough to compromise ventilation to the extent that ventilatory support and airway protection are needed. Seizures, dyskinesias, hypertonia, and muscle rigidity are not associated with myasthenia gravis in general or myasthenic crisis in particular.

A client is devastated to receive a diagnosis of amyotrophic lateral sclerosis (ALS). The symptomatology of this disease is a result of its effects on upper and lower motor neurons. The health care provider caring for this client will focus on which priority intervention for this client? A) Ability to turn from side to side, thereby preventing skin breakdown B) Ability to empty bladder completely, thereby preventing autonomic dysreflexia C) Respiratory ventilation assessment and prevention of aspiration pneumonia D) Assessment of lower extremities to prevent deep vein thrombosis

C) Respiratory ventilation assessment and prevention of aspiration pneumonia Amyotrophic lateral sclerosis is a mixed upper motor neuron (UMN) and lower motor neuron (LMN) disorder. In the more advanced stages of ALS, muscles of the palate, pharynx, tongue, neck, and shoulders become involved, causing impairment of chewing, swallowing (dysphagia), and speech. Dysphagia with recurrent aspiration and weakness of the respiratory muscles produces the most significant acute complications of the disease. Airway/breathing is always the priority over bladder emptying; skin breakdown, and assessing for DVT.

While there is no lab test that is diagnostic for MS, some patients have alterations in their cerebrospinal fluid (CSF) that can be seen when a portion of the CSF is removed during a spinal tap. What findings in CSF is suggestive of MS? A. Decreased immunoglobulin G levels B. Decreased total protein levels C. Oligoclonal patterns D. Decreased lymphocytes

C. Oligoclonal patterns

Duchenne muscular dystrophy usually does not produce any signs or symptoms until between the ages of 2 and 3. What muscles are usually first to be affected in Duchenne muscular dystrophy? A. Muscles of the upper arms B. Large muscles of the legs C. Postural muscles of the hip and shoulder D. Spinal and neck muscles

C. Postural muscles of the hip and shoulder

Herniated disks occur when the nucleus pulposus is compressed enough that it protrudes thought the annulus fibrosus, putting pressure on the nerve root This type of injury occurs most often in the cervical and lumbar region of the spine. What is an important assessment technique for a herniated disk in the lumbar region? A. Hip flexion test B. CT scan C. Straight-leg test D. Electromyelography

C. Straight-leg test

The nurse working in an emergency room is caring for a client who is exhibiting signs and symptoms of a stroke. What does the nurse anticipate that the physician's orders will include?

CT scan

While discussing hormonal control of bone formation, one should note that which hormone lowers blood calcium levels and decreases bone resorption?

Calcitonin

The nurse is conducting a community education program on concussions. The nurse evaluates that the participants understand the education when they state that which of these offers the brain protection from external forces?

Cerebrospinal fluid

A client has suffered a stroke that has affected his speech. The physician has identified the client as having expressive aphasia. Later in the day, the family asks the nurse to explain what this means. The most accurate response would be aphasia that is

Characterized by an inability to easily communicate spontaneously or translate thoughts or ideas into meaningful speech or writing Expressive or nonfluent aphasia is characterized by an inability to easily communicate spontaneously or translate thoughts or ideas into meaningful speech or writing. Conduction aphasia is manifest as impaired repetition and speech riddled with letter substitutions, despite good comprehension and fluency. Anomic aphasia is speech that is nearly normal except for difficulty with finding singular words. Wernicke aphasia is characterized by an inability to comprehend the speech of others or to comprehend written material

The nurse is working in the emergency room. One client's presenting symptoms include the worst headache ever, nuchal rigidity, and nausea. Another client's presenting symptoms include fever, stiff back, and positive Kernig sign. Which client should the nurse assess first?

Client with the worst headache, nuchal rigidity, and nausea

Rhythmic contraction and alternate relaxation of a limb is called?

Clonus

Involuntary jerking movement is called?

Myoclonus

The nurse is caring for a client who states that he is suddenly having severe pain at a leg fracture site. The nurse notes increased swelling in the limb and difficulty palpating a pulse. The nurse suspects that the client may have which of the following?

Compartment syndrome

What term describes an injury to the soft tissue of the body?

Contusion

The nurse is caring for an elderly client with hemiplegia following a stroke. While planning the client's care, the nurse knows the client is at risk for which of the following conditions? a. Disuse atrophy b. Muscular dystrophy c. Involuntary movements d. Pseudohypertrophy

Correct response: a. Disuse atrophy Explanation: Disuse atrophy can occur with prolonged immobilization following a chronic illness. The client suffering from hemiplegia will have paralysis and immobility. Muscular dystrophy is a genetic disorder characterized by muscle necrosis and increased muscle size. Pseudohypertrophy is associated with muscular dystrophy. Involuntary movements are associated with extrapyramidal tract disorders. Stroke is a pyramidal tract disorder with extrapyramidal tract disorder.

Following his annual influenza vaccination, a client begins to feel achy, like he has developed the flu. An hour later, the client is rushed to the emergency department. Diagnosis of Guillain-Barré syndrome was made based on which of the following assessment findings? Select all that apply. a. Rapid deterioration of respiratory status b. Lack of any physical pain c. Flaccid paralysis of limbs d. BP 90/62 e. Pale, cool, dry skin

Correct response: a. Rapid deterioration of respiratory status c. Flaccid paralysis of limbs d. BP 90/62 Explanation: Guillain-Barré syndrome usually is a medical emergency. There may be a rapid development of ventilatory failure and autonomic disturbances that threaten circulatory function. The disorder is characterized by progressive ascending muscle weakness of the limbs, producing a symmetric flaccid paralysis. Paralysis may progress to involve the respiratory muscles. Autonomic nervous system involvement that causes postural hypotension, arrhythmias, facial flushing, abnormalities of sweating, and urinary retention is common. Pain is another common feature of Guillain-Barré syndrome.

Death caused by muscular dystrophy in early adulthood is usually due to which of the following? a. Respiratory and cardiac muscle involvement b. Severe skeletal muscle weakness c. Severe long bone fractures d. Malnutrition

Correct response: a. Respiratory and cardiac muscle involvement Explanation: Frequent respiratory infections and loss of reserve predispose to life-threatening illness. Cardiomyopathy may be severe and life-limiting in early adulthood.

The nurse is caring for a client with myasthenia gravis. Which symptoms displayed by the client would indicate to the nurse that the client may be experiencing mysasthenia crisis? a. The client has a sudden onset of severe weakness. b. The client begins to have projectile vomiting. c. The client begins to have tremors. d. The client has a fever, tachycardia, and low blood pressure.

Correct response: a. The client has a sudden onset of severe weakness. Explanation: People with myasthenia gravis may experience a sudden exacerbation of symptoms and weakness known as myasthenia crisis. Myasthenic crisis occurs when muscle weakness becomes severe enough to compromise ventilation, to the extent that ventilatory support and airway protection are needed. Myasthenic crisis usually occurs during a period of stress, such as infection, emotional upset, pregnancy, alcohol ingestion, cold exposure, or surgery.

A patient diagnosed with early multiple sclerosis (MS) will likely demonstrate which of the following symptoms? Select all that apply. a. Visual clouding b. Paresthesia c. Bladder dysfunction d. Fatigue e. Anxiety

Correct response: a. Visual clouding b. Paresthesia c. Bladder dysfunction d. Fatigue Explanation: Visual disturbances, paresthesias, abnormal gait (ataxia), bladder and sexual dysfunction, vertigo, nystagmus, fatigue, and speech disturbances are early signs of MS. Anxiety and depression are often seen later as a result of the changes the disease causes.

Approximately 6 months after a spinal cord injury, a 29-year-old man has an episode of autonomic dysreflexia. What are the characteristics of autonomic dysreflexia? (Select all that apply.) a.Hypertension b. Fever c. Skin pallor d. Vasoconstriction e. Piloerector response

Correct response: a.Hypertension c. Skin pallor e. Piloerector response Explanation: Autonomic dysreflexia is characterized by vasospasm, hypertension ranging from mild (20 mm Hg above baseline) to severe (as high as 240/120 mm Hg or higher), skin pallor, and gooseflesh associated with the piloerector response. Fever and vasoconstriction are not manifestations of autonomic dysreflexia.

Constant conjugate readjustment of eye position is called?

Nystagmus

Bowel dysfunction is one of the most difficult problems to deal with after a spinal cord injury. After a spinal cord injury, most people experience constipation. Why does this occur? a. Innervation of the bowel is absent b. Defecation reflex is lost c. Internal anal sphincter will not relax d. Peristaltic movements are not strong enough to move stool through the colon

Correct response: b. Defecation reflex is lost Explanation: Even though the enteric nervous system innervation of the bowel remains intact, without the defecation reflex, peristaltic movements are ineffective in evacuating stool. The other answers are incorrect.

Bradykinesia occurring in Parkinson's disease places the Parkinson's client most at risk for which of the following? a. Weight loss b. Falls and injury c. Emotional dysfunction d. Incontinence

Correct response: b. Falls and injury Explanation: Slowed initiation of movement and poor response to sudden movements are characteristics of bradykinesia. These factors strongly correlate to risk of falls and injury.

The nurse is providing client education to a client newly diagnosed with Parkinson's disease. The nurse most accurately describes the disease progression: a. Parkinson's is an acute disorder that can be surgically corrected. b. Parkinson's is a chronic condition and treatment aims to manage symptoms. c. Parkinson's has no known effective treatment. d d. Parkinson's disease, while chronic, will likely improve over time.

Correct response: b. Parkinson's is a chronic condition and treatment aims to manage symptoms. Explanation: Parkinson's disease is a chronic and progressive condition with no known cure. The goal of treatment is to manage uncomfortable symptoms.

The nurse is providing education to a patient recently diagnosed with multiple sclerosis. The nurse instructs the patient regarding which symptoms commonly occurring with multiple sclerosis? Select all that apply. a. Nausea and vomiting b. Visual loss or blurring c. Difficulty swallowing d. Headaches e. Paresthesias of extremities

Correct response: b. Visual loss or blurring c. Difficulty swallowing e. Paresthesias of extremities Explanation: Due to inflammation and demyelination of nerves, visual loss, difficulty swallowing, and paresthesias frequently occur with multiple sclerosis. Nausea and vomiting and headaches are not associated with this disorder.

A client sustained a spinal cord injury and is immediately brought to the emergency department. The client asks the physician if there is any medication he can get to possibly help him, regardless of risks. The physician assesses the client and determines the most important medication to administer would be: a. Naloxone b. Tirilazad c. Methylprednisone d. IV opioids

Correct response: c. Methylprednisone Explanation: Methylprednisone has been shown some neurological benefits if it is administered soon after SCI. The use of high-dose methylprednisolone has become controversial, largely based on the risk of serious adverse effects (e.g., gastric bleeding, wound infection, venous thrombosis, and steroid myopathy) versus what is perceived to be a modest neurologic benefit. Other neuroprotective agents, including monosialoganglioside sodium (GM-1 ganglioside), naloxone, and tirilazad, have been tested in multicenter clinical trials, but primary end points have not been achieved.c

A nurse caring for a client with multiple sclerosis notes that the client has mood swings. Which of the following can best explain this? a. Depression over new diagnosis b. A side effect of treatment c. Psychological manifestation due to involvement of white matter of cerebral cortex d. Likely a pre-existing mental illness

Correct response: c. Psychological manifestation due to involvement of white matter of cerebral cortex Explanation: Involvement of the cerebral cortex can lead to a variety of mood and cognitive disruptions.

A client with a diagnosis of myasthenia gravis has required a mastectomy for the treatment of breast cancer. The surgery has been deemed a success, but the client has gone into a myasthenic crisis on postoperative day 1. Which of the following measures should the care team prioritize in this client's immediate care? a. Positioning the client to minimize hypertonia and muscle rigidity b. Seizure precautions with padded side rails and bed in lowest height c. Respiratory support and protection of the client's airway d. Monitoring the client for painful dyskinesias

Correct response: c. Respiratory support and protection of the client's airway Explanation: Myasthenic crisis occurs when muscle weakness becomes severe enough to compromise ventilation to the extent that ventilatory support and airway protection are needed. Seizures, dyskinesias, hypertonia, and muscle rigidity are not associated with myasthenia gravis in general or myasthenic crisis in particular.

Which one of the following is a manifestation of a serious condition that causes new-onset back pain in persons 50 years of age or older? a. Subdural hematoma b. Hypertension c. Arteriovenous malformation d. Aortic aneurysm

Correct response: d. Aortic aneurysm Explanation: New-onset pain in persons 50 years of age or older is more likely to be a manifestation of serious conditions such as an aortic aneurysm, malignancy, or compression fracture.

A client has been diagnosed with Guillain-Barre syndrome and is being treated in the intensive care unit. The client is experiencing rapidly ascending paralysis. What is the nurse's priority intervention when caring for this client? a. Inserting a foley catheter b. Assessing distal peripheral pulses c. Restarting the IV when it infiltrates d. Maintenance of the client's airway

Correct response: d. Maintenance of the client's airway Explanation: The rate of disease progression varies. Paralysis may progress to involve the respiratory muscles, which will mandate the use of a ventilator for this patient. Maintenance of the airway is the priority intervention at this time.

A parent brought her 8-year-old child to the emergent care center to be examined following a fall off a playground set, resulting in a head injury. On discharge, the nurse explains to the parent that some symptoms may continue, including the inability to remember what happened before the fall. Which term best describes the diagnosis?

Retrograde amnesia

A recently injured (3 months ago) client with a spinal cord injury at T4 to T5 is experiencing a complication. He looks extremely ill. The nurse recognizes this as autonomic dysreflexia (autonomic hyperreflexia). His BP is 210/108; skin very pale; gooseflesh noted on arms. The priority nursing intervention would be to: a. Check the mouth/throat for pustules and redness b. Check the jugular vein for distention c. Assess calves of legs for redness, warmth, or edema d. Scan his bladder to make sure it is empty

Correct response: d. Scan his bladder to make sure it is empty Explanation: Autonomic hyperreflexia, an acute episode of exaggerated sympathetic reflex responses that occur in persons with injuries at T6 and above, in which central nervous system (CNS) control of spinal reflexes is lost, does not occur until spinal shock has resolved and autonomic reflexes return. Autonomic dysreflexia is characterized by vasospasm, hypertension ranging from mild to severe, skin pallor, and gooseflesh associated with the piloerector response. In many cases, the dysreflexic response results from a full bladder. There is no indication the client has right-sided heart failure (jugular vein distention); has a DVT (calf redness, warmth, or edema); or has strep throat (pustules and red throat/tonsils).

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? a. Flaccid loss of muscle tone b. Difficulty starting movement, stopping movement and maintaining rhythmic movements. c. Tremor, rigidity and bradykinesia d. Unsteady gait and difficulty speaking and swallowing

Correct response: d. Unsteady gait and difficulty speaking and swallowing Explanation: An unsteady gait characterizes cerebellar ataxia and both swallowing and speaking are partly the domain of the cerebellum. Flaccid loss of muscle tone is not noted to accompany cerebellar insult and difficulties with starting movement, stopping movement and maintaining rhythmic movements are indicative of basal ganglia disorders. Tremor, rigidity and bradykinesia and associated with Parkinson disease.

The family of a multiple sclerosis client asks, "What psychological manifestations may we expect to see in our mother?" The health care provider informs them to expect which of the following? Select all that apply. a. Depression b. Hallucinations c. Delirium d. Inattentiveness e. Forgetfulness

Correct response: a. Depression d. Inattentiveness e. Forgetfulness Explanation: Psychological manifestations, such as mood swings, may represent an emotional reaction to the nature of the disease or, more likely, involvement of the white matter of the cerebral cortex. Depression, euphoria, inattentiveness, apathy, forgetfulness, and loss of memory may occur. Hallucinations and delirium are not usually associated as a manifestation of MS.

A client's recent diagnosis of Parkinson disease has prompted his care provider to promptly begin pharmacologic therapy. The drugs that are selected will likely influence the client's levels of: a. Dopamine b. Acetylcholine c. Serotonin d. Adenosine

Correct response: a. Dopamine Explanation: Although some antiparkinsonian drugs act by reducing the excessive influence of excitatory cholinergic neurons, most act by improving the function of the dopaminergic system. Serotonin and adenosine are not known to participate directly in the pathophysiology of Parkinson disease.

A client diagnosed with Parkinson disease is displaying the following manifestations: tremor, rigidity, and slowness of movement. The nurse would interpret these as: a. Normal manifestations of Parkinson disease b. Signs of clinical deterioration c. Signs of clinical improvement d. Manifestations of another disease process

Correct response: a. Normal manifestations of Parkinson disease Explanation: The client is manifesting normal responses of the disease. The cardinal manifestations of Parkinson disease are tremor, rigidity, and bradykinesia or slowness of movement.

Which of the following treatments should take place immediately in a patient experiencing autonomic dysreflexia? a. Position the patient in upright position, and correct the initiating stimulus. b. Increase the patient's blood pressure to allow for adequate perfusion. c. Place the patient in a supine position, and increase intravenous fluids. d. Apply binders and support hose to shunt the blood to the main organs.

Correct response: a. Position the patient in upright position, and correct the initiating stimulus. Explanation: Autonomic dysreflexia is a clinical emergency, and requires monitoring of blood pressure while correcting the initiating stimulus (i.e., full bladder, pain). The nurse should place the patient in an upright position and remove all support hose binders to promote venous pooling to help decrease an extremely elevated blood pressure. Intravenous fluids are not an immediate intervention for this condition.

A client has developed spinal shock. The most important assessment for the nurse to perform would be: a. Inability to void or defecate b. Loss of tendon reflexes c. Vasoconstriction causing hypertension d. Paresthesia of the extremities below the injury

Correct response: b. Loss of tendon reflexes Explanation: Spinal shock is characterized by flaccid paralysis with loss of tendon reflexes below the level of injury, absence of somatic and visceral sensations below the level of injury, and loss of bowel and bladder function. Loss of systemic sympathetic vasomotor tone may result in vasodilation, increased venous capacity, and hypotension.

A patient is admitted to the hospital with second degree burns over 30% of the body. Which is a characteristic of second degree burns?

They involve the dermis and the epidermis.

A client who experienced a traumatic head injury from a severe blow to the back of his head now lives with numerous function deficits, including an inability to maintain steady posture while he is in a standing position, although he is steadier when walking. Which of the following disorders most likely resulted from his injury? A) Cerebellar dystaxia B) Cerebellar tremor C) A lower motor neuron lesion D) A vestibulocerebellar disorder

D) A vestibulocerebellar disorder Damage to the part of the cerebellum associated with the vestibular system leads to difficulty in maintaining or to inability to maintain a steady posture of the trunk, which normally requires constant readjusting movements. Tremors are repetitive movements, while dystaxia is a characterized by uneven movement. An LMN lesion typically manifests as hypotonia.

Knowing that she is a carrier for Duchene muscular dystrophy (DMD), a pregnant woman arranged for prenatal genetic testing, during which her child was diagnosed with DMD. As her son develops, the woman should watch for which of the following early signs that the disease is progressing? A) Impaired sensory perception and frequent wounds B) Spasticity and hypertonic reflexes C) Muscle atrophy with decreased coordination D) Frequent falls and increased muscle size

D) Frequent falls and increased muscle size Pseudohypertrophy, falls, and muscle weakness are characteristic signs during the early course of DMD. Spasticity and muscle atrophy do not occur and sensory function is not affected.

While teaching a class of nursing students about spinal cord injury, the instructor mentions that male SCI clients will be able to have a sexual response if their injury is at which level on the spinal column? A) T12 B) S1 C) L2 D) S4

D) S4 Sexual function, like bladder and bowel control, is mediated by the S2 to S4 segments of the spinal cord. The S2 to S4 cord segments have been identified as the sexual touch reflex center. The T11 to L2 cord segments have been identified as the mental-stimulus, or psychogenic, sexual response area, where autonomic nerve pathways in communication with the forebrain leave the cord and innervate the genitalia. In T10 or higher injuries, reflex sexual response to genital touch may occur freely. However, a sexual response to mental stimuli (T11 to L2) does not occur because of the spinal lesion blocking the communication pathway. In an injury at T12 or below, the sexual reflex center may be damaged, and there may be no response to touch.

A recently injured (3 months ago) client with a spinal cord injury at T4 to T5 is experiencing a complication. He looks extremely ill. The nurse recognizes this as autonomic dysreflexia (autonomic hyperreflexia). His BP is 210/108; skin very pale; gooseflesh noted on arms. The priority nursing intervention would be to: A) Check the mouth/throat for pustules and redness B) Check the jugular vein for distention C) Assess calves of legs for redness, warmth, or edema D) Scan his bladder to make sure it is empty

D) Scan his bladder to make sure it is empty Autonomic hyperreflexia, an acute episode of exaggerated sympathetic reflex responses that occur in persons with injuries at T6 and above, in which central nervous system (CNS) control of spinal reflexes is lost, does not occur until spinal shock has resolved and autonomic reflexes return. Autonomic dysreflexia is characterized by vasospasm, hypertension ranging from mild to severe, skin pallor, and gooseflesh associated with the piloerector response. In many cases, the dysreflexic response results from a full bladder. There is no indication the client has right-sided heart failure (jugular vein distention); has a DVT (calf redness, warmth, or edema); or has strep throat (pustules and red throat/tonsils).

The basal ganglia play a role in coordinated movements. Part of the basal ganglia system is the striatum, which involves local cholinergic interneurons. What disease is thought to be related to the destruction of the cholinergic interneurons? A. Parkinson syndrome B. Guillain-barre syndrome C. Myasthenia gravis D. Huntington disease

D. Huntington disease

Antibiotics such as gentamicin can produce a disturbance in the body that is similar to botulism by preventing the release of acetylcholine from nerve endings. In persons with preexisting neuromuscular transmission disturbances, these drugs can be dangerous. Which disease falls into this category? A. Multiple sclerosis B. Duchenne muscular dystrophy C. Becker muscular dystrophy D. Myasthenia gravis

D. Myasthenia gravis

Which of the following project from the motor strip in the cerebral cortex to the ventral horn and are fully contained within the CNS? A. Motor neurons B. Motor unit C. Lower motor neurons D. Upper motor neurons

D. upper motor neurons

The health care provider is concerned that a client may be at risk for problems with cerebral blood flow. The most important data to assess would be:

Decreased level of oxygen

Muscle shrinkage due to loss of neural stimulus is called?

Denervation atrophy

? muscle dystrophy is inherited as a recessive single-gene defect on the X chromosome and is transmitted from the mother to her male offspring

Duchenne

The failure to accurately perform rapid alternating movements is called?

Dysdiadchokinesia

Inaccuracies of movements leading to a failure to reach a specified target is called?

Dysmetria

Abnormal simultaneous contractions of agonist and antagonist muscles is called?

Dystonia

A child is being seen in the emergency department (ED) after ingesting crayons with lead in them. He is disoriented and having seizures. The provider suspects he has which of the following?

Encephalitis

In patients with acute diarrhea, many require no treatment. However, the nurse knows the priority assessment in all patients with diarrhea is which of the following?

Fluid and electrolyte status

? are found in muscle tendons and transmit information about muscle tension or force of contraction at the junction of the muscle and tendon that attaches to bone

Golgi tendon organs

A high school student sustained a concussion during a football game. The school nurse will educate the family about postconcussion syndrome and ask them to watch for and report which manifestations of its presence?

Headaches and poor concentation

The most common forms of peptic ulcer are duodenal and gastric ulcers. Which of the following are the most common risk factors for peptic ulcer disease?

Helicobacter pylori (H. pylori)

The client develops osteomyelitis that has originated from infectious organisms that reach the bone through the bloodstream. This is known as which type of osteomyelitis?

Hematogenous

A client tells the nurse that he is concerned about developing hepatitis after being exposed to contaminated feces, saliva, and food. The nurse is aware that the client is at risk for:

Hepatitis A

The nurse planning a community education class on brain tumors and their prevention should include which risk factors in the presentation? Select all that apply.

High dose irradiation exposure Acquired immune suppression

When caring for the client with acute pancreatitis, which of these alterations does the nurse recognize is consistent with the disease?

Hyperglycemia

? suggests the presence of an LMN lesion

Hyporefexia

The nurse is planning an inservice on hypoxia versus ischemia in brain-injured clients. The nurse should include which of the following?

Hypoxia produces a generalized depressive effect on the brain.

A client has been diagnosed with cholecystitis (gallbladder inflammation) that has impaired the normal release of bile. Which of the following gastrointestinal consequences is this client likely to experience?

Impaired digestion of fats

A family brings a client to the emergency department with increasing lethargy and disorientation. They think the client had a seizure on the drive over to the hospital. The client has been sick with a "cold virus" for the last few days. On admission, the client's temperature is 102°F (38.9°C). Which other clinical manifestations may lead to the diagnosis of encephalitis?

Impaired neck flexion resulting from muscle spasm

A client has developed global ischemia of the brain. The nurse determines this is:

Inadequate to meet the metabolic needs of the entire brain

Restoration of the integrity of myelin sheaths would likely result in a slowing or stopping of the progression of:

Multiple sclerosis (MS)

Generalized convulsive status epilepticus is a medical emergency caused by a tonic-clonic seizure that does not spontaneously end, or recurs in succession without recovery. What is the first-line drug of choice to treat status epilepticus?

Intravenous lorazepam

A client's emergency magnetic resonance imaging (MRI) has been examined by the physician and tissue plasminogen activator (tPA) has been administered to the client. What was this client's most likely diagnosis?

Ischemic stroke

The liver has many jobs. One of the most important functions of the liver is to cleanse the portal blood of old and defective blood cells, bacteria in the bloodstream, and any foreign material. Which cells in the liver are capable of removing bacteria and foreign material from the portal blood?

Kupffer cells

Disorders affecting the nerve cell body are often referred to as ? ; those affecting the nerve axon, as ? neuropathies; and primary disorders affecting the muscle fibers as ?

Lower motor neuron disorders, peripheral, myopathies

The emergency room doctor suspects a client may have bacterial meningitis. The most important diagnostic test to perform would be:

Lumbar puncture

A client has been diagnosed with Guillain-Barre syndrome and is being treated in the intensive care unit. The client is experiencing rapidly ascending paralysis. What is the nurse's priority intervention when caring for this client?

Maintenance of the client's airway

?, whether it involves walking, running, or precise finger movements, requires movement and maintenance of posture

Motor function

A client has developed hydrocephalus and asks the nurse what may have caused this to occur. The best response would be:

Overproduction of cerebrospinal fluid

The nurse recognizes that parathyroid Hormone (PTH) has what relationship to bone formation?

PTH is a regulator of calcium and phosphate.

When assessing a client with acute cholecystitis, the nurse anticipates the client's report of pain will be consistent with which of these descriptions?

Pain in the right upper quadrant referred to the same shoulder

Loss of movement is called?

Paralysis

Incomplete loss of strength is called?

Paresis

What disease results from the degeneration of the dopamine nigrostriatal system of the basal ganglia?

Parkinson disease

The nurse is providing client education to a client newly diagnosed with Parkinson's disease. The nurse most accurately describes the disease progression:

Parkinson's is a chronic condition and treatment aims to manage symptoms.

Syndrome arising from the degenerative changes in basal ganglia function is called?

Parkinsonism

A client suffering a thrombotic stroke is brought into the emergency department by ambulance and the health care team is preparing to administer a synthetic tissue plasminogen activator for which purpose?

Thrombolysis

A client's recent computed tomography (CT) scan has revealed the presence of hydrocephalus. Which treatment measure is most likely to resolve this health problem?

Placement of a shunt

A 55 year-old man has been diagnosed with a gastroesophageal reflux disease GERD, in which the function of his lower esophageal sphincter is compromised. Which of the following consequences of this condition is most likely?

Protrusion of the stomach or regurgitation of stomach contents into the esophagus.

Following a car accident in which the driver did not have his seatbelt on, the client is diagnosed with a traumatic brain injury requiring emergent craniotomy for severe cerebral edema. Which assessments should the nurse report immediately since they correspond to a supratentorial herniation progressing to midbrain involvement? Select all that apply.

Pupils fixed at ~ 5 mm in diameter Respiration rate of 40 breaths/min Decerebrate posturing following painful stimulation of the sternum

A parent brought her 8-year-old child to the emergent care center to be examined following a fall off a playground set, resulting in a head injury. On discharge, the nurse explains to the parent that some symptoms may continue, including the inability to remember what happened before the fall. Which of the following terms best describes the diagnosis?

Retrograde amnesia The loss of memory following a concussion can be part of the postconcussion syndrome. The term for loss of memory before the accident is retrograde amnesia. Loss of memory following the accident is anterograde amnesia

Increased muscle resistance that varies and commonly becomes worse at the extremities of the range of motion is called?

Spasticity

The nurse taking a report on a client coming into the emergency room plans care for a client with brain dysfunction based on which symptom?

Stupor

What term is used to describe a level of consciousness that sees a client responding only to vigorous and repeated stimuli and has minimal or no spontaneous movement?

Stupor

The MRA scan of a client with a suspected stroke reports ruptured berry aneurysm. The nurse plans care for a client with which of the following?

Subarachnoid hemorrhage

The most common cause of an ischemic stroke is which of the following?

Thrombosis

A client who is being seen in the outpatient clinic reports a single episode of unilateral arm and leg weakness and blurred vision that lasted approximately 45 minutes. The client is most likely experiencing:

Transient ischemic attack (TIA)

Which of the following pain disorders is a manifestation of a disruption of cranial nerve function?

Trigeminal neuralgia

Neurotoxins from the botulism organism (C. botulinum) produce paralysis by blocking ? release

acetylcholine

A client is brought to the emergency department and is diagnosed with an ischemic stroke confirmed by CT scan. The most important treatment for this client would be to:

administer IV tissue plasminogen activator (tPA).

? affects motor neurons in three locations: the anterior horn cells of the spinal cord; the motor nuclei of the brain stem, particularly the hypoglossal nuclei; and the UMNs of the cerebral cortex

amyotrophic lateral sclerosis

The ? are a group of deep, interrelated subcortical nuclei that play an essential role in control of movement

basal ganglia

The cardinal manifestations of Parkinson disease are tremor, rigidity, and ? or slowness of movement

bradykinesia

Loss of ? function can result in total incoordination of these functions even though its loss does not result in paralysis

cerebellar

The ? and ? provide feedback circuits that regulate cortical and brain stem motor areas

cerebellum, basal ganglia

A client has suffered a stroke that has affected his speech. The physician has identified the client as having expressive aphasia. Later in the day, the family asks the nurse to explain what this means. The most accurate response would be aphasia that is:

characterized by an inability to communicate spontaneously with ease or translate thoughts or ideas into meaningful speech or writing.

Cerebellar ? are involved with the timing and coordination of movements that are in progress and with learning of motor skills

circuits

The ? is the highest level of motor function

cortex

A client suffering global cerebral ischemia a week after a suicide attempt by hanging is in the intensive care unit receiving treatment. The parent asks the nurse why it is necessary to keep the client paralyzed with medications and on the ventilator. The most appropriate response would be that these therapies:

decrease metabolic needs and increase oxygenation.

The high risk for ? in acute spinal cord injury patients is due to immobility, decreased vasomotor tone below the level of injury, and hyper-coagulability and stasis of blood flow

deep venous thrombosis

The pathophysiology of multiple sclerosis involves the ? of nerve fibers in the white matter of the brain, spinal cord, and optic nerve

demyelination

Muscular ? is a term applied to a number of genetic disorders that produce progressive deteriorations of skeletal muscles because of mixed muscle cell hypertrophy, atrophy, and necrosis

dystrophy