Check Your Understanding - 44, 45, 47, 51, 52

What type of seizure usually occurs in children and is characterized by brief staring spells? A. Idiopathic. B. Absence. C. Epileptic. D. Partial.

B. Absence. Absence or petite mal seizures usually occur only in children. They are very brief (2 to 10 seconds), and episodes are characterized by staring spells that last only seconds. Epilepsy refers to recurrent seizures. Idiopathic seizures are those that have no explanation for the disorder. Partial seizures are those in which activity is restricted to one brain hemisphere.

Risk factors for hemorrhagic stroke include: A. Atherosclerosis. B. Dysrhythmias. C. Acute hypertension. D. Sedentary lifestyle.

C. Acute hypertension. Intracerebral hemorrhage is a hemorrhage within the brain parenchyma and usually occurs in the context of severe and often longstanding hypertension. Risk factors for stroke are similar to those for other atherosclerotic vascular disease. Cardiac disease complicated by atrial fibrillation is an important risk factor for embolic stroke. Sedentary lifestyle is not a risk factor for hemorrhagic stroke.

Rheumatoid arthritis involves joint inflammation caused by: A. Trauma. B. Congenital hypermobility. C. Bacterial infection. D. Autoimmune injury.

D. Autoimmune injury. Rheumatoid arthritis is caused by autoimmune injury to synovial joints. Rheumatoid arthritis is not a joint infection, is not caused by trauma, and is not caused by congenital hypermobility.

_________ 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. Meningocele B. Myelomeningocele C. Spina bifida occulta D. Meningomyelocele

A. Meningocele In the meningocele form of spina bifida cystica, a saclike cyst filled with CSF protrudes through the spinal defect but does not involve the spinal cord. In spina bifida occulta, the posterior vertebral laminae have failed to fuse. A myelomeningocele or meningomyelocele deformity contains meninges, CSF, and a portion of the spinal cord that protrudes from the vertebral defect in a cystlike sac.

Bone healing may be impaired by: A. Excessive vitamin C. B. A high-protein diet. C. Immobilization. D. Nicotine use.

D. Nicotine use. Nicotine can delay bone healing. Vitamin C, protein, and immobilization are necessary for bone healing.

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. Growing pains are worse at night in the calves, shins, and thighs. Growing pains are not worse during activity or following strenuous exercise. Growing pains are worse at night, not upon awakening.

Which treatment is helpful in neuropathic pain but not used for acute pain? A. Anticonvulsants. B. Nonsteroidal anti-inflammatory drugs and aspirin. C. Narcotic analgesics. D. Nonnarcotic analgesics.

A. Anticonvulsants. Management of pain associated with neuralgia includes antiseizure medications. Narcotic analgesics are discouraged for long-term therapy. NSAIDs and aspirin are not indicated for treatment of neuropathic pain. Management of neuralgia includes topical and systemic therapies.

The gate control theory of pain transmission predicts that activity in touch receptors will: A. Decrease pain signal transmission in the spinal cord. B. Increase secretion of substance P in the spinal cord. C. Activate opioid receptors in the CNS. D. Enhance perception of pain.

A. Decrease pain signal transmission in the spinal cord. The gate control theory is used to explain how stimulation of large "touch" neurons could inhibit the transmission of nociceptor impulses. Central to the gate control theory is the capacity for interneurons in the spinal cord to modify the transmission of nociceptor impulses. The gate control theory is not based on a theory that activity in touch receptors will enhance perception of pain. Opioid receptors are thought to be the mediators of presynaptic inhibition. One way to inhibit synaptic transmission is through presynaptic inhibition of substance P release from nociceptor neurons.

Modulation of pain signals is thought to be mediated by the release of: A. Endorphins. B. Histamine. C. Cholecystokinin. D. Glutamine.

A. Endorphins. Pain modulation occurs not only at the cord level but also in the brain itself. Opioids such as endorphins produced in the brain are thought to be important modulators of pain perception. Histamine is a chemical mediator of pain which is involved in the transduction phase. Cholecystokinin is a substance involved in synaptic transmission in the spinal cord. The excitatory neurotransmitter glutamate is involved in carrying the nociceptive message from primary afferent fibers to secondary neurons.

A tool used to assess levels of consciousness is: A. Glasgow Coma Scale (GCS). B. Intracranial pressure (ICP) monitoring. C. Magnetic resonance imaging (MRI). D. Central perfusion pressure (CPP).

A. Glasgow Coma Scale (GCS). The Glasgow Coma Scale (GCS) is a standardized tool developed for the purpose of assessing the level of consciousness in acutely brain-injured patients. An MRI is useful in evaluating a patient with an increase in ICP or change in mental status. ICP monitoring is useful in monitoring and treating patients with head trauma or other sources of excessive CSF. Central perfusion pressure is a useful tool in guiding therapy along with ICP.

Enteropathic arthritis is associated with: A. Inflammatory bowel disease. b. Chronic constipation. C. Chronic diarrhea. D. Irritable bowel syndrome.

A. Inflammatory bowel disease. Enteropathic arthritis is associated with inflammatory bowel disease (Crohn disease and ulcerative colitis). Irritable bowel syndrome, chronic constipation, and chronic diarrhea are not symptoms of enteropathic arthritis.

The most important determinant for prescribing therapy for acute stroke is: A. Ischemic versus hemorrhagic cause. B. Location of ischemia. c. Thrombotic versus embolic cause. D. Age of the patient.

A. Ischemic versus hemorrhagic cause. Treatment pathways differ between ischemic and hemorrhagic stroke. The goals of therapy for ischemic stroke are to minimize infarct size and preserve neurologic function. Secondary prevention for thrombotic stroke includes lifestyle modification to address risk factors. It is critical to prevent further hypoxia or ischemia after ischemic stroke regardless of the age of the patient.

A patient presenting with a severe, pounding headache accompanied by nausea and photophobia is likely experiencing a ________ headache. A. Migraine B. Sinus C. Tension D. Chronic

A. Migraine. Typical signs of a migraine headache include severe unilateral pounding or throbbing pain that may be accompanied by nausea, vomiting, photophobia, phonophobia, and lacrimation. A severe, pounding headache with nausea and photophobia is likely to be a migraine headache. A sinus headache is not typically associated with nausea and photophobia. Pain is considered chronic when it lasts more than several months beyond the expected healing time.

Anticholinesterase inhibitors may be used to manage: A. Myasthenia gravis. B. Fibromyalgia. C. Muscular dystrophy. D. Rheumatoid arthritis.

A. Myasthenia gravis. Anticholinesterase inhibitors may be used to manage myasthenia gravis. Anticholinesterase agents are not used to manage muscular dystrophy, fibromyalgia, or rheumatoid arthritis.

The physiologic mechanisms involved in the pain phenomenon are termed: A. Nociception. B. Proprioception. C. Neurotransmission. D. Sensitization.

A. Nociception. The physiologic mechanisms involved in the pain phenomenon are termed nociception. Sensitization is not the physiologic mechanism of pain phenomena. Neurotransmission is not related to the physiologic pain mechanism. The physiologic mechanisms involved in the pain phenomenon are not known as proprioception.

A malignant bone-forming tumor is referred to as a(n): A. Osteosarcoma. B. Chondrosarcoma. C. Liposarcoma. D. Rhabdosarcoma.

A. Osteosarcoma. An osteosarcoma is a malignant bone-forming tumor. Rhabdo- refers to skeletal muscle. Lipo- refers to fat. Chondro- refers to cartilage.

The first indication of brain compression from increasing intracranial pressure (ICP) may be: A. Sluggish pupil response to light. B. Glasgow Coma Scale score of 13. C. Absence of verbalization. D. Decorticate posturing.

A. Sluggish pupil response to light. Careful monitoring of the pupillary response to light during the acute phase is critical, as a failing response may be the first indication of brain compression from increasing ICP. Mild dilation of a pupil with sluggish or absent light response is ominous. Decorticate posturing is related to a deteriorating motor status. Absence of verbalization is not the first indication of brain compression. A GCS score of 13 is not the first indication of brain compression. Although, acute changes in level of consciousness should be further investigated.

Paget's disease is characterized by: A. Inflammatory disorder resulting in fusion of spine joints. B. Excessive bone resorption followed by excessive formation of fragile bone. C. Failure of resorption by osteoclasts resulting in hard bones. D. Overactivity of osteoblasts leading to multiple bone tumors.

B. Excessive bone resorption followed by excessive formation of fragile bone. Paget's disease is characterized by excessive bone resorption followed by excessive formation of fragile bone. Overactivity of osteoblasts that lead to multiple bone tumors is not the cause of Paget's disease. Paget's disease is not characterized by the fusion of spine joints. Fragile bone, not hard bone, is a characteristic of Paget's disease.

Manifestations of acute brain ischemia (Cushing reflex) are due primarily to: A. Sympathetic nervous system activation. B. Loss of brainstem reflexes. C. Autoregulation of body systems. D. Parasympathetic nervous system activation.

A. Sympathetic nervous system activation. An extreme increase in ICP can precipitate an intense reaction by the sympathetic nervous system as it attempts to maintain cerebral perfusion through the compressed blood vessels. This has been termed an ischemic response or Cushing reflex. Manifestations of acute brain ischemia are because of sympathetic nervous system activation. The sympathetic nervous system activates to attempt to lower the intracranial pressure accompanied by acute brain ischemia. The Cushing reflex generally is viewed as a "last-ditch" effort by the brain to reestablish cerebral perfusion but is not as a result of loss of brainstem reflexes.

"Tell me again the name of that chemical that makes crystals when my gout flares up," asks the client. The nurse's best response is: A. Uric acid. B. Calcium phosphate. C. Beta-hydroxybutyric acid. D. Urea.

A. Uric acid. Gout occurs when uric acid crystals form in joints. Calcium phosphate and beta-hydroxybutyric acid do not lead to crystal formation in gout. Uric acid, not urea, leads to crystal formation in gout.

The stage of spinal shock that follows spinal cord injury is characterized by: A. Autonomic dysreflexia. B. Absent spinal reflexes below the level of injury. C. Reflex urination and defecation. D. Motor spasticity and hyperreflexia below the level of injury.

B. Absent spinal reflexes below the level of injury. Spinal shock may occur after injury to the spinal cord, and can last from a few hours to a few weeks. Symptoms below the level of injury include flaccid paralysis of all skeletal muscles; loss of all spinal reflexes; loss of pain, proprioception, and other sensations; bowel and bladder dysfunction with paralytic ileus; and loss of thermoregulation. Bowel and bladder dysfunction may occur with spinal shock. Spinal shock is not characterized by autonomic dysreflexia. Spinal shock is generally associated with flaccid paralysis and loss of spinal reflexes.

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

B. Amyotrophic lateral sclerosis. ALS is also known as Lou Gehrig disease, after the famed "Iron Man" of the New York Yankees, who died from the disease. Multiple sclerosis, Parkinson disease, and Alzheimer disease are not named after Lou Gehrig.

Systemic lupus erythematosus (SLE) is a rheumatic disease attributed to: A. Wear and tear on weight-bearing joints. B. Autoimmune mechanisms. C. Septic joint inflammation and necrosis. D. Unknown etiologic factors.

B. Autoimmune mechanisms. Systemic lupus erythematosus (SLE) is a rheumatic disease attributed to autoimmune mechanisms. Wear and tear on weight-bearing joints and septic joint inflammation and necrosis do not lead to SLE. SLE is known to be attributed to autoimmune mechanisms.

It is true that encephalitis is usually: A. Because of a bacterial infection in the CNS. B. Because of a viral infection in brain cells. C. Fatal. d. Asymptomatic.

B. Because of a viral infection in brain cells. Encephalitis is an inflammation of the brain which is caused by a variety of agents. Viral causes account for the majority of encephalitis cases. Bacteria can be responsible for the inflammation of the brain associated with encephalitis. Death occurs in 5% to 20% of encephalitis cases. Clinical manifestations of HSV encephalitis typically evolve over several days.

A compound, transverse fracture is best described as a bone that is: A. Broken along the long axis. B. Broken and protruding through the skin. C. Cracked but not completely separated. D. Broken in two or more pieces.

B. Broken and protruding through the skin. The type of fracture described is broken and protruding through the skin. A comminuted fracture is one that is broken in two or more pieces. An incomplete fracture is cracked but not completely separated. A longitudinal fracture is broken along the long axis.

The physiologic change most likely to lead to an increase in intracranial pressure is: A. Respiratory hyperventilation. B. Cerebral vasodilation. C. Hypernatremia. D. REM sleep.

B. Cerebral vasodilation. Cerebral edema starts a cyclic process whereby fluid collection in the brain leads to compression of vessels, which results in inadequate blood and oxygen perfusion into the cells. This results in ischemia, which triggers vasodilation, increased capillary pressure, and increased edema. An increase in intracranial pressure is not associated with hypernatremia nor caused by respiratory hyperventilation. The physiologic change most likely to lead to increased intracranial pressure is not related to sleep.

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. Excessive volume loss. B. Cerebral vasospasm. C. Increased intracranial pressure. D. Hypotension.

B. Cerebral vasospasm. In patients experiencing subarachnoid hemorrhage as a consequence of ruptured aneurysm, the complications of cerebral vasospasm and hydrocephalus must be monitored and managed. Vasospasm can be managed by keeping blood volume and blood pressure at normal to high levels. Vasospasm is managed by keeping blood volume and blood pressure at normal to high levels. Subarachnoid hemorrhage does not predispose to excessive volume loss. Subarachnoid hemorrhage is not associated with predisposition to increases in intracranial pressure.

Pain that waxes and wanes and is exacerbated by physical exertion is likely related to: A. Intermittent claudication. B. Fibromyalgia syndrome. C. Neuropathy. D. Neuralgia.

B. Fibromyalgia syndrome. Patients complain of pain that waxes and wanes and that does not follow a dermatomal pattern in fibromyalgia syndrome. The pain tends to be exacerbated by physical exertion. Trigeminal neuralgia is a form of neuropathic pain that can be quite disabling for patients. It is sudden, momentary, but excruciating pains along the second and third divisions of the trigeminal nerve. In the early stages, intermittent claudication is associated with physical activity and alleviated with rest and has a cramping quality. In severe cases, ischemic neuropathy may ensue and cause a more consistent burning, shooting pain in the leg or foot. In pain related to neuropathy, patients complain of burning pain in the distal bilateral lower extremities that is frequently worse at night.

Autonomic dysreflexia is characterized by: A. Hypotension and shock. B. Hypertension and bradycardia. C. Extreme pain below the level of injury. D. Pallor and vasoconstriction above the level of injury.

B. Hypertension and bradycardia. Autonomic dysreflexia is a potentially life-threatening complication that may occur any time after spinal shock has resolved. It is characterized by a sudden episode of hypertension, headache, bradycardia, upper-body flushing and lower body vasoconstriction, piloerection, and sweating. Autonomic dysreflexia is associated with hypertension and lower body vasoconstriction. Extreme pain below the level of injury is not characteristic of autonomic dysreflexia.

An example of inappropriate treatment for head trauma would be: A. Head elevation. B. Hypoventilation. C. Bed rest. D. Free water restriction.

B. Hypoventilation. Hyperventilation, not hypoventilation, is indicated in the management of an acute elevation of intracranial pressure. Elevating the head is aimed at maintaining intracranial pressure and cerebral blood flow. Normal intravascular volume is indicated in the management of intracranial pressure. Bed rest would be indicated for the head trauma patient.

Gouty arthritis is a complication of: A. Group A streptococcal infection. B. Inadequate renal excretion of uric acid. C. Autoimmune destruction of joint collagen. D. Excessive production of urea.

B. Inadequate renal excretion of uric acid. Gouty arthritis is a complication of inadequate renal excretion of uric acid. Rheumatic fever-related arthritis is related to group A streptococcal infection. Gout is not an autoimmune disorder. Gout is because of inadequate renal excretion of uric acid, not excessive production of urea.

Ankylosing spondylitis causes: A. Instability of synovial joints. B. Intervertebral joint fusion. C. Costal cartilage degeneration. D. Temporomandibular joint degeneration.

B. Intervertebral joint fusion. Ankylosing spondylitis causes joint fibrosis, ossification, and fusion, most commonly of the intervertebral and sacroiliac joints. Ankylosing spondylitis does not cause instability of synovial joints, degeneration of cartilage, or temporomandibular joint degeneration.

Healing of a fractured bone with poor alignment is called: A. Disunion. B. Malunion. C. Delayed union. D. Nonunion.

B. Malunion. Malunion is a complication that occurs when the bone fails to align correctly during the healing process. Nonunion and delayed union are different complications of bone healing. Disunion is not the term used for fracture healing with poor alignment.

It is recommended that women of childbearing age take folic acid daily for prevention of: A. Hydrocephalus. B. Neural tube defects. C. Cerebral palsy. D. Seizure disorders.

B. Neural tube defects. The use of folic acid during the period prior to conception has been shown to significantly decrease the risk of having a child with a neural tube defect. Folic acid does not prevent seizure disorders. An etiologic factor in the development of cerebral palsy is mechanical trauma before, during, or after birth. Hydrocephalus is not prevented with the use of folic acid.

The classic manifestations of Parkinson disease include: A. Skeletal muscle rigidity and intention tremor. B. Rest tremor and skeletal muscle rigidity. C. Ataxia and intention tremor. D. Intention tremor and akinesia.

B. Rest tremor and skeletal muscle rigidity. Tremor is often the first symptom of Parkinson disease that prompts patients to seek treatment. The tremor is generally at rest, unilateral affecting distal extremities. Difficulty initiating and controlling movements results in akinesia, tremor, and rigidity. The clinical manifestations of cerebellar disorders primarily include ataxia, hypotonia, intention tremors, and disturbances of gait and balance. Skeletal muscle rigidity and intention tremors are not the classic manifestations of Parkinson disease.

Systemic disorders include: A. Verrucae. B. Rheumatoid arthritis. C. Osteoarthritis. D. Adhesive capsulitis.

B. Rheumatoid arthritis. Systemic manifestations of rheumatoid arthritis include fever, malaise, and lymphadenopathy. Adhesive capsulitis and osteoarthritis are not systemic diseases. Verrucae are warts, and they are not systemic.

The final stage of gout, characterized by crystalline deposits in cartilage, synovial membranes, and soft tissue, is called A. Asymptomatic hyperuricemia. B. Tophaceous gout. C. Complicated gout. D. Gouty arthritis.

B. Tophaceous gout. The final chronic stage of gout is called tophaceous gout. Gouty arthritis and complicated gout are not the final stages. Asymptomatic hyperuricemia is the first stage of gout.

Rickets is characterized by soft, weak bones resulting from a deficiency of: A. Phosphate. B. Vitamin D. C. Estrogen. D. Calcium.

B. Vitamin D. Rickets is characterized by soft, weak bones resulting from vitamin D deficiency. Rickets is not caused by poor calcium intake or phosphate deficiency. Estrogen deficiency is related to osteoporosis, not rickets.

Referred pain may be perceived at some distance from the area of tissue injury, but generally felt: A. On the same side of the body. B. Within the same dermatome. C. Within 10 to 15 cm area. D. With slightly less intensity.

B. Within the same dermatome. Referred pain is perceived in an area other than the site of the injury. It is often felt at some distance from the point of nociceptor activation. Pain is generally referred to other structures in the same sensory dermatome. The brain cannot differentiate the two sources of pain signals and tends to attribute the visceral pain to a body surface location regardless of on which side of the body the injury occurs and on which side of the body the referred pain is felt. Referred pain is not felt with less intensity. Referred pain is not perceived at a distance that is within 10 to 15 cm.

Upper extremity weakness in association with degeneration of CNS neurons is characteristic of: A. Guillain-Barré syndrome. B. Myasthenia gravis. C. Amyotrophic lateral sclerosis. D. Multiple sclerosis.

C. Amyotrophic lateral sclerosis. Amyotrophic lateral sclerosis (ALS) is a progressive degenerative disease affecting both the upper and lower motor neurons characterized by muscle wasting and atrophy of the hands, arms, and legs. Symptoms of multiple sclerosis include double vision, weakness, poor coordination, and sensory deficits. Patients with Guillain-Barré syndrome have progressive ascending weakness or paralysis that usually begins in the legs. Upper extremity weakness associated with degeneration of CNS neurons is not characteristic of myasthenia gravis.

A patient who experiences early symptoms of muscle twitching, cramping, and stiffness of the hands may be demonstrating signs of: A. Guillain-Barré syndrome. B. Hydrocephalus. C. Amyotrophic lateral sclerosis. D. Parkinson disease.

C. Amyotrophic lateral sclerosis. Most patients with ALS demonstrate muscle weakness and atrophy. The earliest symptoms may be muscle twitching, cramping, and stiffness. Often the hands or upper extremities are affected first. Guillain-Barré syndrome is characterized by ascending weakness that usually begins in the legs. Tremors at rest are usually the earliest symptoms of Parkinson disease. Hydrocephalus is characterized by abnormal accumulation of CSF in the cerebral ventricular system.

The most important preventive measure for hemorrhagic stroke is: A. Management of dysrhythmias. B. Thrombolytics. C. Blood pressure control. D. Anticoagulation.

C. Blood pressure control. Hemorrhagic stroke is a hemorrhage that is usually the result of longstanding hypertension. Blood pressure control is the most important preventive measure. Anticoagulation would be useful for preventing embolic stroke. Risk reduction strategies for thrombotic stroke are aimed at reducing atherosclerosis. Dysrhythmias are not related to a risk of hemorrhagic stroke.

The most common symptom of multiple myeloma is: A. Fever. B. Pathologic fracture. C. Bone pain. D. Osteomyelitis.

C. Bone pain. The most common symptom of multiple myeloma is bone pain. Although pathologic fractures occur in multiple myeloma, bone pain is the most common symptom. Fever and osteomyelitis are not common in multiple myeloma.

A fracture in which bone breaks into two or more fragments is referred to as: A. Open. B. Greenstick. C. Comminuted. D. Stress.

C. Comminuted. A fracture in which the bone breaks into two or more fragments is called a comminuted fracture. Open fractures, greenstick fractures, and stress fractures do not involve two or more bone fragments.

________ edema occurs when ischemic tissue swells because of cellular energy failure. A. Vasogenic B. Interstitial C. Cytotoxic D. Osmotic

C. Cytotoxic. Cytotoxic edema occurs when ischemic tissue swells because of cellular energy failure. A lack of ATP allows Na + to accumulate in the cell, creating an osmotic force to draw in water. Interstitial edema is usually secondary to increased capillary pressure, damage to the capillary endothelium from a chemical injury, or sudden increase in vascular pressure beyond autoregulatory limits. A lack of ATP allows Na + to accumulate in the cell, creating an osmotic force to draw in water. Vasogenic edema is a consequence of stroke, ischemia, and severe hypertension, and may occur surrounding brain tumors.

The chief pathologic features of osteoarthritis are: A. Thinning of the joint capsule, resorption of bone, excessive formation of new bone, and formation of bone spurs. B. Autoimmune damage to the synovium, destruction of articular cartilage by pannus, and thickening of synovial fluid. C. Degeneration of articular cartilage, destruction of the bone under the cartilage, and thickening of the synovium. D. Stress fractures of the epiphysis, inflammation of the diaphysis, and accumulation of excessive synovial fluid.

C. Degeneration of articular cartilage, destruction of the bone under the cartilage, and thickening of the synovium. The chief pathologic features of osteoarthritis are degeneration of articular cartilage, destruction of the bone under the cartilage, and thickening of the synovium. Although osteoarthritis does involve formation of bone spurs, all the other answer choices listed do not occur with osteoarthritis.

Acceleration-deceleration movements of the head often result in polar injuries in which: A. Injury is localized to the site of initial impact. B. Bleeding from venules fills the subdural space. C. Focal injuries occur in two places at opposite poles. D. Widespread neuronal damage is incurred.

C. Focal injuries occur in two places at opposite poles. Polar injuries occur as a consequence of the brain shifting within the skull and meninges during the course of an acceleration-deceleration movement resulting in local injury at two opposite poles of the brain. Focal injuries are those that are localized to the site of impact to the skull. Diffuse injuries occur when movement of the brain causes widespread neuronal damage. An intracranial hematoma is a localized collection of blood within the cranium.

Ascending paralysis with no loss of sensation is characteristic of: A. Myasthenia gravis. B. Amyotrophic lateral sclerosis. C. Guillain-Barré syndrome. D. Multiple sclerosis.

C. Guillain-Barré syndrome. Patients with Guillain-Barré syndrome have progressive ascending weakness or paralysis. It usually begins in the legs, spreading often to the arms and face. Symptoms of multiple sclerosis include double vision, weakness, poor coordination, and sensory deficits. Ascending paralysis is not characteristic of myasthenia gravis. Amyotrophic lateral sclerosis (ALS) is a progressive degenerative disease affecting both the upper and lower motor neurons characterized by muscle wasting and atrophy of the hands, arms, and legs.

One of the most common causes of acute pain is: A. Fibromyalgia. B. Malignancy. C. Headache. D. Trigeminal neuralgia.

C. Headache. Headache is one of the most common causes of acute pain, accounting for approximately 13 million visits each year in the Unites States to physician's offices, urgent care clinics, and emergency departments. Fibromyalgia syndrome is a chronic pain syndrome. Cancer pain is a subcategory of chronic pain, although it may be acute. Trigeminal neuralgia is a form of neuropathic pain.

The most common type of osteomyelitis is: A. Brodie abscess. B. Direct invasion. C. Hematogenous. D. Contiguous focus.

C. Hematogenous. Hematogenous osteomyelitis is the most common type of osteomyelitis. Contiguous focus osteomyelitis is not the most common type. Brodie abscess is when an infection becomes enclosed by fibrotic tissue. Osteomyelitis may be caused by a direct invasion of organisms into the bone, but this is not the most common cause.

The pathophysiology of rheumatoid arthritis involves: A. Free radicals attaching to the synovial membrane and tunneling into articular cartilage. B. Excessive wear and tear and microtrauma that damage articular cartilage. C. Immune cells accumulating in pannus and destroying articular cartilage. D. Cysts developing in subchondral bone and creating fissures in articular cartilage.

C. Immune cells accumulating in pannus and destroying articular cartilage. In rheumatoid arthritis, immune cells accumulate in pannus and destroy articular cartilage. Free radicals do not attach to membranes; they damage them by removing electrons from them. Rheumatoid arthritis is not caused by excessive wear and tear. Subchondral cysts and fissures in articular cartilage are not characteristic of rheumatoid arthritis.

Ankylosing spondylitis is characterized by: A. Loss of articular cartilage in weight-bearing joints. B. Immune mechanisms leading to widespread joint inflammation. C. Inflammation, stiffness, and fusion of spinal joints. D. Excessive bone remodeling leading to soft bone.

C. Inflammation, stiffness, and fusion of spinal joints. Ankylosing spondylitis is characterized by inflammation, stiffness, and fusion of spinal joints. Osteoarthritis involves loss of articular cartilage in weight-bearing joints. Paget's disease involves excessive bone remodeling leading to soft bone. RA involves immune mechanisms leading to widespread joint inflammation.

Which disorder usually causes skeletal pain and involves significant bone demineralization from vitamin D deficiency? A. Osteopenia. B. Osteomyelitis. C. Osteomalacia. D. Osteoporosis.

C. Osteomalacia. Osteomalacia is inadequate mineralization of bone tissue, most commonly caused by vitamin D deficiency, and it usually causes skeletal pain. Osteopenia, osteomyelitis, and osteoporosis are not caused by vitamin D deficiency.

The disorders characterized by softening and then enlargement of bones is referred to as: A. Osteomyelitis. B. Osteoporosis. C. Paget disease. D. Rickets.

C. Paget disease. Paget disease is characterized by excessive bone resorption and formation, causing fractures and deformities. Osteomyelitis, osteoporosis, and rickets do not involve softening and then enlargement of bones.

The earliest manifestation of scleroderma is: A. Skin hyper/hypopigmentation. B. Renal impairment. C. Raynaud phenomenon. D. Thick, tight, shiny skin.

C. Raynaud phenomenon. Raynaud phenomenon with blanching of the digits in response to cold is the earliest manifestation. Thick, tight, shiny skin and hyper/hypopigmentation are not the earliest manifestation. Renal impairment is a late manifestation.

A clinical finding consistent with a diagnosis of rheumatoid arthritis would be: A. Reduced excretion of uric acid by the kidney. B. Firm, crystallized nodules or "tophi" at the affected joints. C. Systemic manifestations of inflammation. D. Localized pain in weight-bearing joints.

C. Systemic manifestations of inflammation. Systemic manifestations of inflammation are a clinical finding consistent with rheumatoid arthritis. The pain of rheumatoid arthritis is not localized to weight-bearing joint. Uric acid is not a causative factor in this disorder. Gout causes firm, crystallized nodules, or "tophi," at the affected joints.

Complete healing of a bone fracture occurs when: A. No movement of the break is detectable. B. The fracture site and surrounding soft tissue are pain free. C. The callus has been completely replaced with mature bone. D. A cast is no longer required to stabilize the break.

C. The callus has been completely replaced with mature bone. Complete healing of a bone fracture occurs when the callus has been completely replaced with mature bone. A lack of detectable movement of the break does not indicate that the fracture is healed. Even when a bone fracture is healed, pain at the fracture site and surrounding soft tissue may be present. The patient may progress from a cast to a splint, sling, or brace as the bone fracture continues to heal.

"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; repeated use just wears out the cartilage, until it becomes thin and denuded. That causes pain and will eventually cause joint inflammation." B. "No; autoimmune cells infiltrate the joint and collect on the cartilage in a mass called 'pannus' that eventually thins and destroys the cartilage." C. "Yes; with increasing age, the inflammation from repeated joint use accumulates and causes the cartilage to get thin and ragged until it disappears." 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." Osteoarthritis involves a complex interaction between osteoclasts, osteoblasts, chondrocytes, and synoviocytes that eventually destroy cartilage and damage subchondral bone. Repeated use of a joint and pannus are not the causes of osteoarthritis. Inflammatory mediators, not inflammation from repeated joint use, are the cause of osteoarthritis.

Although skin manifestations may occur in numerous locations, the classic presentation of systemic lupus erythematosus (SLE) includes: A. Cracked, scaly areas in the webs of fingers. B. Lesions affecting the palms of hands and the soles of feet. C. Dry, scaly patches in the antecubital area and behind the knees. D. A butterfly pattern rash on the face across the bridge of the nose.

D. A butterfly pattern rash on the face across the bridge of the nose. The classic presentation of SLE includes a butterfly pattern rash on the face across the bridge of the nose. The classic presentation does not involve lesions affecting the palms of the hands and the soles of the feet; dry, scaly patches in the antecubital area and behind the knees; or cracked, scaly areas in the webs of the fingers.

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

D. Assumes decorticate posture with light touch, no verbal response. Decorticate posturing is an abnormal flexor response of the arms and wrists, with legs and feet extended and internally rotated. This occurs as the neurologic functioning deteriorates. Normal response occurs with spontaneous eye opening, movement on command and orientation to self. Eye opening to touch is not indicative of poor neurologic functioning. A lower neurologic functioning is indicated by a patient who is able to withdraw from painful stimulus and localize the source of pain.

A severe complication of elevated intracranial pressure is: A. Hydrocephalus. B. Cushing reflex. C. Burr hole. D. Brain herniation.

D. Brain herniation. A dreaded complication of elevated ICP is brain compression and herniation. Compression of midbrain and brainstem structures is associated with rapid neurologic demise unless corrected quickly. An extreme increase in ICP precipitates a reaction by the sympathetic nervous system as it attempts to maintain perfusion. Cushing reflex is the brain's effort to reestablish cerebral perfusion. A burr hole is an opening in the skull which is used to monitor ICP. A cause of increased ICP is an excessive accumulation of CSF (hydrocephalus).

Secondary injury after head trauma refers to: A. Focal areas of bleeding. B. Injury as a result of medical therapy. C. Brain injury resulting from the initial trauma. D. Brain injury resulting from the body's response to tissue damage.

D. Brain injury resulting from the body's response to tissue damage. Secondary injury is a consequence of the body's response to the primary injury. Injury that is directly related to the initial impact is primary injury. A focal area of bleeding is related to primary injury. Injury that results from medical therapy is not known as secondary injury.

It is true that epidural bleeding is: A. Usually because of venous leakage. B. Located between the arachnoid and the dura mater. C. Associated with widespread vascular disruption. D. Characterized by a lucid interval immediately after injury.

D. Characterized by a lucid interval immediately after injury. The source of bleeding in most epidural hematomas is arterial. The patient may suffer only a brief period of disturbed consciousness followed by a period of normal cognition (lucid interval). Then consciousness rapidly deteriorates as the epidural hematoma expands and compresses brain structures. As the epidural hematoma expands, pressure is placed on the brain structures. The bleeding associated with an epidural hematoma occurs between the inner surface of the skull and the dura mater. The source of bleeding in most epidural hematomas is arterial.

Tophi are: A. Painful edematous joints. B. Renal calculi composed of uric acid. C. Spots that coalesce in a malar rash. D. Deposits of urate crystals in tissues.

D. Deposits of urate crystals in tissues. Tophi are deposits of urate crystals in tissues that occur in gout. Tophi are not renal calculi, painful edematous joints, or a type of rash.

A bone disorder that results from insufficient vitamin D is referred to as: A. Rickets. B. Subluxation. C. Osteoporosis. D. Osteomalacia.

D. Osteomalacia. Osteomalacia is caused by vitamin D deficiency in adults. Rickets is caused by vitamin D deficiency in children. Osteoporosis is related to decreased estrogen. Subluxation refers to a bone displacement.

It is true that Bell palsy is a: A. Permanent facial paralysis after stroke. B. Herpetic outbreak in a facial dermatome. C. Painful neuropathic pain affecting the trigeminal nerve. D. Paralysis of the muscles innervated by the facial nerve.

D. Paralysis of the muscles innervated by the facial nerve. Bell palsy is an acute idiopathic paresis or paralysis of the facial nerve involving an inflammatory reaction. Bell palsy patients generally recover facial nerve function spontaneously within 3 weeks. Patients with Bell palsy may complain of a heavy sensation in their face. Bell palsy is not related to a herpetic outbreak.

The disease that is similar to osteomalacia and occurs in growing children is: A. Osteopenia. B. Osteosarcoma. C. Paget disease. D. Rickets.

D. Rickets. Rickets is similar to osteomalacia in that it is caused by vitamin D deficiency and leads to soft, deformable bones. Rickets occurs in growing children. Osteosarcoma, Paget disease, and osteopenia are not similar to osteomalacia.

What effect do demyelinating disorders such as multiple sclerosis have on neurotransmission? A. Faster rate of repolarization. B. Facilitation of action potential initiation. C. Increased rate of action potential conduction. D. Slower rate of action potential conduction.

D. Slower rate of action potential conduction. The inflammation and scarring that occur with MS slow or interrupt the conduction of nerve impulses. Multiple sclerosis does not have an increased rate of action potential conduction on neurotransmission. Action potential initiation is not facilitated in demyelinating disorders. There is not a faster rate of repolarization in demyelinating disorders such as MS.

The displacement of two bones in which the articular surfaces partially lose contact with each other is called: A. Dislocation. B. Sublimation. C. Subjugation D. Subluxation.

D. Subluxation. Subluxation is partial dislocation of a joint. Subjugation, sublimation, and dislocation are not the terms for partial loss of contact of articular surfaces.