Unit 8
A client with chronic low back pain presents to the clinic. In addition to a detailed pain assessment, which questions would be appropriate to ask? Select all that apply.
"Are you having trouble sleeping?"; "What kind of stressors are you experiencing?"; "Can you financially afford your medicine?"
An older adult client has been diagnosed with macular degeneration. Which statement by the client best demonstrates an accurate understanding of the new diagnosis?
"I suppose that this may be one of the things that happens when you get older."
A 2-year-old child has been diagnosed with uncomplicated acute otitis media by a nurse practitioner. When explaining the plan of care, which description is most appropriate?
"Let's keep a close eye on his condition for a couple of days before starting antibiotics."
A client asks if pain threshold and pain tolerance are the same. The best response by the health care provider would be:
"Pain threshold is the point at which a stimulus is perceived as painful"
The nurse offers a client recovering from knee surgery a prescribed opioid analgesic. The client states, "I don't find the pain that severe. I think acetaminophen will be fine." How should the nurse respond?
"This is fine as long as your pain tolerance allows you to participate in the prescribed postoperative exercises."
The nurse is teaching a client who has tinnitus about suggested dietary modifications. What information is most important for the nurse to include?
"Try cutting down on foods high in monosodium glutamate"
The nurse assesses a client's patellar reflex. The client asks, "Why do you do that test? Is it normal that my foot kicks forward?" What is the nurse's best response?
"Your response to the patellar reflex test is normal. It tells us that your peripheral and central nervous system are communicating properly with one another"
The nurse is caring for a client with a spinal cord injury who suffers from urinary retention. The client asks if there are any options besides catheterization to treat urinary retention. Which information should the nurse provide?
"if you are a candidate, you may be able to have an electrode implanted that can stimulate bladder emptying"
Which intracranial pressure (ICP) would the nurse consider a normal reading?
0 to 15 mm Hg
Which client may be experiencing the effects of neuropathic pain?
A man with pain secondary to his poorly controlled diabetes
What happens during the depolarization phase of nerve cells?
A rapid change in polarity to one that is positive on the inside, and the membrane becomes open to sodium ions
A child with a history of a seizure disorder has been observed suddenly and repetitively patting his knee. The child has a brief loss of contact with the environment and then is ready to resume normal activity. What type of seizure did this client most likely experience?
Absence seizure
A client reports sudden, acute left eye pain with blurred vision and a headache on the affected side. The client is most likely experiencing:
Acute angle-closure glaucoma
The nurse is teaching a client about the treatment of open-angle glaucoma. The most appropriate information for the nurse to give the client would be:
Administration of topical beta-adrenergic antagonists to lower the pressure.
A client arrives at the emergency department after experiencing multiple trauma. During the assessment, the client was unable to discern which side of the body was feeling pain or stimulus, was nauseous, and failed the two-point discrimination test. Which spinal pathway is still intact?
Anterolateral tract
A client arrives at the clinic reporting back pain, left-sided sciatic pain radiating down the thigh, and numbness on the outer aspect of the left foot. the client's blood pressure is 150/92 mm Hg, pulse rate is 102 beats/min, respiratory rate is 18 breaths/min, and the skin is intact, warm, and dry. Which clinical manifestation(s) will be labeled as "symptoms"? Select all that apply.
Back pain; left-sided sciatic pain radiating down the thigh; numbness on the outer aspect of the left foot
A client who has cut a finger drops the knife in pain. Which component of this pain signal was transmitted by third-order neurons?
Between the thalamus and the cerebral cortex
The pia mater is a connective tissue sheath that covers the spinal cord and primarily contains which body structure?
Blood vessels
Which cardinal assessment finding would lead the nurse to suspect a client has developed Parkinson disease?
Bradykinesia
A teenager has been in a car accident and experienced an acceleration-deceleration head injury. Initially, the client was stable but then started to develop neurological signs/symptoms. The nurse caring for this client should be assessing for which type of possible complication?
Brain contusions and hematomas
At which level of the cervical spine would a complete cord injury result in the client retaining the ability to flex and extend the fingers?
C8
A 14-year-old girl has been thrown from the back of a pick-up truck. MRI shows complete cord injury at the level of C2. What is the main significance of an injury at this level of the spinal column?
Cannot breathe on own, needs ventilator assistance
Peripheral nerve disorders are not uncommon. What is an example of a fairly common mononeuropathy?
Carpal tunnel syndrome
Severe head trauma from a coup-contrecoup injury may result in which type of brain injury?
Cerebral hematoma
Which intracranial volume is most capable of compensating for increasing intracranial pressure?
Cerebrospinal fluid
Drugs like diazepam, a benzodiazepine, exert their action on ion channels. These drugs do not open the GABA-operated ion channel, but they:
Change the effect that GABA has when it binds to the channel at the same time as the drug
A client with a diagnosis of epilepsy has required surgical removal of part of her prefrontal cortex. Which effect should her family and care team anticipate?
Changes in behavior and judgment
The nurse is caring for a client with cataracts. Which assessment findings does the nurse anticipate? (Select all that apply.)
Clouding of the lens; decreased visual acuity
Select the function of the occipital lobe.
Color, motion, and depth perception
A client who is diagnosed with seizures describes feeling a strange sensation before losing consciousness. The family members report that the client has been smacking his lips prior to having a seizure. Which type of seizure disorder presents with these symptoms?
Complex partial or focal seizure with impairment of consciousness
A client presents to the clinic complaining, "I have something in my eye." When questioned, the client admits to a scratching and burning sensation and light sensitivity. The health care provider suspects the client has developed:
Conjuctivitis
The health care provider is concerned that a client may be at risk for problems with cerebral blood flow. The most important data to assess would be:
Decreased level of oxygen
The family of a multiple sclerosis client asks, "What psychological manifestations may we expect to see in our mother?" The health care provider informs them to expect which of the following? Select all that apply.
Depression, inattentiveness, forgetfulness
The client presents with a traumatic complete spinal cord transection at the C5 level. Based on this injury, the health care worker can expect the client to have control of which body function/part?
Diaphragm
Unlike disorders of the motor cortex and corticospinal (pyramidal) tract, lesions of the basal ganglia have which effect on motor ability?
Disrupt movement without causing paralysis
The nurse is caring for an older adult client with Parkinson disease who has been prescribed levodopa-carbidopa. The client is having increased difficulty initiating voluntary movement. Which class of medication will the nurse recommend to the health care provider as most appropriate?
Dopamine agonist
A client with Parkinson disease presents with bradykinesia and an altered gait. These symptoms arise in response to the progressive deterioration of which structure in the brain?
Dopamine nigrostriatal system
Which principles should underlie the pain control strategy in the care of a child with a diagnosis of cancer?
Dosing and timing should aim for a steady serum level of the prescribed drug
Which of the meninges provides the major protection for the brain and spinal cord?
Dura mater
Which characteristic differentiates open-angle glaucoma from angle-closure glaucoma?
Dysfunction of the aqueous humor drainage system
The nurse is caring for a client who has just been diagnosed with relapsing-remitting multiple sclerosis (MS). Which information will the nurse include when teaching the client about the condition? Select all that apply.
Early treatment with beta interferon medications is highly recommended; there will be periods when neurological function will be relatively stable; acute exacerbations will occur and may require a temporary change in treatment
A parent of a child with otitis media with effusion (OME) asks, "How is this different from typical acute otitis media (AOM)?" Which response by the nurse correctly identifies the main difference?
Excess middle ear fluid
A 60-year-old client's long history of poorly controlled hypertension has culminated in a diagnosis of retinal detachment. What type of retinal detachment is this client most likely to have experienced?
Exudative retinal detachment
A client with a history of a seizure disorder has been observed suddenly and repetitively patting his knee. After stopping this repetitive action, the client appears confused—he is oriented to person and place but not time. What type of seizure did this client most likely experience?
Focal seizure with impairment to consciousness
Following a case of "the flu," a client develops symmetrical limb weakness and loss of tendon reflexes. Which disorder of neuromuscular function typically has this rapid onset of flaccid paralysis?
Guillain-Barré syndrome
A client has sustained damage to cranial nerve VIII. The nurse recognizes that the client may experience difficulty with:
Hearing
A client arrives in the clinic after having a tongue piercing performed and is unable to control the movement of the tongue. The nurse is aware that which nerve may have been damaged from the piercing?
Hypoglossal
The health care provider is assessing the muscle tone of a client who has been diagnosed with a lower motor neuron (LMN) lesion. Which assessment finding is congruent with the client's diagnosis?
Hypotonia
A family brings a client to the emergency department with increasing lethargy and disorientation. They think the client had a seizure on the drive over to the hospital. The client has been sick with a "cold virus" for the last few days. On admission, the client's temperature is 102°F (38.9°C). Which other clinical manifestations may lead to the diagnosis of encephalitis?
Impaired neck flexion resulting from muscle spasm
Among the treatments for multiple sclerosis (MS), which medication will reduce the exacerbation of relapsing-remitting MS?
Interferon-B, a cytokine injection
A client's emergency magnetic resonance imaging (MRI) has been examined by the physician and tissue plasminogen activator (tPA) has been administered to the client. What was this client's most likely diagnosis?
Ischemic stroke
The nurse is caring for a client who is displaying signs of an acute ischemic stroke. The nurse associates the neurologic symptoms with which primary pathophysiologic process?
Lack of access to oxygen and glucose, resulting in cellular dysfunction
The nurse is assessing sensation along dermatomes for a client who is receiving a spinal anesthetic. Which information is the nurse collecting by assessing sensation along the dermatomes?
Level at which the spinal nerves are being affected by the anesthetic
The region of the brain involved in emotional experience and control of emotional behavior is the:
Limbic system
A 5-month-old infant is being treated for acute otitis media (AOM) for the second time in the past 10 weeks. Which action should the nurse recommend to prevent future recurrences?
Limiting the infant's exposure to large group settings
Which role do supporting cells of the nervous system—such as Schwann cells, satellite cells, and types of glial cells—provide in functioning to protect neurons?
Local protection
The emergency room doctor suspects a client may have bacterial meningitis. The most important diagnostic test to perform would be:
Lumbar puncture
The nurse is assessing a client who has been diagnosed with esotropia. The nurse would expect the assessment findings to include:
Medial deviation
Which is a manifestation(s) of peripheral neuropathy? Select all that apply.
Muscle wasting, muscle weakness, sensory changes
Which peripheral nerve injury will likely result in cellular death with little chance of regeneration?
Nerve fibers destroyed close to the neuronal cell body
During embryonic development, which structure develops into the central nervous system (CNS)?
Neural tube
The nurse is caring for a client experiencing phantom limb pain after amputation. The nurse applies which theory of pain to best help explain the client's pain?
Neuromatrix
The nurse is assessing the function of a client's cranial nerves. Which technique should the nurse use in assessing cranial nerve XII function?
Note any deviation when the client sticks out the tongue
To maintain fixation on stable objects during head rotation, the eyes slowly drift in the opposite direction and then jump rapidly back toward the direction of rotation. This process is known by what term?
Nystagmus
What disease results from the degeneration of the dopamine nigrostriatal system of the basal ganglia?
Parkinson disease
The basis for assessing the function of any peripheral nerve lies in which principle?
Peripheral nerves contain processes of more than one of the four afferent and three efferent cell columns
A client's recent computed tomography (CT) scan has revealed the presence of hydrocephalus. Which treatment measure is most likely to resolve this health problem?
Placement of a shunt
With aging, progressive inelasticity and thickening of the lens causes which accommodation disorder?
Presbyopia
Which stimulus would be used to elicit the withdrawal reflex when testing response to nociceptive stimuli?
Pressure from a sharp object
A client with laryngeal dystonia has gotten to the point that people on the telephone cannot understand her. She has heard about getting Botox injections into her vocal cords. The nurse will teach about the actions of Botox. What is the most accurate description? This drug:
Produces paralysis of the larynx muscles by blocking acetylcholine release
The nurse is assessing a client's hearing and wants to determine if the client has hearing loss of certain frequencies. Which audiometry test will the nurse perform?
Pure-tone audiometry
Neurotransmitters exert their actions through specific proteins that are known as:
Receptors
A client is experiencing chest pain that radiates to the left arm and neck. The nurse would interpret this pain as:
Referred
The transmission of impulses at the neuromuscular junction is mediated by which action?
Release of neurotransmitter acetylcholine from autonomic nerve endings
A client is devastated to receive a diagnosis of amyotrophic lateral sclerosis (ALS). The symptomatology of this disease is a result of its effects on upper and lower motor neurons. The health care provider caring for this client will focus on which priority intervention for this client?
Respiratory ventilation assessment and prevention of aspiration pneumonia
Which types of cells are supporting cells of the peripheral nervous system?
Schwann cells
The nurse is caring for an older adult client with a suspected diagnosis of presbycusis. Select the most likely manifestation.
Sensorineural hearing loss caused by natural aging
Full localization, discrimination of intensity, and interpretation of somatosensory stimuli requires processing by which region of the brain?
Somatosensory cortex
The vertebral column provides protection of which parts of the body? Select all that apply.
Spinal cord, spinal nerves, supporting structures
A client who experiences constant cloudiness of vision, sees floaters, and has an opaque lens is diagnosed with a cataract. The most appropriate treatment would be:
Surgical lens replacement to correct vision
Neurons communicate with each other through which structure?
Synapses
Which lobe of the brain performs functions of perception, long-term memory, and recognition of auditory stimuli?
Temporal lobe
The nurse is explaining to a client's family how vasogenic brain edema occurs. The most appropriate information for the nurse to provide would be:
The blood-brain barrier is disrupted, allowing fluid to escape into the extracellular fluid
A nurse is discussing how vascular dementia differs from Alzheimer disease with a client. Select the most appropriate information.
The main presenting symptom of vascular dementia is slow psychomotor function.
A student is feeling inside her backpack to find her mobile phone. There are a number of other items in the backpack. Which component of somatosensory conduction is most likely to provide the detailed sensory information that will help her distinguish her phone from other items?
The primary dorsal root ganglion neuron, dorsal column neuron, and the thalamic neuron
Which do chemical synapses rely on to provide communication between neurons?
Transmitter molecules
A 2-year-old child who has had otitis media (OM) for 4 months and been treated with several courses of antibiotics now appears to have some hearing loss. The nurse anticipates that the most appropriate treatment for the child would be:
Tympanostomy tube insertion
A client is devastated to receive a diagnosis of amyotrophic lateral sclerosis (ALS). The symptomatology of this disease is a result of its effects on which region of the brain?
Upper and lower motor neurons
A client has experienced the α1-receptor stimulation. The nurse would assess the client for:
Vasoconstriction
A client with a history of migraine headaches tells the physician that he or she usually experiences an aura before the onset of the headache. The client is most likely experiencing:
Visual disturbances ences
Which characteristic differentiates a migraine with aura from a migraine without aura?
Visual symptoms such as flickering lights precede the headache
Overstimulation of glutamate receptors is the cause of which type of brain injury?
excitotoxic
A client who suffered cardiac arrest had cardiopulmonary resuscitation (CPR) performed for 20 minutes. The client is sedated and on mechanical ventilation. A family member asks if there will be brain damage when the client wakes up. Which factor is most important when determining the risk for neurologic impairment?
how effectively CPR maintained cerebral perfusion
A client tells the health care provider he has noticed a recent change in his vision: he can bring distant images into focus, but near images become blurred. The client has most likely developed:
hyperopia.
The ophthalmologist is performing a client's annual eye exam and notes an increase in intraocular pressure. The condition most likely is the result of:
imbalance between aqueous production and outflow.
The nurse is making a plan of care for a client in the initial stage of otosclerosis. Which assessment finding correlates to the early development of this diagnosis?
inability to hear whispering
The nurse is caring for a client who has a visual acuity reported as 20/15 from a Snellen chart assessment. Which action should the nurse take related to these findings when planning care for the client?
make no alterations to the patient's care plan based on the visual acuity results
A client seeks medical care when he wrecks his car because of poor eyesight. At the time of admission, his blood glucose level was 390 mg/dL. The client is diagnosed with diabetes (type 2). The ophthalmologist must perform an urgent intravitreal injection. The nurse explains this to the client by stating the doctor will:
put a needle with syringe into your eyeball and inject some medication to decrease active bleeding.
The nurse is assessing a client and notes the client is now displaying decerebrate posturing. The position would be documented as:
rigidity of the arms with palms of the hands turned away from the body and with stiffly extended legs and plantar flexion of the feet.
While walking down the street, a cat jumps out of an alley into the pathway of an adult. They note that the man's heart is "racing." This physiologic response is primarily due to:
secretions of sympathetic neurotransmitters produced in the adrenal medulla
