Med Surg II Neuro Exam

There are _______ cranial nerves that control the sensory and motor activities of the body.

ANS: 12 twelve There are 12 cranial nerves that control the sensory and motor activities of the body.

When documenting pupillary response that is normal, the acceptable abbreviation is _______.

ANS: PERRLA perrla PERRLA (Pupils Equally Round and Reactive to Light with Accommodation) is an acceptable and recognizable abbreviation of an assessment of pupillary response.

If conservative measures are unsuccessful in treating a herniated disk, a(n) __________ may be necessary to remove the posterior arch of the vertebrae, along with the disk.

ANS: diskectomy laminectomy A diskectomy or laminectomy is performed to decompress the nerve root when other, less invasive, methods of treatment are not successful.

The nurse is aware that increasing intracranial pressure can cause _____________ of the brain, which results in the brain impinging on the brainstem.

ANS: herniation When the brain is under unreduced pressure, it can herniate through the notch of the tentorium and impinge on the brainstem.

A neurologically damaged patient who cannot interpret communication directed to him is said to have ____________ aphasia.

ANS: receptive The person who cannot interpret communication is said to have receptive aphasia.

During a physical assessment of the neurologic system, the nurse checks the patient's __________, which is built into the nervous system and does not need the intervention of conscious thought to take place.

ANS: reflex A reflex is an automatic response (an action or movement) that is built into the nervous system and does not need the intervention of conscious thought to take place. (The knee jerk is an example of the simplest type of reflex.)

Following a craniotomy to relieve increased intracranial pressure (ICP), which implementation should the nurse implement? a. Elevate the head of the bed 20 to 30 degrees b. Place drip pad or cotton to absorb cerebrospinal fluid (CSF) drainage from the nose or ears. c. Stimulate the patient to better assess changing level of consciousness (LOC). d. Reposition the patient frequently for comfort.

ANS: A A patent airway must be secured, and the head raised 20 to 30 degrees with the body in correct alignment. Elevation helps reduce ICP. Neurologic signs are monitored closely. An IV line is inserted for access for diuretic drugs, if needed, and for administration of fluid. IV fluids are infused very slowly to prevent fluid overload that would increase the ICP. Diuretics are used to decrease vascular volume and keep ICP as low as possible. Drip pads, patient stimulation, and changing positions frequently may increase ICP.

Which reflex indicates an abnormality in the motor control pathways from the cerebral cortex? a. Babinski reflex b. Biceps reflex c. Brachioradialis reflex d. Knee jerk reflex

ANS: A A positive Babinski reflex indicates an abnormality in the motor pathways from the cerebral cortex.

The nurse is caring for a patient with a spinal cord injury who develops autonomic dysreflexia (AD). Which action is most important for the nurse to take first? a. Elevate the head of the bed. b. Notify the charge nurse. c. Decrease the IV fluid rate. d. Administer antihypertensive medication.

ANS: A AD (hyperreflexia) response is potentially dangerous to the patient, because it can produce vasoconstriction of the arterioles with an immediate elevation of blood pressure. Elevating the head of bed is the initial intervention to decrease the rising blood pressure. The nurse should notify the charge nurse and the physician. The IV fluids can be decreased but are not the most important intervention. The vital signs should be obtained and the cause of AD should be addressed before administering any hypertensive medication.

In assessing the patient with a significant right intracerebral hemorrhage, the nurse anticipates that the patient will demonstrate which signs? a. Left-sided hemiplegia with dilated right pupil b. Right-sided hemiplegia with brisk right pupil response c. Bilateral motor hemiplegia with bilaterally dilated pupils d. Left-sided hemiplegia and bilateral PERRLA

ANS: A An acute intracerebral bleed causing hematoma formation is accompanied by unconsciousness, hemiplegia on the contralateral (opposite) side, and a dilated pupil on the ipsilateral (same) side. However, the symptoms indicating a slow buildup of pressure within the skull are more subtle and less easily detected.

The nurse is caring for a patient with a head injury. Over a time span of 30 minutes, the nurse observes the following vital signs changes: temperature from 97° to 98° F; pulse from 86 to 78 beats/min; respirations from 18 to 14 breaths/min; and blood pressure from 140/86 to 150/82. Which action is most important for the nurse to take? a. Notify the physician immediately. b. Document the findings. c. Determine the patient's Glasgow Coma Scale (GCS) score. d. Observe pupils for size, equality, and reactivity.

ANS: A An increasing temperature, decreasing pulse and respirations, and a widening pulse pressure are indicative of increasing intracranial pressure (ICP). Any identified change must be reported to the provider promptly. The nurse should also observe the pupils for any changes, determine the patient's GCS score, and document the findings.

The nurse is performing a neurologic assessment on a patient. Which action should the nurse take to adequately test the effectiveness for the hypoglossal nerve? a. Ask the patient to touch the tip of the tongue to each cheek. b. Check air movement through each nostril separately. c. Ask the patient to wrinkle the forehead. d. Ask the patient to shrug the shoulders.

ANS: A Asking the patient to touch the tip of the tongue to each cheek (while the nurse palpates the outside of the cheek) tests the effectiveness of the hypoglossal nerve (CN XII: a cranial motor nerve responsible for tongue movement and articulation of speech). Checking air movement through each nostril separately evaluates the olfactory nerve (CN I). Asking the patient to wrinkle the forehead tests the facial nerve (CN VII). Asking the patient to shrug the shoulders tests the spinal accessory nerve (CN XI).

The nurse is planning care for a patient with Parkinson disease. Which problem statement/nursing diagnosis is most appropriate for the patient experiencing bradykinesia? a. Risk for falls b. Impaired swallowing c. Acute confusion d. Risk for suicide

ANS: A Bradykinesia is a condition that is associated with Parkinson disease, characterized by slow speech and movement, which produces poor body balance, a characteristic shuffling gait, and difficulty initiating movement. This condition places the patient at risk for falling.

The nurse is caring for an anxious 20-year-old college student who just suffered his first seizure in his dorm room. The patient asks the nurse if he is now an epileptic. What is the nurse's best response? a. "No. All other causes of seizure activity must be ruled out before the diagnosis of epilepsy is made." b. "Yes, but you may never have another seizure since it has just now manifested itself." c. "No, but you should see a physician to get a prescription for a preventative antispasmodic." d. "Yes. All seizures are considered to be epilepsy."

ANS: A Epilepsy diagnosis is made after all other causes of seizure activity have proven negative. All seizures are not considered to be epilepsy.

Which nursing intervention best encourages self-feeding in a patient with right-sided paralysis after a CVA? a. Place finger foods on the left side of the plate. b. Support the right hand in holding an adaptive cup. c. Seat the patient in the dining room with other residents. d. Place large helpings of food in the center of the plate.

ANS: A Finger foods on the nonparalyzed side encourage self-feeding. Privacy is more supportive to early efforts than being in a common dining room. Smaller helpings on the same side of the nonparalyzed limb are conducive to self-feeding.

A patient presents to the health clinic with low back pain that radiates into the buttocks and below the knee. The nurse suspects which condition? a. Herniated disk b. Muscle spasm in lower back c. Spinal cord injury d. Sciatica

ANS: A Herniated disks typically cause compression on the sciatic nerve and allow the pain to radiate into the buttocks and leg. Muscle spasm in the lower back will result in back pain. There is no indication of spinal cord injury. Pain from sciatica does not involve back pain.

The nurse is assisting a patient with agnosia after a CVA. Which intervention is most appropriate? a. Showing the patient a spoon while calling it by name and describing its purpose. b. Moving the patient's hand with a toothbrush in repetitive motion to brush teeth. c. Describing the placement of food on the plate. d. Providing an adaptive fork to enhance self-feeding.

ANS: A Identifying objects and their intended use is helpful to people with agnosia who can no longer recognize items. The other options are helpful to people with apraxia, hemianopsia, and altered coordination, respectively.

The caregiver of a patient with Parkinson disease is concerned with the patient's recent weight loss. The home health nurse should suggest which modification to help the caregiver enhance the patient's nutrition? a. Provide six mini-meals throughout the day. b. Be sure to increase milk and cheese daily in the diet. c. Limit fluid intake in order to increase the appetite. d. Prepare larger meals of fibrous foods.

ANS: A Mini-meals can be eaten before food cools since it takes longer for the patient with Parkinson disease to eat. Large meals are overwhelming and may become unappetizing before they can be consumed. Reduced fluid and increased dairy products increase the threat of constipation.

The nurse is aware that absence (petit mal) seizures are difficult to detect for which reason(s)? (Select all that apply.) a. Lack of an aura b. Appearance as a brief moment of absentmindedness c. Brief loss of consciousness (LOC) d. Absence of patient memory of the event e. Absence of postictal signs

ANS: A, B, D, E Factors that make petit mal seizures difficult to detect include lack of an aura and appearance as a brief moment of absentmindedness with no patient memory of the event or presence of postictal signs. Petit mal seizures do not result in LOC.

The nurse is caring for a patient with brain tumor-related hydrocephalus who is scheduled to undergo placement of a ventriculoperitoneal (V-P) shunt. Which information is most important for the nurse to include when explaining the purpose of the procedure? a. A V-P shunt redirects the cerebrospinal fluid (CSF) from the ventricles to the peritoneum. b. A V-P shunt stimulates ventricles to reabsorb excess CSF. c. A V-P shunt channels excess CSF to the left atrium. d. A V-P shunt provides a port from which excess CSF can be aspirated.

ANS: A Obstruction of CSF flow may require placing a shunt to reduce CSF pressure and prevent increased intracranial pressure (ICP). A shunt is a tube placed in a ventricle and attached to a small manual pump that moves excess CSF fluid from the ventricles to the peritoneal cavity or into the atrium of the heart, so that it may be absorbed.

Which problem statement/nursing diagnosis is most appropriate for a person with Parkinson disease? a. Risk for falls related to unsteady gait. b. Ineffective airway clearance related to drooling. c. Risk for impaired skin integrity related to tremor. d. Nutrition: less than body requirements related to nausea.

ANS: A Rigidity and impaired balance with the propulsive gait create a risk for falls. The tremor decreases with voluntary movement, making eating relatively trouble free. Drooling is not a threat for aspiration, and there is no characteristic nausea.

The nurse is providing teaching to a patient newly diagnosed with simple partial seizure disorder. Which statement by the nurse is most accurate? a. "Your seizures will typically only affect one side of your body." b. "Simple partial seizures may result in an alteration of consciousness." c. "The simple partial seizure may cause motor impairment to begin in all of your extremities." d. "Simple partial seizures are not treatable."

ANS: A Simple partial seizures only involve one side of the brain and one side of the body. Complex partial seizures may or may not result in an alteration in level of consciousness. Generalized seizures affect both sides of the body. Simple partial seizures may respond to treatment.

The nurse is assessing a patient with suspected myasthenia gravis. The nurse is aware that which assessment finding supports this diagnosis? a. Ptosis b. Hand tremors during voluntary movement c. Dizziness with sudden head movement d. Postural hypotension

ANS: A Symptoms of myasthenia gravis include diplopia (double vision), difficulty chewing and swallowing, and ptosis.

Why is the older adult more at risk for a cranial bleed following a head injury? a. The older adult's brain is smaller, which allows for more movement inside the cranium. b. The older adult's brain features fragile vessels more likely to rupture. c. The older adult's brain contains less cerebrospinal fluid (CSF) to cushion the brain. d. The older adult's brain has less flexible meninges to absorb impact.

ANS: A The brain atrophies with age and does not take up as much space in the cranial vault. This change allows for more movement and more potential for torn vessels and contusions on the brain when an accident occurs that involves a head injury.

Which factor(s) is/are most likely a potential cause(s) of multiple sclerosis (MS)? a. Environmental factors and genetic predisposition b. Allergic response to antiviral medications c. Hypersensitivity reaction attacking the myelin d. Bacterial infection of the myelin

ANS: A The cause of MS is not known, but it is attributed to an environmental factor (bacteria, virus, or chemical) combining with a genetic predisposition for the disease. Current thought also includes the hypothesis that MS is an autoimmune disease where the immune system attacks healthy central nervous system tissues.

The nurse is caring for a patient with bacterial meningitis. What interventions should the nurse include in the plan of care? a. Maintain a quiet environment with minimal stimulation. b. Provide all care using sterile technique. c. Limit intake of oral fluids. d. Provide magazines and other activities to reduce daytime naps.

ANS: A The environment is kept quiet with minimal stimulation to reduce the possibility of seizure. The care is done with general precautions. Fluid intake is encouraged, as are daytime naps to preserve energy.

The nurse is caring for the patient who has had an injury to the hypothalamus. Which intervention is most important for the nurse to implement? a. Closely control room temperature. b. Monitor for signs of hemorrhage. c. Protect the patient's eyes from bright lights. d. Turn the patient hourly to maintain skin integrity.

ANS: A The hypothalamus regulates body temperature; therefore, it is important to maintain adequate temperature control of the environment since the body's ability to regulate the temperature will be affected by injury to the organ. Bleeding, photophobia, and skin integrity are not issues associated with the hypothalamus.

The nurse is explaining Parkinson disease to the student nurse. Which statement indicates that the student nurse correctly understands the pathophysiology of the disease? a. "Regardless of the actual etiology, Parkinson disease is caused by depletion of dopamine and excess of acetylcholine." b. "The pathophysiology of the disease is caused by the deterioration of the myelin sheath of the basal ganglia." c. "Excess dopamine and deficient acetylcholine are the cause of Parkinson disease." d. "When there is decreased dopamine uptake at receptors in brain cells, Parkinson disease results."

ANS: A The specific cause of Parkinson disease is unknown, but the basic pathophysiology is depletion of dopamine and excess of acetylcholine.

Bladder training begins with scheduling the patient's toileting in what time increment? a. Every hour b. Every 2 hours c. Every 4 hours d. Every 6 hours

ANS: B Bladder training begins with toileting the patient every 2 hours.

The nurse differentiates the sympathetic from the parasympathetic nervous systems. Which statement about the sympathetic system is accurate? a. The sympathetic system provides energy for "fight or flight" in stressful situations. b. The sympathetic system slows the heart rate after a stressful situation. c. The sympathetic system supports deep sleep after large expenditures of energy. d. The sympathetic system relaxes blood vessels to counteract hypertension.

ANS: A The sympathetic nervous system "gears up" the body for "fight or flight" situations with epinephrine that will raise the blood pressure (BP), reduce bowel motility, and energize the whole body to defend itself in a stressful situation. The parasympathetic system slows the heart rate after stress, supports deep sleep, and relaxes blood vessels.

The nurse is caring for a patient who requires neurologic checks. When performing an assessment, how should the nurse best evaluate the patient's thinking? a. Ask the patient to add three numbers together in his head. b. Ask the patient to identify the name of the present month. c. Ask the patient what he would do in the event of a fire. d. Ask the patient what the last major holiday was.

ANS: A Thinking can be evaluated by asking the patient to add three numbers together; to count by 6s; or to solve a simple puzzle. Asking the patient to identify the name of the present month evaluates orientation. Asking the patient what he would do in a fire evaluates judgment. Asking the patient to name the last major holiday assesses for memory lapses.

While performing an assessment, the nurse taps a patient's knee and observes that the quadriceps muscle reflexively contracts. How should the nurse document this finding? a. Patellar reflex 2/5 b. Patellar reflex 4/5 c. Achilles reflex 2/5 d. Achilles reflex 4/5

ANS: A This action describes a normal patellar reflex. The knee jerk, or patellar reflex, tests nerve pathways to and from the spinal cord at the level of the second through fourth lumbar nerves. When the knee is tapped, the nerve that receives this stimulus sends an impulse to the spinal cord, where it is relayed to a motor nerve. This causes the quadriceps muscle at the front of the thigh to contract and to move the leg upward. This reflex, or simple reflex arc, involves only two nerves and one synapse. The leg begins to jerk up while the brain is just becoming aware of the tap on the knee. Reflexes are graded as follows: 0/5 = absent; 1/5 = weak response; 2/5 = normal; 3/5 = exaggerated response; and 4/5 = hyperreflexia with clonus.

The nurse is caring for a patient who recently suffered a cerebrovascular accident (CVA). Family members ask the nurse why their father had a seizure. Which response is best for the nurse to make? a. "The seizure was most likely caused by brain cells being deprived of oxygen due to a blood clot in the brain." b. "The stroke generated a toxin that excites the brain cells." c. "The stroke causes an alteration in the cells adjacent to the blood clot." d. "The stroke causes an increase in the depolarization of the brain cells due to the clot formation."

ANS: A Thrombi from a CVA can occlude vessels, cutting off oxygen supply to cells of the brain and causing a seizure.

When turning the patient who is in Crutchfield tongs traction, the nurse should employ which technique? a. Turn the patient as a unit by log rolling. b. Release the weights to prevent injury while turning. c. Turn the patient quickly to avoid muscle spasms. d. Advise the patient to hold his breath and bear down during turning.

ANS: A Turning the patient as a unit by log rolling with the weights in place immobilizes the affected vertebrae and maintains alignment. Releasing the weights or turning quickly will affect vertebrae and alignment. Deep breathing will decrease muscle tension.

The nurse is caring for an adolescent who has lower limb paralysis after sustaining a spinal injury yesterday. The patient's anxious mother asks if the paralysis is permanent. Which response is most appropriate for the nurse to make? a. "It is possible that motor function may or may not return after spinal cord swelling has subsided." b. "Motor function may improve, but there will always be a deficit." c. "In all likelihood, the paralysis will be permanent." d. "Have you asked the physician about your concerns?"

ANS: A Until spinal cord edema has subsided, the extent or the permanency of the paralysis cannot be evaluated. It would be incorrect to indicate that there will definitely be a deficit or paralysis. Not addressing the question and suggesting only to talk to the physician will likely frighten the parent.

The loss of neurons in the autonomic nervous system (ANS) of the older adult will cause the older adult to take longer to complete which action(s)? (Select all that apply.) a. Recuperate from an illness b. Apply brakes to stop a car c. Form words into sentences d. Climb stairs e. Learn new material

ANS: A, B Recuperation and response times are lengthened with the loss of neurons from the ANS. Taking longer to form words into sentences and learn new material result from mentation loss, and taking longer to climb stairs results from decreased strength.

After an older adult falls, the nurse suspects the development of a subdural hematoma based on which finding(s)? (Select all that apply.) a. Increasing irritability b. Complaint of a dull headache c. Frequent "nodding off" in chair during the day d. Focal seizures e. Staggering gait

ANS: A, B, C Increasing irritability and complaint of headache as well as changing level of consciousness are signs of increasing intracranial pressure. Seizures and staggering gait are not specifically indicative of subdural hematoma.

The nurse is caring for a patient admitted with a transient ischemic attack (TIA). A carotid ultrasound reveals a 40% obstruction. The nurse anticipates that the treatment will likely consist of which factor(s)? (Select all that apply.) a. Diet modification b. Lifestyle alteration c. Aspirin for antiplatelet aggregation d. Daily doses of nitrates e. Endarterectomy

ANS: A, B, C Since the patient has a carotid obstruction below 60%, the patient will likely be treated conservatively with measures that include diet and lifestyle modification in conjunction with aspirin therapy. Nitrates and endarterectomy are not initial treatment options for carotid obstruction below 60%.

The nurse is caring for a patient with Huntington chorea. Which symptom(s) is/are characteristic manifestation(s) of this disease? (Select all that apply.) a. Fidgeting b. Restlessness c. Constant movement d. Dementia e. Difficulty swallowing

ANS: A, B, C, D Huntington chorea is a degenerative neurologic disorder characterized by abnormal movements (chorea). The disease begins with the patient being fidgety and progresses to constant movement and intellectual decline. Death usually occurs within 15 to 20 years after diagnosis.

The patient with a right-sided paralysis from a stroke becomes frustrated when attempting to self-feed. He throws the spoon at the nurse and begins to cry. What nursing action(s) is/are most appropriate at this time? (Select all that apply.) a. Retrieve the spoon and sit quietly for a few seconds. b. Touch the patient and inquire if he would rather have a high-protein milkshake for his meal. c. Remind the patient that such behavior is not acceptable. d. Add an intervention to the NCP for increased support with self-feeding. e. Complete an incident report.

ANS: A, B, C, D Quietly retrieving the spoon, offering an alternative, reassuring the patient, and devoting new interventions related to the self-feeding deficit are appropriate nursing actions in this situation. Completing an incident report is not necessary unless the nurse or someone else was injured.

The FOUR (Full Outline of UnResponsiveness) tool is based on the assessment of which components? (Select all that apply.) a. Eye response b. Motor response c. Brainstem response d. Respiratory function e. Reflex response

ANS: A, B, C, D The FOUR outline evaluates eye response, motor response, brainstem response, and respiratory function. Reflex response is not part of the assessment tool.

The nurse is caring for a patient with Guillain-Barré syndrome (GBS). Which area(s) should the care plan address? (Select all that apply.) a. Assessment of advancing paralysis b. Provision for ventilation support c. Maintenance of adequate nutrition d. Prevention of complications of immobility e. Assessment of hypertension

ANS: A, B, C, D The nurse should include assessment of paralysis, provision for ventilation support, nutritional maintenance, and prevention of complications from immobility. The care plan should address assessment of hypotension rather than hypertension.

The nurse is caring for a patient with a complete transection of the cord at C7. The patient asks the nurse what functions he will be able to perform. The nurse responds that the patient will most likely be able to perform which activities? (Select all that apply.) a. Transferring himself b. Dressing himself c. Using a wheelchair with standard hand rims d. Feeding himself e. Typing using all digits

ANS: A, B, C, D With physical and occupational therapy, the patient may be able to transfer himself, dress and feed himself, and use a wheelchair with standard hand rims. The patient with an injury at C7 does not have full control of all digits. The third finger is the most functional.

Which statement(s) provide examples of ways in which individuals may be proactive in reducing neurologic injuries? (Select all that apply.) a. Refusing to start the car until all seat belts are buckled. b. Requiring children to wear bike helmets. c. Reminding swimmers to test water depth before diving. d. Encouraging use of hard hats at industrial sites. e. Discouraging recreational drug use.

ANS: A, B, C, D, E All options would be supportive of the reduction of CNS injury.

Which condition(s) may cause seizures? (Select all that apply.) a. Stroke b. Cerebral tumor c. Hyperpyrexia d. Epilepsy e. Metabolic toxicity

ANS: A, B, C, D, E Stroke, cerebral tumors, hyperpyrexia, epilepsy, and metabolic toxicity are conditions that may all potentially cause seizures

The nurse is educating a patient about his cluster headaches. The nurse includes information that cluster headaches may be accompanied by which signs or symptoms? (Select all that apply.) a. Reddened conjunctiva b. Nasal congestion c. Ptosis d. Lethargy e. Sensitivity to touch

ANS: A, B, C, E Manifestations of cluster headaches may include severe unilateral orbital, supraorbital, or temporal pain along with one of the following: redness of the conjunctiva of the eye, tearing, nasal congestion, dripping nose, facial swelling, pupil constriction, ptosis (drooping) of the eyelid, and sensitivity to touch. Cluster headaches might cause restlessness (patients often pace), not lethargy.

The nurse is caring for an adult patient with a history of seizures. In the event of a seizure, the nurse should document which information? (Select all that apply.) a. Duration of seizure b. Location of initiation of seizure c. Description of movements d. Family's reaction during the seizure e. Presence of incontinence

ANS: A, B, C, E The nurse should document seizure duration, location of seizure initiation, description of unilateral or bilateral movement, and presence of incontinence. The family's reaction to the seizure is not included in documentation of a seizure.

The nurse outlines nutritional needs for the patient with multiple sclerosis (MS). Which dietary instruction(s) is/are most important for the nurse to emphasize? (Select all that apply.) a. Maintain fluid intake of at 1500 mL each day. b. Include intake of high-fiber foods in the diet. c. Include high intake of carbohydrates. d. Add supplemental calcium and vitamin D to the diet. e. Increase intake of high-fat foods.

ANS: A, B, D Fluids and high fiber in the diet will prevent constipation, and calcium and vitamin D will help in preventing osteoporosis. High levels of carbohydrates and fats are not emphasized in the diet for an MS patient.

The nurse is caring for a patient with (AD). The nurse should assess the patient for which conditions or situations? (Select all that apply.) a. Distended bladder b. Constipation c. Increased fluid intake d. Wrinkles in bed linens e. Abrupt environmental temperature changes

ANS: A, B, D, E Bladder distention, constipation, wrinkled bed linens, and temperature changes are potential triggers for AD that the nurse should assess for. This condition causes a rapid increase in blood pressure. Increased fluid intake is not relevant to AD.

To help prevent aspiration while feeding a patient who has a right-sided paralysis, the nurse should implement which intervention(s)? (Select all that apply.) a. Place the patient in high Fowler position. b. Instruct the patient to tilt the head and neck forward. c. Instruct the patient to drink liquids through a straw. d. Place food in the left side of the mouth. e. Avoid mixing foods with different textures.

ANS: A, B, D, E To help prevent aspiration in this patient, the nurse should position the patient in high Fowler position, instruct the patient to tilt the head and neck forward, place food in the left side of the mouth, and avoid mixing foods with different textures. Drinking through a straw rather than sipping from a cup increases the risk for aspiration.

The student nurse is researching relapsing-progressive forms of multiple sclerosis (MS). What characteristic(s) is/are typical of this form of the disease? (Select all that apply.) a. Steadily worsens b. Partial remissions c. Clear, acute relapses d. Temporary minor improvements e. Long plateau periods

ANS: A, C Steady worsening and clear acute relapses are the principle characteristics of relapsing-progressive MS.

The nurse performs a reflex test on a newly admitted adult patient. The nurse runs a tongue blade along the sole of the foot and the patient responds with the great toe bending backward (upward) and the smaller toes fanning outward. These findings cause the nurse to suspect that the patient may have experienced which problem(s)? (Select all that apply.) a. Injury to the central nervous system (CNS) that resulted in an abnormality in the motor control pathways leading from the cerebral cortex b. Myocardial infarction that resulted in hypoxemia c. Influence of chemical substances d. Damage to the peripheral nervous system (PNS) e. Trauma to the hypothalamus

ANS: A, C This response in the adult indicates a positive Babinski reflex, indicative of an abnormality in the motor control pathways leading from the cerebral cortex, or from the influence of chemical substances. Hypoxemia, damage to the PNS, and trauma to the hypothalamus would not cause a positive Babinski reflex.

The nurse is completing a care plan for a stroke patient who is at risk for impaired physical mobility. Which interventions should the nurse include in the care plan? (Select all that apply.) a. Assist the patient to stand. b. Remind the patient to ambulate as much as possible. c. Ensure that the call light is within reach. d. Coach the patient in active range-of-motion (ROM). e. Reinforce the use of a walker or cane.

ANS: A, C, D, E Fall precautions important for this patient include helping the patient to stand, placing the call light within reach, coaching the patient in active ROM, and reinforcing the use of a walker or cane. Reminding the patient to ambulate as much as possible would potentially increase the risk of falls.

The nurse is preparing a care plan for a person with late-stage Parkinson disease. The nurse should plan interventions to address which problem(s)? (Select all that apply.) a. Dysphagia b. Hallucinations c. Immobility d. Insomnia e. Urinary incontinence

ANS: A, C, D, E The nurse should plan interventions to address dysphagia, immobility, insomnia, and urinary incontinence. Hallucinations are not part of the late Parkinson disease symptoms.

A patient diagnosed with a primary brain tumor asks the nurse if this is a common disease. Which response is most appropriate for the nurse to make? a. "Brain tumors are very rare." b. "About 40,000 people a year are diagnosed with a primary brain tumor." c. "It doesn't really matter. We are just concerned with helping you." d. "Almost all primary brain tumors are malignant."

ANS: B About 200,000 new brain tumors are discovered each year in the United States with approximately 40,000 of those being primary tumors and the rest are metastatic tumors from a different site of origin. Many primary brain tumors are benign. Telling the patient his question doesn't really matter is dismissive and nontherapeutic.

The dysarthric patient seated in the dining room of the long-term care facility yells, "Poon! Poon! Poon!" with increasing frustration. What is the nurse's best response? a. "Slow down so that I can understand what you are saying." b. "Are you asking for a spoon?" c. "Not being able to speak is frustrating." d. "If you tell me what you want, I will get it."

ANS: B Attempting to interpret the dysarthric communication through questions that can be answered simply will reduce frustration.

The nurse is providing medication teaching to a patient with epilepsy who is taking phenytoin (Dilantin). Which statement best indicates that the nurse's teaching has been successful? a. "I should decrease my alcohol intake to a single drink per day." b. "I should visit the dentist every 3 to 6 months while taking this medication." c. "I should take my antacid an hour after my Dilantin." d. "This medication may turn my urine orange."

ANS: B Dilantin can cause gingival hyperplasia. The patient should brush teeth and floss regularly, and schedule dentist visits every 3 to 6 months. Alcohol interferes with the metabolism of anticonvulsants, increases lethargy, and may trigger seizures. The patient should not consume alcohol at all while taking Dilantin. The patient should not take antacids within 2 hours of taking Dilantin. Dilantin may turn the urine pink.

The nurse is assessing an 80-year-old patient. The nurse correctly attributes the slowed knee jerk reflex with which age-related change? a. Diminished brain cells b. Degeneration of myelin sheath c. Weakened muscles d. Irritation of nerve rootsf

ANS: B In the peripheral nervous system (PNS), the motor nerve fibers and the myelin sheath degenerate with advancing age; reflexes may become diminished or absent with advanced age.

The nurse instructs a person taking phenytoin (Dilantin) that periodic blood tests will be necessary. The nurse explains that the laboratory checks will monitor for which potential medication-induced change? a. Potassium depletion b. Liver damage c. Increasing creatinine d. Increasing sedimentation rates

ANS: B Periodic blood tests are recommended for people taking phenytoin to monitor for liver damage.

The nurse is caring for a patient with spastic paralysis. Which technique is most appropriate for the nurse to use when moving the patient? a. Firmly grasp the muscles. b. Use the palms of hands to support the joints. c. Log roll the patient as a unit. d. Perform passive range-of-motion (ROM).

ANS: B Spastic paralysis features involuntary skeletal muscle contractions. These muscle spasms may be violent enough to throw the patient from the bed or wheelchair and must be anticipated, and the patient must be secured so that accidents can be avoided. To avoid stimulating the muscles when moving the patient and thereby precipitating a spasm of the muscles, the nurse should avoid grasping the muscle itself. Instead, the nurse should use the palms of the hands to support the joints above and below the affected muscles. Firmly grasping the muscles, log rolling, and ROM may initiate spasms.

The patient is caring for a patient who spontaneously opens his eyes, localizes pain, and carries out confused conversation. The nurse correctly documents which Glasgow Coma Scale (GCS) rating for this patient? a. 12 b. 13 c. 14 d. 15

ANS: B The GCS is used to evaluate a patient's neurologic functioning and level of consciousness. Scores range from 3 to 15 points. The higher the score, the higher the level of consciousness. Spontaneous eye movement (4 points), localizing pain (5 points), and confused conversation (4 points) total a GCS rating of 13.

The nurse is performing a neurologic assessment on a newly admitted patient with a head injury. Which sign best indicates that the patient may have experienced a brainstem injury? a. Nystagmus b. Decerebrate posturing c. Seizure activity d. Glasgow Coma Scale score of 3

ANS: B The appearance of decerebrate, as well as decorticate, posturing is an indicator of brainstem injury. Nystagmus, seizures, and a GCS score of 3 are not necessarily signs of brainstem injury.

The nurse is caring for a patient with a neurologic injury who is awake. On assessment, the patient displays mild disorientation to surroundings and time and needs additional verbal cues to stimulate response to commands. The nurse correctly documents the patient's level of consciousness (LOC) by using which term? a. Alert b. Confused c. Lethargic d. Obtunded

ANS: B The confused patient is awake, but slightly confused and needs coaching to respond to commands. Alert indicates appropriate response to questions and commands with little stimulation. Lethargic is described as the patient being drowsy, but easily aroused. Obtunded patients are more difficult to arouse and respond slowly to stimulation.

A patient is admitted to the hospital to rule out the possibility of bacterial meningitis. Which test will be most helpful in diagnosing this condition? a. Magnetoencephalography (MEG) b. Myelography c. Cerebral angiography d. Lumbar puncture for cerebrospinal fluid (CSF) analysis and culture

ANS: D A lumbar puncture is performed to remove a sample of CSF to detect abnormalities that are indicative of specific neurologic problems and determine which organism is responsible for an infection such as bacterial meningitis.

To enhance more erect posture in the patient with Parkinson disease, the nurse should encourage the patient to practice which activity? a. Imagine stepping over an object. b. Sleep in the prone position. c. Walk with a marching step. d. Limit exercise to increase joint mobility.

ANS: B The nurse should teach the patient to consciously assume correct posture. Sleeping in the prone position without a pillow will help to improve erect posture. Imagining stepping over something helps prevent "freezing" when walking. Walking may also improve by having the patient think about imaginary lines across the pathway on which to walk. The patient should be encouraged to exercise; the physical therapist will institute an exercise program to help the patient maintain muscle function and promote joint mobility.

The patient with a suspected subdural hematoma is on an intravenous (IV) drip of mannitol infusing at 50 mL/hr. The nurse explains that the slow infusion rate is essential for what purpose? a. To ensure effectiveness of the drug. b. To avoid fluid overload. c. To maintain electrolyte balance. d. To maintain adequate blood pressure (BP).

ANS: B The slow infusion rate will not cause fluid overload, which would add to the possibility of increased intracranial pressure (ICP).

A patient was recently diagnosed as having Bell palsy. Which nursing intervention is most important for the nurse to include in the patient's care plan? a. Administer pain medication as needed. b. Administer artificial tears and aclyclovir. c. Implement aspiration precautions. d. Offer the patient a small fan to cool the face.

ANS: B Treatment consists of closing and patching the eye if it loses the blink reflex. Artificial tear eyedrops also are used to prevent dryness of the cornea. Corticosteroids are given if they can be started right after the beginning of symptoms. They are ineffective if delayed more than 7 days. Acyclovir may be prescribed as well, since herpes virus may be a causative organism. Bell palsy is usually a painless condition. Bell palsy does not pose a particular risk for aspirations. Cool air may trigger or exacerbate Bell palsy.

The nurse is assessing a patient with Parkinson disease. Which statement likely characterizes this patient's tremors? a. Tremors occur constantly. b. Tremors decrease with voluntary movement. c. Tremors are absent when the body is at rest. d. Tremors are characterized by tonic/clonic muscle activity.

ANS: B Tremors in Parkinson disease decrease with voluntary movement, are absent during sleep, and occur when the body is at rest. Parkinsonian muscle activity is that of "pill rolling." Tonic/clonic movement is associated with seizures.

The patient scheduled for a PET (positron emission tomography) scan of the brain asks if there is any special preparation for the test. The nurse correctly responds with which statement(s)? (Select all that apply.) a. "There is no special preparation involved with this test since it is noninvasive." b. "You should avoid any tranquilizers or sedatives the night before and the day of the test." c. "You will need to sign a consent form for this test to be performed." d. "You will have two IVs inserted for the examination." e. "You should wait to empty your bladder once the test is completed."

ANS: B, C, D During a PET scan, radioactive material is given through an intravenous (IV) line and provides differing color in areas of cellular activity. A consent form is required because this is an invasive test, and tranquilizers and sedatives should be avoided because this PET scan is of brain activity. The test requires insertion of two IVs. Obviously, special preparation is indicated, and the patient should empty his bladder before the test begins.

The nurse documents which sign(s) of epidural hematoma in a patient with a closed head injury? (Select all that apply.) a. Mottling of extremities b. Periorbital ecchymosis c. Battle sign d. Nausea and vomiting e. PERRLA

ANS: B, C, D Raccoon eyes (periorbital ecchymosis), bruising behind the ears (Battle sign), and nausea and vomiting are some of the typical signs of epidural hematoma.

The nurse is aware that an epidural hematoma warrants immediate intervention based on which criteria? (Select all that apply.) a. An epidural hematoma is related to bleeding from arterial venous source. b. An epidural hematoma can increase intracranial pressure (ICP) quickly. c. An epidural hematoma changes overall condition quickly. d. An epidural hematoma can cause death. e. An epidural hematoma can cause irreversible brain damage.

ANS: B, C, D, E An epidural hematoma can increase ICP quickly, changes overall condition quickly, and can cause death or irreversible brain damage. Bleeding is related to an arterial source. An epidural hematoma is a medical emergency.

The nurse is evaluating the patient to determine if adequate learning has occurred regarding care of lower back pain. Which activities indicate that the patient adequately understands the nurse's teaching? (Select all that apply.) a. The patient carries items away from the center of the body. b. The patient bends the knees, with the back straight, and crouches to lift an item off the floor. c. The patient uses a lumbar pillow or roll when sitting for long periods. d. The patient performs proper back exercises twice a day. e. The patient maintains proper body weight.

ANS: B, C, D, E Bending the knees with a straight back while crouching to lift an item off the floor, using a lumbar pillow or roll when sitting for long periods, exercising twice a day, and maintaining proper body weight are actions that indicate correct lower back care. The patient should carry items close to the center of the body rather than away from the center of the body.

The nurse uses a visual aid to demonstrate how a coup-contrecoup injures the brain. Which information should the nurse include? (Select all that apply.) a. These injuries allow the brain to twist on the brainstem. b. These injuries cause the brain to move forward to strike the anterior interior skull. c. These injuries allow the brain to compress on itself. d. These injuries cause the brain to strike the bony area opposite of the site of impact. e. These injuries cause the brain to lose small amounts of cerebrospinal fluid.

ANS: B, D In a coup-contrecoup injury, the brain moves forward, striking the anterior interior wall of the cranium, and moves back, striking the bony area opposite the site of the impact, causing two areas of injury.

The nurse describes a concussion as a closed head injury in which: a. The brain tissue is bruised. b. No loss of consciousness occurs. c. There is amnesia related to the incident. d. There are no subsequent symptoms.

ANS: C A concussion is a closed head injury in which there is a brief disruption of consciousness, amnesia, and subsequent headaches that may last for several weeks.

Which symptom is a key sign of a brain tumor? a. Morning nausea b. Difficulty reading c. A headache that awakens patient d. Increasing blood pressure

ANS: C A headache that awakens the patient is an early sign of a brain tumor. Morning nausea, difficulty reading, and increasing blood pressure are nonspecific findings that can be attributed to multifactorial causes.

The nurse is caring for a patient with a closed head injury. Which finding causes the nurse to suspect that the patient has developed diabetes insipidus (DI)? a. Increased lethargy b. Widening pulse pressure c. Copious pale urine output d. Increasing blood glucose levels

ANS: C A large increase in urinary output of pale urine with a low specific gravity is the clue to the development of DI related to edema of the posterior pituitary. Antidiuretic hormone is released in inadequate amounts, resulting in polyuria, and the awake patient may complain of polydipsia (excessive thirst). IV vasopressin and fluid replacement are the preferred treatments. Lethargy and increased pulse pressure are not typical signs of DI. Increased serum glucose levels is a sign of diabetes mellitus, not DI.

The nurse interprets the physician's finding of a grade of 2/5 on the Achilles tendon to mean what has occurred? a. Hyperreflexive response for the fifth and sixth cervical nerves b. Exaggerated response for the seventh and eighth cervical nerves c. Normal response for the first and second sacral nerves d. Weak response for the second through the fourth lumbar nerves

ANS: C A score of 2/5 is a normal grade. The Achilles tendon reflex or ankle jerk reflex evaluates the first and second sacral nerves.

The emergency room nurse is assessing a newly admitted patient with a head injury. The nurse observes clear drainage from the nose. Which action should the nurse perform first? a. Document the presence of rhinorrhea. b. Inform the physician of the assessment. c. Test the fluid with a Dextrostix. d. Tape a drip pad under the nose.

ANS: C Head injury symptoms may include rhinorrhea (fluid from the nose) or otorrhea (fluid from the ear), among many others. Rhinorrhea and otorrhea should be tested to determine if there is a cerebrospinal fluid (CSF) leak. Testing with a Dextrostix will determine whether glucose is present; the presence of glucose indicates CSF. Documentation, informing the physician, and applying a drip pad under the nose are actions that should occur after confirmation of the fluid type.

When feeding a patient with dysphagia with a left-sided hemiplegia, how should the nurse position the patient? a. Side-lying on the right side b. Semi-Fowler c. High Fowler d. Upright at a table in a wheelchair

ANS: C High Fowler is the most comfortable and safe position. Sitting upright at a table may prove stressful because of weakness and impaired balance.

The nurse is assessing a patient on intravenous (IV) phenytoin (Dilantin). Which assessment finding is most concerning to the nurse? a. Blood pressure (BP) 138/92 b. Frequent hiccups c. Irregular apical pulse d. Nausea and vomiting

ANS: C IV phenytoin can cause cardiac arrhythmias and hypotension, especially if given faster than 50 mg/min.

The student nurse is planning care for a patient with a recent spinal cord injury. Which intervention indicates that the student nurse requires further instruction regarding appropriate care for this patient? a. Keep the halo jacket fastened unless the patient is in a supine position. b. Monitor the bladder every 4 hours for signs of bladder distention. c. Instruct unlicensed assistive personnel (UAP) to turn and reposition the patient every 2 hours. d. Assess compression stockings for proper fit.

ANS: C Moving or positioning the patient with neurologic injury or surgery should not be delegated to unlicensed personnel. Following proper instruction, the UAP can assist the nurse with moving or repositioning the patient. Halo jackets must be kept fastened unless the patient is in a supine position in order to prevent sudden head movement. Bladder distention should be avoided to prevent infection or autonomic dysreflexia. Compression stockings are used to prevent deep vein thrombosis.

Which type of multiple sclerosis (MS) is the most common? a. Secondary progressive b. Primary progressive c. Relapsing-remitting d. Relapsing-progressive

ANS: C Relapsing-remitting is the most common type of MS.

The home health nurse is caring for a patient with multiple sclerosis (MS) who complains of severe fatigue. What activity should the nurse suggest to diminish the effects of fatigue? a. Relaxing in a warm bath b. Performing deep-breathing exercises c. Scheduling rest periods during the day d. Including daily-dose multivitamins

ANS: C Scheduling and observing rest periods during the day will reduce fatigue. Heat increases sense of fatigue. Muscular problems are associated with ineffective impulse transmission rather than muscle weakness related to nutritional deficiency.

The patient reports intense intermittent headaches over the last 6 months that are preceded by specific symptoms. What symptom is the patient most likely experiencing? a. Nausea and vomiting b. Focal seizures c. Scotoma d. Fainting

ANS: C The headaches are most likely migraines. Scotoma (spots before the eyes) is the typical prodromal symptom of a migraine headache.

The nurse is caring for an older adult patient who was admitted to the hospital following a closed head injury that resulted in a 5-minute period of unconsciousness. The nurse most carefully monitors the patient for which change? a. Increasing respiratory rate b. Decreasing heart rate c. Decreasing pulse pressure d. Decreasing level of consciousness (LOC)

ANS: D Assessment of LOC provides the greatest amount of information about neurologic condition. A reduction in LOC may signal the onset of complications in the patient who has had a head injury.

The nurse reinforces the information given by the physician that endarterectomy as an intervention for stroke prevention is reserved for people who have carotid obstruction of greater than what percentage? a. 30% b. 40% c. 50% d. 60%

ANS: D Endarterectomy is reserved for people with carotid obstruction of more than 60%.

The nurse is caring for a stroke patient who is experiencing homonymous hemianopsia. The patient asks if he is going to have any limitations when discharged from the hospital. The nurse anticipates the patient will be restricted from what activity? a. Ambulating independently b. Cooking on a stove c. Reading a book d. Driving a vehicle

ANS: D Homonymous hemianopsia is blindness in part of the visual field of both eyes. Driving a vehicle may be very dangerous for this patient. With proper occupational therapy, the patient should be able to ambulate independently, cook, and read.

The nurse is caring for a patient with Huntington disease. The patient asks if his disease will affect future children. Which reply is most appropriate? a. "Huntingdon disease does not have a genetic component." b. "Male children would have Huntington disease and female children would be carriers." c. "Huntington disease is caused by an autoimmune response." d. "The genetic nature of the disease means that 50% of your children will inherit it."

ANS: D Huntington disease is an autosomal dominant disorder, meaning that 50% of the children of a person who has the disease will inherit it. If a child does not inherit the disease, the gene is not passed on to the next generation. Huntington disease has an autosomal link and can be passed on to 50% of the children of a person with the disease.

Which position is best for an unconscious patient with a right-sided closed head injury? a. High Fowler b. Right side-lying c. Flat with small pillow under head d. Head of bed 20 to 30 degrees

ANS: D Keeping the head of the bed 20 to 30 degrees with the body in good alignment will help reduce intracranial pressure and keep the airway patent.

Which factors predominantly determine probable diagnosis of multiple sclerosis (MS)? a. Blood tests revealing identifiable MS markers b. Lumbar puncture results revealing inflammatory response c. Muscle biopsies revealing characteristic lesions d. Signs and symptoms assessed and reported by the patient

ANS: D No laboratory test will definitively establish a diagnosis of MS, although most patients have elevated IgG levels in their cerebrospinal fluid (CSF), with the presence of oligoclonal bands (bands of IgG produced by electrophoresis of the CSF). An magnetic resonance imaging (MRI) study usually shows characteristic white matter lesions scattered through the spinal cord and/or brain, which confirms the diagnosis of MS. However, the clinical signs and symptoms presented by a patient usually are sufficient characteristics of the disorder to allow the neurologist to make a diagnosis that the patient possibly or probably has MS.

Following a craniotomy for the removal of a brain tumor, the patient exhibits nuchal rigidity, rash on the chest, headache, and a positive Brudzinski sign. What do these assessment findings indicate to the nurse? a. Intracranial bleeding b. Encephalitis c. Increasing intracranial pressure d. Meningitis

ANS: D Nuchal rigidity, skin rash, headache, and a positive Brudzinski sign are indicative of meningitis

Which behavior causes the nurse to report a positive Romberg test? a. The patient cannot keep his eyes closed. b. The patient cannot touch his nose with eyes closed. c. The patient complains of dizziness. d. The patient sways from side to side.

ANS: D Romberg test evaluates equilibrium. The patient stands with eyes closed and feet only slightly apart. Swaying from side to side during the Romberg test is a positive sign for impaired balance.

The unconscious patient with a closed head injury is on mechanical ventilation. To improve brain perfusion through increased blood pressure, the carbon dioxide (CO2) should be maintained at what level? a. 10 to 15 mm Hg b. 15 to 20 mm Hg c. 20 to 25 mm Hg d. 25 to 30 mm Hg

ANS: D The CO2 level is set to be maintained at 25 to 30 mm Hg to create vascular constriction, raise blood pressure, and perfuse the cerebrum.

The nurse is caring for a patient with flaccid paralysis after sustaining a spinal cord injury 3 days earlier. The family excitedly notifies the nurse that the patient has flexed his arm. Which response is best for the nurse to make? a. "I will give the doctor this wonderful news." b. "Avoid directly touching the arm muscles so that you don't cause more muscle spasms." c. "This movement means that the spinal cord is adjusting to the injury." d. "These muscles spasms are a type of involuntary movement that happens frequently in patients with spinal cord injuries."

ANS: D The patient is experiencing the spastic phases of paralysis that occurs as the cord adjusts to injury. The family members may interpret these spasms as a return of voluntary limb function and an indicator of impending complete recovery. First, the nurse should explain that this movement is not purposeful and an expected finding that often occurs in patients with spinal cord injuries. The nurse should not describe this finding as wonderful news. While it is important to avoid stimulating spasms when moving the patient and the technique involves avoiding direct contact with the muscles, the family could misunderstand the nurse's teaching as an accusation that someone's touch caused this movement. While the spinal cord is adjusting to injury, this statement is vague enough that the family may not realize that the movement is not purposeful.

The component of the peripheral nervous system (PNS) that carries the impulse to the central nervous system (CNS) is the ____________ impulse.

ANS: afferent The afferent impulse carries the impulse to the CNS from the PNS.

The nurse is assessing muscle strength in a fully conscious patient as part of a neurologic assessment. Which technique should the nurse employ? a. Press down on the patient's extended arms one at a time while the patient attempts to raise the arm. b. Apply pressure above the eye and push upward while the patient attempts to remove the hand. c. Pinch the trapezius muscle at the angle of the shoulder and neck while twisting the fingers slightly. d. Rub the sternum with fisted knuckles in a twisting motion while the patient attempts to remove the fist.

ANS:A To test muscle strength, have the patient extend her arms in front of her, and press down on each arm one at a time, while asking her to try to raise her arm. Applying pressure above the eye, pinching the trapezius muscle, or employing a sternal rub tests the degree of unconsciousness in a patient (and does not include asking the patient to attempt to remove the hand).

The nurse is writing the care plan for a cerebrovascular accident (CVA) patient who has partial left-sided paralysis and is experiencing ataxia. Which intervention is most beneficial for this patient? a. Encourage the patient to ambulate as much as possible when she feels the energy to do so. b. Ensure the patient receives pureed foods and thickened liquids. c. Place the patient's call light on the right side of the patient and remind her to call for assistance before getting up. d. Encourage the patient to use a communication board.

ANS:C The patient with ataxia has experienced a loss of balance or poor coordination; therefore, placing the call light on this patient's right side and reminding her to call for help will best address her high risk for falling. Pureed foods and thickened liquids are necessary for the patient with dysphagia, and a communication board would assist a patient with dysarthria or aphasia.

A student nurse questions the nurse about the difference between a quadriplegic and a tetraplegic patient. Which statement correctly describes tetraplegia? a. Tetraplegic patients are capable of fewer fine motor movements. b. Tetraplegic patients can experience pain in paralyzed parts. c. Tetraplegic patients are more easily rehabilitated. d. Tetraplegia is the newer term for the old term quadriplegia.

ANS:D Tetraplegia is the newer term for the old term quadriplegia.

The degree of consciousness in an otherwise unresponsive patient can be assessed by the use of progressive painful stimuli. Arrange the painful stimuli in the appropriate sequence of their application. a. Press on the orbital notch. b. Press the mandibular angle. c. Shake gently. d. Rub sternum. e. Pinch trapezius.

Step 1- Shake gently. Step 2- Press on the orbital notch. Step 3- Pinch trapezius Step 4- Press the mandibular angle. Step 5- Rub sternum.