week 8 check your understanding

Which group of clinical findings indicates the poorest neurologic functioning? a. Spontaneous eye opening, movement to command, oriented to self only b. Assumes decorticate posture with light touch, no verbal response c. No eye opening, responds to painful stimulus by withdrawing d. Eyes open to light touch on shoulder, pupils briskly reactive to light bilaterally

b. Assumes decorticate posture with light touch, no verbal response

________ edema occurs when ischemic tissue swells because of cellular energy failure. a. Vasogenic b. Cytotoxic c. Osmotic d. Interstitial

b. Cytotoxic

A tool used to assess levels of consciousness is a. magnetic resonance imaging (MRI). b. Glasgow Coma Scale (GCS). c. central perfusion pressure (CPP). d. intracranial pressure (ICP) monitoring.

b. Glasgow Coma Scale (GCS).

Most muscle strains are caused by a. a tear in an adjoining tendon. b. abnormal muscle contraction. c. muscle asymmetry. d. bleeding into the muscle.

b. abnormal muscle contraction.

Upper extremity weakness in association with degeneration of CNS neurons is characteristic of a. Guillain-Barré syndrome. b. amyotrophic lateral sclerosis. c. myasthenia gravis. d. multiple sclerosis.

b. amyotrophic lateral sclerosis.

The most important preventive measure for hemorrhagic stroke is a. management of dysrhythmias. b. blood pressure control. c. anticoagulation. d. thrombolytics.

b. blood pressure control.

It is true that scleroderma involves a. autoantibodies against acetylcholine receptors. b. inflammation caused by antigenic fragments of dead organisms. c. infection by beta-hemolytic streptococcus. d. inflammation and fibrosis of connective tissue.

d. inflammation and fibrosis of connective tissue.

Parkinson disease is associated with a. a pyramidal nerve tract lesion. b. a deficiency of dopamine in the substantia nigra. c. demyelination of CNS neurons. d. insufficient production of acetylcholine in the basal ganglia.

d. insufficient production of acetylcholine in the basal ganglia.

A malignant bone-forming tumor is referred to as a(n) a. rhabdosarcoma. b. liposarcoma. c. osteosarcoma. d. chondrosarcoma.

c. osteosarcoma.

Following a bone fracture, the most likely event to occur is A. development of a blood clot beneath the periosteum B. leukocyte infiltration into bone tissue C. blood vessel growth at the fracture site D. migration of osteoblasts to the fracture site.

A. development of a blood clot beneath the periosteum

Ankylosing spondylitis is characterized by A. inflammation, stiffness, and fusion of spinal joints. B. loss of articular cartilage in weight-bearing joints. C. excessive bone remodeling leading to soft bone. d. immune mechanisms leading to widespread joint inflammation.

A. inflammation, stiffness, and fusion of spinal joints.

A clinical finding consistent with a diagnosis of rheumatoid arthritis would be A. systemic manifestations of inflammation B. localized pain in weight-bearing joints C. reduced excreation of uric acid by the kidney D. firm, crystallized nodules or tophi at the affected joints

A. systemic manifestations of inflammation

The final stage of gout, characterized by crystalline deposits in cartilage, synovial membranes, and soft tissue, is called A. tophaceous gout. B. gouty arthritis. C. complicated gout. D. asymptomatic hyperuricemia.

A. tophaceous gout.

It is useful to conceptualize pain physiology according to the four stages because each stage provides an opportunity for A. education. B. stimulation. C. intervention. D. documentation.

C. intervention.

Rheumatoid arthritis is commonly associated with the presence of rheumatoid factor autoantibodies in the bloodstream. This indicates that rheumatoid arthritis is likely to be A. due to bacterial infection B. an autoimmune process C. an infective process D. due to an enzymatic defect

B. an autoimmune process

Tophi are A. renal calculi composed of uric acid. B. deposits of urate crystals in tissues C. painful edematous joints. D. spots that coalesce in a malar rash.

B. deposits of urate crystals in tissues

Enteropathic arthritis is associated with A. irritable bowel syndrome. B. inflammatory bowel disease. C. chronic constipation. D. chronic diarrhea.

B. inflammatory bowel disease.

A patient diagnosed with diabetes, smokes a pack of cigarettes daily and eats very few green leafy vegetables. After experiencing a fractured toe, this patient is at risk for a. delayed healing. b. malunion. c. nonunion. d. dysunion.

a. delayed healing.

The complication which is not likely to result from a compound, transverse fracture of the tibia and fibula is A. bone infection. B. fat emboli. C. air embolus. D. compartment syndrome

C. air embolus.

Rheumatoid arthritis involves joint inflammation caused by A. bacterial infection B. trauma C. autoimmune injury D. congenital hypermobility

C. autoimmune injury

The chief pathologic features of osteoarthritis are A. stress fractures of the epiphysis, inflammation of the diaphysis, and accumulation of excessive synovial fluid B. autoimmune damage to the synovium, destruction of cartilage by pannus, thickening of synovial fluid C. degeneration of articular cartilage, destruction of the bone under the cartilage, thickening of the synovium D. thinning of the joint capsule, reabsorption of bone, excessive formation of new bone, and formation of bone spurs

C. degeneration of articular cartilage, destruction of the bone under the cartilage, thickening of the synovium

Prosthetic joint infection is most often due to A. defective replacement material B. injury to joint C. hematogenous transfer D. arthritis

C. hematogenous transfer

Which neurologic disorder is commonly referred to as Lou Gehrig disease? A. Multiple sclerosis B. Parkinson disease C. Alzheimer disease D. Amyotrophic lateral sclerosis

D. Amyotrophic lateral sclerosis

People who have osteoporosis are at risk for A. rhabdomyolysis. B. osteomyelitis. C. osteomalacia. D. bone fractures.

D. bone fractures.

Pain in fibromyalgia involves A. muscle inflammation. B. autoimmune destruction of muscle tissue. C. nerve inflammation. D. changes in pain transmission in the spinal cord.

D. changes in pain transmission in the spinal cord.

The pathophysiology of osteomalacia involves A. increased osteoclast activity. B. collagen breakdown in the bone matrix. C. crowding of cells in the osteoid. D. inadequate mineralization in the osteoid.

D. inadequate mineralization in the osteoid.

Gouty arthritis is a complication of A. group A streptococcal infection B. autoimmune destruction of joint collagen C. excessive production of urea D. inadequate renal excreation of uric acid

D. inadequate renal excreation of uric acid

In contrast to osteoarthritis, rheumatoid arthritis may be associated with A. debilitating joint pain and stiffness B. improvement in symptoms with asprin therapy C. changes in activities of daily living D. systemic aching in the musculoskeletal system

D. systemic aching in the musculoskeletal system

Rickets is characterized by soft, weak bones resulting from a deficiency of A. calcium. B. estrogen. C. phosphate. D. vitamin D.

D. vitamin D.

Ascending paralysis with no loss of sensation is characteristic of a. Guillain-Barré syndrome. b. myasthenia gravis. c. amyotrophic lateral sclerosis. d. multiple sclerosis.

a. Guillain-Barré syndrome.

Which disorder usually causes skeletal pain and involves significant bone demineralization from vitamin D deficiency? a. Osteomalacia b. Osteopenia c. Osteomyelitis d. Osteoporosis

a. Osteomalacia

Which statement is true about the incidence of multiple sclerosis? a. The age of onset ranges from 20 to 50 years. b. There is a higher incidence of MS in military veterans. c. MS is more common in men than women. d. There is a higher rate of MS in African-Americans.

a. The age of onset ranges from 20 to 50 years.

The pain of nonarticular rheumatism ("growing pain") is worse a. during the night. b. upon awakening. c. following strenuous exercise. d. during activity.

a. during the night.

Pain that waxes and wanes and is exacerbated by physical exertion is likely related to a. fibromyalgia syndrome. b. neuralgia. c. intermittent claudication. d. neuropathy.

a. fibromyalgia syndrome.

The most common type of osteomyelitis is a. hematogenous. b. contiguous focus. c. Brodie abscess. d. direct invasion.

a. hematogenous.

An example of inappropriate treatment for head trauma would be a. hypoventilation. b. bed rest. c. free water restriction. d. head elevation.

a. hypoventilation.

The most common site affected in Paget's disease is the a. lower spine. b. skull. c. pelvis. d. joints.

a. lower spine.

The initial treatment of an individual experiencing a seizure is concentrated on a. maintaining an airway. b. documenting the seizure pattern. c. administering anticonvulsant medication d. obtaining an EEG.

a. maintaining an airway.

Healing of a fractured bone with a poor alignment is called a. malunion. b. nonunion. c. disunion. d. delayed union.

a. malunion.

It is true that Bell palsy is a a. paralysis of the muscles innervated by the facial nerve. b. painful neuropathic pain affecting the trigeminal nerve. c. herpetic outbreak in a facial dermatome. d. permanent facial paralysis after stroke.

a. paralysis of the muscles innervated by the facial nerve.

The displacement of two bones in which the articular surfaces partially lose contact with each other is called a. subluxation. b. subjugation c. sublimation. d. dislocation

a. subluxation.

Subarachnoid hemorrhage is usually managed with volume expansion and blood pressure support to enhance cerebral perfusion. This is necessary because subarachnoid hemorrhage predisposes to a. increased intracranial pressure. b. cerebral vasospasm. c. excessive volume loss. d. hypotension.

b. cerebral vasospasm.

A risk factor for osteoporosis is a. endometriosis. b. early menopause c. late menopause. d. ovarian cysts.

b. early menopause

In older women, osteoporosis is thought to be primarily because of a. dietary inadequacies. b. estrogen deficiency. c. malabsorption syndrome. d. inactivity

b. estrogen deficiency.

Paget's disease is characterized by a. overactivity of osteoblasts leading to multiple bone tumors. b. excessive bone resorption followed by excessive formation of fragile bone. c. inflammatory disorder resulting in fusion of spine joints. d. failure of resorption by osteoclasts resulting in hard bones.

b. excessive bone resorption followed by excessive formation of fragile bone.

Assessment of an extremity six hours after surgical alignment and casting demonstrates pulselessness and pallor. The priority action to take is to a. increase the administration his pain medication. b. initiate action to have the cast split or removed. c. note the increase in pain in his chart, and recheck the extremity in 30 minutes. d. elevate the extremity to relieve swelling.

b. initiate action to have the cast split or removed.

The most important determinant for prescribing therapy for acute stroke is a. thrombotic versus embolic cause. b. ischemic versus hemorrhagic cause. c. location of ischemia. d. age of the patient.

b. ischemic versus hemorrhagic cause.

It is recommended that women of childbearing age take folic acid daily for prevention of a. seizure disorders. b. neural tube defects. c. cerebral palsy. d. hydrocephalus.

b. neural tube defects.

Pain with passive stretching of a muscle is indicative of a. skeletal muscle damage. b. noncontractile tissue injury. c. vascular insufficiency. d. contractile tissue injury.

b. noncontractile tissue injury.

Compartment syndrome occurs secondary to a. muscle necrosis. b. soft-tissue damage. c. bone infarction. d. breakdown of RBCs.

b. soft-tissue damage.

predisposes to ischemic brain damage is that a. cardiovascular regulation is impaired. b. the lack of airway maintenance can lead to hypoxia. c. the brainstem is depressed. d. neurons are unable to transport glucose.

b. the lack of airway maintenance can lead to hypoxia.

The ________ is the level of painful stimulation required to be perceived a. perception b. threshold c. tolerance d. expression

b. threshold

The person at highest risk of a greenstick fracture from falling off a tall ladder is age a. 68. b. 44. c. 8. d. 23.

c. 8.

Which treatment is helpful in neuropathic pain but not used for acute pain? a. Nonnarcotic analgesics b. Nonsteroidal anti-inflammatory drugs and aspirin c. Anticonvulsants d. Narcotic analgesics

c. Anticonvulsants

Myasthenia gravis is an autoimmune disease in which a. neuronal demyelination disrupts nerve transmission. b. muscles become increasingly bulky but weakened. c. acetylcholine receptors are destroyed or dysfunctional. d. acetylcholine release from motor neurons is disrupted

c. acetylcholine receptors are destroyed or dysfunctional.

It is true that epidural bleeding is a. located between the arachnoid and the dura mater. b. usually because of venous leakage. c. characterized by a lucid interval immediately after injury. d. associated with widespread vascular disruption.

c. characterized by a lucid interval immediately after injury.

Modulation of pain signals is thought to be mediated by the release of a. glutamine. b. histamine. c. endorphins. d. cholecystokinin.

c. endorphins.

The stroke etiology with the highest morbidity and mortality is a. intracranial thrombosis. b. intracranial embolization. c. intracranial hemorrhage. d. cardiac arrest.

c. intracranial hemorrhage.

A college student living in a dormitory reports a stiff neck and headache and is found to have a fever of 102°F. This information is most consistent with a. skull fracture. b. cerebral ischemia. c. meningitis. d. encephalitis.

c. meningitis.

Before making a diagnosis of Alzheimer disease a. increased protein is found in a lumbar puncture. b. a brain biopsy demonstrating organic changes is necessary. c. other potential causes of dementia must be ruled out. d. biochemical tests for aluminum toxicity must be positive.

c. other potential causes of dementia must be ruled out.

Cerebral aneurysm is most frequently the result of a. embolic stroke. b. subarachnoid hemorrhage. c. subdural hemorrhage. d. meningitis.

c. subdural hemorrhage.

_________ is a form of spina bifida in which a saclike cyst filled with CSF protrudes through the spinal defect but does not involve the spinal cord. a. Spina bifida occulta b. Meningomyelocele c. Myelomeningocele d. Meningocele

d. Meningocele

To avoid the progression of cutaneous lesions, a patient diagnosed with systemic lupus erythematosus (SLE) should a. refrain from washing the affected areas. b. avoid excessive use of moisturizers. c. apply warm, wet compresses daily. d. avoid sun exposure.

d. avoid sun exposure.

Inflammation of the sacs that overlie bony prominences is called a. epicondylitis. b. arthritis. c. tendinitis. d. bursitis.

d. bursitis.

Autonomic dysreflexia is characterized by a. extreme pain below the level of injury. b. pallor and vasoconstriction above the level of injury. c. hypotension and shock. d. hypertension and bradycardia.

d. hypertension and bradycardia.

"Please explain the pathophysiology of osteoarthritis to me," says another nurse. "Is it just wear and tear so that the cartilage wears out?" Your best response is a. "Yes; with increasing age, the inflammation from repeated joint use accumulates and causes the cartilage to get thin and ragged until it disappears. "b. "Yes; repeated use just wears out the cartilage, until it becomes thin and denuded. That causes pain and will eventually cause joint inflammation. "c. "No; autoimmune cells infiltrate the joint and collect on the cartilage in a mass called 'pannus' that eventually thins and destroys the cartilage. "d. "No; cells in bone, cartilage, and the synovial membrane all get activated and secrete inflammatory mediators that destroy cartilage and damage bone."

"d. "No; cells in bone, cartilage, and the synovial membrane all get activated and secrete inflammatory mediators that destroy cartilage and damage bone."

Secondary injury after head trauma refers to a. injury as a result of medical therapy. b. brain injury resulting from the body's response to tissue damage. c. focal areas of bleeding. d. brain injury resulting from the initial trauma.

b. brain injury resulting from the body's response to tissue damage.

In the acute phase of stroke, treatment is focused on a. risk factor modification. b. neurologic rehabilitation. c. prevention of bedsores and contractures. d. stabilization of respiratory and cardiovascular function.

d. stabilization of respiratory and cardiovascular function.