Unit 9
A 20-year-old college student has presented to his campus medical clinic because of his unshakable despondency in recent months. He has been diagnosed with depression based on his signs, symptoms, and history. The nurse knows that which of the following treatments will likely be prescribed for this student? A) Medication that inhibits the reuptake of serotonin in his presynaptic space B) Drugs that inhibit the accumulation of cyclic adenosine monophosphate (cAMP) C) Benzodiazepines such as clonazepam that modulate his GABA receptors. D) Cholinesterase inhibitors that potentiate the action of available acetylcholine E) Antipsychotics such as olanzapine
A
A 20-year-old has been diagnosed with an astrocytic brain tumor located in the brain stem. Which of the following statements by the oncologist treating the client is most accurate? A) "Your prognosis will depend on whether we can surgically resect your tumor." B) "Our treatment plan will depend on whether your tumor is malignant or benign." C) "This is likely a result of a combination of heredity and lifestyle." D) "The major risk that you face is metastases to your lungs, liver, or bones."
A
A 45-year-old diabetic male is experiencing erectile dysfunction. If his erectile dysfunction is caused by the nervous system, then the nurse can educate the patient that the venous blood supply to the penis is controlled by A) sacral parasympathetic fibers. B) the hypothalamus. C) the vagus nerve. D) postganglionic sympathetic neurons
A
A 5-year-old boy has starting sitting up in bed displaying signs of extreme anxiety. In the morning, when the parents ask the boy about this, he has no recollection. What should the nurse convey to the parents if this happens again? A) Assist the boy in settling down without awakening him after an episode. B) Watch him closely to see if he has any twitching or thrashing about. C) Bring him back to the clinic if this keeps happening, so we can prescribe some sleep medicine. D) Shake him to wake him up, and then comfort him and put him back in bed.
A
A 50-year-old woman has experienced devastating consequences in her family and work life as a result of her long-standing alcohol addiction. The levels and pathways of which of the following neurotransmitters in her body are likely to differ from an individual without addiction? A) Dopamine B) Acetylcholine C) Serotonin D) Norepinephrine
A
A badly burned firefighter has been in an induced coma for 3 weeks. When he awakens, he thanks his son for singing Happy Birthday to him a week earlier. Which part of the brain is responsible for allowing him to hear and comprehend while comatose? A) Thalamus B) Hypothalamus C) Corpus callosum D) Basal ganglia
A
A client with a diagnosis of insomnia is surprised when his physician explains to him that his brain is still highly active during normal sleep. Which of the following statements best captures the character of brain activity during sleep? A) "Fewer neurons in your brain are firing when you're asleep, but they're more synchronized than when you're awake." B) "While you're obviously less aware of stimuli when you're asleep, your brain is actually more active when you're asleep than when you're awake." C) "There are four types of brain activity, and actually all of them occur at different stages of sleep." D) "Your brain alternates between periods of activity and periods of inactivity when you're asleep, and these correspond to your eye movement."
A
A male newborn infant has been diagnosed with spina bifida occulta. Which of the following pathophysiological processes has most likely contributed to the infant's health problem? A) The neural groove failed to fuse and completely close across the top of the neural plate. B) The infant's spinal cord and meninges protrude through his skin. C) The child's central and peripheral nervous systems have insufficiently differentiated during embryonic development. D) The infant's soma and viscera are underdeveloped.
A
A psychiatrist is providing care for a 68-year-old female whose anxiety disorder is significantly decreasing her quality of life. The nurse knows that the client will likely benefit from which of the following pharmacologic therapies listed below? A) A drug that influences gamma-aminobutyric acid (GABA) levels B) An MAO inhibitor to increase the concentration of serotonin and norepinephrine C) An antipsychotic medication that blocks dopamine receptors D) A calcium channel-blocking agent
A
A student notices that at certain times during his studying for final exams, he is more awake and his ability to think at a higher level is happening easier. The nurse knows that this experience may be attributed to which of the following neurological functions? A) Release of excitatory neurotransmitters such as glutamate B) Release of GABA, an inhibitory neurotransmitter C) Release of corticotrophin-releasing hormone D) Heightened precortex processes
A
During a clinical assessment of a 68-year-old client who has suffered a head injury, a neurologist suspects that a client has a sustained damage to her vagus (CN X) nerve. Which of the following assessment findings is most likely to lead the physician to this conclusion? A) The client has difficulty swallowing and has had recent constipation and hypoactive bowel sounds. B) The client is unable to turn her head from side to side, and her tongue is flaccid. C) The client has a unilateral facial droop, dry eyes, and decreased salivary production. D) The client is unable to perform any fine motor movements of her tongue.
A
During a flu shot clinic, one of the questions the student nurse asks relates to whether the patient has had Guillain-Barré syndrome in his medical history. The patient asks, "What is that?" How should the nursing student reply? A) "A type of paralysis that affects movement on both sides of the body that may even involve the respiratory muscles" B) "Swelling of your arm where you got your flu shot, and maybe your eyes and lips had some swelling as well" C) "A degenerative disease where you have trouble walking without the help of a cane or walker" D) "Influenza-like illness where you had fever and chills for 2 to 3 days after your last flu shot"
A
During an acute phase of schizophrenia when the patient is experiencing hallucinations and delusions, the nurse should anticipate that the physician will prescribe which of the following medication categories listed below? A) An antipsychotic like risperidone B) A benzodiazepine like lorazepam C) A cholinesterase inhibitor like donepezil D) An opioid receptor antagonist like naltrexone
A
Following a collision while mountain biking, the diagnostic workup of a 22-year-old male has indicated the presence of an acute subdural hematoma. Which of the following pathophysiological processes most likely underlies his diagnosis? A) Blood has accumulated between the man's dura and subarachnoid space. B) Vessels have burst between the client's skull and his dura. C) A traumatic lesion in the frontal or temporal lobe has resulted in increased ICP. D) Blood has displaced CSF in the ventricles as a consequence of his coup-contrecoup injury.
A
The nurse is educating the new mother about the sleep patterns of a newborn. Which of the following statements should she include in her education? A) "Newborns usually sleep approximately 16 to 20 hours/day." B) "Newborns generally sleep 6 to 8 hours/day and then are awake for 2 to 4 hours." C) "Don't worry about them sleeping too long; they will wake up when they are hungry." D) "Most newborns will have their days and nights mixed up."
A
The parents of a 15-year-old boy are frustrated at his persistent inability to fall asleep at a reasonable hour at night, as well as the extreme difficulty that they have rousing him in the morning. While sleepy after waking, the son claims not to feel drowsy after lunch or in the evening. What is the most likely classification of the boy's sleep disorder? A) Delayed sleep phase syndrome (DSPS) B) Non-24-hour sleep-wake syndrome C) Advanced sleep phase syndrome (ASPS) D) Chronic insomnia
A
The unique clinical presentation of a 3-month-old infant in the emergency department leads the care team to suspect botulism. Which of the following assessment questions posed to the parents is likely to be most useful in the differential diagnosis? A) "Have you ever given your child any honey or honey-containing products?" B) "Is there any family history of neuromuscular diseases?" C) "Has your baby ever been directly exposed to any chemical cleaning products?" D) "Is there any mold in your home that you know of?"
A
When educating a patient about to undergo a pacemaker insertion, the nurse explains the normal phases of cardiac muscle tissue. During the repolarization phase, the nurse will stress that membranes must be repolarized before they can be reexcited. Within the cell, the nurse understands that A) potassium channels open while sodium channels close, causing repolarization to the resting state. B) the influx of calcium is the primary stimulus for the repolarization of cardiac tissue. C) only the electrical activity within the heart will determine when repolarization occurs. D) the cell membranes need to stay calm resulting in muscle tissue becoming refractive.
A
Which of the following clients' signs and symptoms would allow a clinician to be most justified in ruling out stroke as a cause? An adult A) has had a gradual onset of weakness, headache, and visual disturbances over the last 2 days. B) has experienced a sudden loss of balance and slurred speech. C) has vomited and complained of a severe headache. D) states that his left arm and leg are numb, and gait is consequently unsteady.
A
Which of the following diagnostic findings is likely to result in the most serious brain insult? A) Mean arterial pressure (MAP) that equals intracranial pressure (ICP) B) Moderate decrease in brain tissue volume secondary to a brain tumor removal C) Increased ICP accompanied by hyperventilation D) High intracellular concentration of glutamate
A
Which of the following is the most likely course of Wernicke syndrome? A) If the symptoms are correctly diagnosed, most of the effects of the disease can be reversed through better nutrition and supplemental thiamine. B) Wernicke syndrome is uniformly fatal, with death most often occurring within a few months of onset. C) Wernicke syndrome has no treatment, but drugs may be used to treat its associated dyskinesias and behavioral disturbances. D) The course of the disease is relentless, and most affected persons will die of infection within 2 to 10 years.
A
A 41-year-old woman was diagnosed with multiple sclerosis (MS) 7 years ago and is sharing her story with members of an MS support group, many of whom have been diagnosed recently. Which of the following aspects of her health problem should the woman warn others to expect at some point in the progression of the disease? Select all that apply. A) Debilitating fatigue B) Progressive loss of visual acuity C) Gradual development of a resting tremor D) Loss of mental acuity E) Shuffling gait
A B C
Nurses regularly rotate between day shift hours and overnight work hours. Following an overnight shift, nurses frequently exhibit which of the following manifestations? Select all that apply. A) Unable to sleep for a long period of time during the day B) Falling asleep while sitting in front of a computer charting during the night C) Finding it difficult to sleep when they have a night off D) Heightened alertness and reflexes on their drive home after work E) Increased hunger and thirst in the middle of the night
A B C
Which of the following clinical manifestations would the nurse assess in the patient with bipolar disorder who is experiencing mania? Select all that apply. A) Labile mood B) Highly distractible C) Inflated self-esteem D) Despondent when asked questions E) Excessive sleepiness
A B C
A 70-year-old woman has been brought to the emergency department by her daughter who noticed the woman is weak, confused, and forgetful in recent months, along with uncoordinated movements and visual disturbances at times. Which of the following questions by the physician are most likely to address her probable diagnosis? Select all that apply. A) "What medications is your mother currently taking?" B) "Does your mother drink alcohol?" C) "Does your mother have a history of stroke?" D) "Is your mother facing significant stressors right now?" E) "Is your mother lonely?"
A B
A geriatrician is assessing an 84-year-old male recently admitted to a subacute medical unit of a hospital for rehabilitation following a recent fall resulting in a hip contusion. Which of the following aspects of the client's sleep history would the physician want to follow up with education? Select all that apply. A) "I make sure that I take a long nap each afternoon to compensate for my frequent waking at night." B) "I've got a bottle of diazepam at home, but I only take them once or twice a month." C) "I try my best to get out for a walk after breakfast or after supper." D) "I make it a rule not to drink any alcohol in the evening." E) "Once my head hits the pillow, I am fast asleep."
A B
When explaining an upcoming test, a polysomnography, the nurse should include which of the following education related to equipment placements the patient will have placed on his or her person during the sleep study? Select all that apply. A) An ECG with lots of chest leads will monitor heart rate and rhythm. B) A pulse oximeter placed on a finger is used to determine arterial oxygen saturation. C) An EOG will be placed on the skin near the eye to record eye movements. D) An EMG patch will be placed under the chin to record muscle movement. E) An actigraph device will be placed on the wrists and ankles to measure body motion.
A B C D
A brain tumor causing clinical manifestations of headache, nausea, projectile vomiting, and mental changes is likely located in which parts of the brain? Select all that apply. A) Intra-axially B) Extra-axially C) Brain stem D) Temporal lobe E) Frontal lobe
A B E
The nurse knows that the patient admitted for opioid addiction may benefit from which of the following treatment modalities? Select all that apply. A) Prescription for dolophine (Methadone) B) Administration of a long-term pain reliever like duragesic (Fentanyl) C) Involvement in a self-help group like Opioid Anonymous (an offshoot of Alcoholics Anonymous) D) Intense exercise therapy under supervision of a body builder E) Administering beta-blocking medications to minimize agoraphobia symptoms
A C
A 20-year-old has been admitted to a rehabilitation center after hospital treatment for an ischemic stroke. Which of the following aspects of the client's history would be considered to have contributed to his stroke? Select all that apply. The client A) is an African American male. B) takes iron supplements for the treatment of chronic anemia. C) blood pressure has historically been in the range of 150s/90s. D) was diagnosed with type 2 diabetes 8 years ago. E) takes corticosteroids for the treatment of rheumatoid arthritis.
A C D
If the nurse suspects a spinal cord injury, the patient has developed autonomic dysreflexia. Which of the following assessments would confirm this complication? Select all that apply. A) BP 180/98 B) Skin covered with macular rash C) Pulse rate 49 D) Complains of a pounding headache E) Cold, cyanotic lower legs
A C D
A 21-year-old male is brought to the ED following a night of partying in his fraternity. His friends found him "asleep" and could not get him to respond. They cannot recall how many alcoholic beverages he drank the night before. While educating a student nurse and the roommates in the fraternity, the nurse begins by explaining that alcohol is A) water-soluble compound that is easily absorbed by the gastric lining of the stomach. B) very lipid soluble and rapidly crosses the blood-brain barrier. C) able to reverse the transport of some substances to remove them from the brain. D) very likely to cause sedation, and therefore the patient just needs to sleep it off.
B
A 22-year-old female college student is shocked to receive a diagnosis of myasthenia gravis. What are the etiology and most likely treatment for her health problem? A) Autoimmune destruction of skeletal muscle cells; treatment with intensive physical therapy and anabolic steroids B) A decline in functioning acetylcholine receptors; treatment with corticosteroids and intravenous immunoglobulins C) Cerebellar lesions; surgical and immunosuppressive treatment D) Excess acetylcholinesterase production; treatment with thymectomy
B
A 26-year-old female is resting after a one-minute episode during which she lost consciousness while her muscles contracted and extremities extended. This was followed by rhythmic contraction and relaxation of her extremities. On regaining consciousness, she found herself to have been incontinent of urine. What has the woman most likely experienced? A) A myoclonic seizure B) A tonic-clonic seizure C) An absence seizure D) A complex partial seizure
B
A 44-year-old female has been diagnosed with major depression. Which of the following neuroimaging findings is most congruent with the woman's diagnosis? A) Decreased brain activity in the pons and brain stem B) Reduced activity and gray matter volume in the prefrontal cortex C) Atrophy and decreased blood flow in the amygdala D) Enlargement of the lateral and third ventricles and reduction in frontal and temporal volumes
B
A 9-year-old boy has been brought to the emergency department by his father who is concerned by his son's recent fever, stiff neck, pain, and nausea. Examination reveals a petechial rash. Which of the following assessment questions by the emergency room physician is most appropriate? A) "Is your son currently taking any medications?" B) "Has your son had any sinus or ear infections in the last little while?" C) "Does your son have a history of cancer?" D) "Was your son born with any problems that affect his bone marrow or blood?"
B
A clinician is conducting an assessment of a male client suspected of having a disorder of motor function. Which of the following assessment findings would suggest a possible upper motor neuron (UMN) lesion? A) The client has decreased deep tendon reflexes. B) The client displays increased muscle tone. C) The client's muscles appear atrophied. D) The client displays weakness in the distal portions of his limbs.
B
A nurse on a neurology unit is assessing a female brain-injured client. The client is unresponsive to speech, and her pupils are dilated and do not react to light. She is breathing regularly, but her respiratory rate is 45 breaths/minute. In response to a noxious stimulus, her arms and legs extend rigidly. What is her level of impairment? A) Delirium B) Coma C) Brain death D) Vegetative state
B
An adult, who was sexually abused as a child, has been displaying some stress. She seems to complain of increasing medical problems when she is under more stress. The nurse would classify this as an example of A) vitamin deficiency. B) the stress-diathesis theory. C) mendelian research. D) parental disassociation.
B
As you are walking in the park, a huge black Labrador (dog) runs up to you and places his paws on your shoulders. Immediately your heart starts racing, you feel palpations and anxiety, and your hands become a little shaky. The nurse knows that this response is primarily caused by A) fear of dogs that make you feel like your chest is being tightened and that you have lost control of the situation. B) increased levels of glucocorticoids by the adrenal glands that result in an increase in epinephrine level. C) response of the cholinergic muscarinic receptors on innervational targets of postganglionic fibers. D) stimulation of the release of β2-adrenergic receptors, which will open the airway and increase oxygenation
B
Following a motor vehicle accident 3 months prior, a 20-year-old female who has been in a coma since her accident has now had her condition declared a persistent vegetative state. How can her care providers most accurately explain an aspect of her situation to her parents? A) "Your daughter has lost all her cognitive functions as well as all her basic reflexes." B) "Though she still goes through a cycle of sleeping and waking, her condition is unlikely to change." C) "If you or the care team notices any spontaneous eye opening, then we will change our treatment plan." D) "Your daughter's condition is an unfortunate combination with total loss of consciousness but continuation of all other normal brain functions."
B
The nurse knows which of the following phenomena listed below is an accurate statement about axonal transport? A) Anterograde and retrograde axonal transport allow for the communication of nerve impulses between the neuron and the central nervous system (CNS). B) Materials can be transported to the nerve terminal by either a fast or slow component. C) The unidirectional nature of the axonal transport system protects the CNS against potential pathogens. D) Axonal transport facilitates the movement of electrical impulses but precludes the transport of molecular materials.
B
When reviewing the purpose/action of neurotransmitters as they interact with different receptors, the nursing instructor gives an example using acetylcholine. When acetylcholine is released at the sinoatrial node in the right atrium of the heart, it is A) positively charged. B) inhibitory. C) overstimulated. D) dormant.
B
Which of the following observations of a female client in a sleep lab would indicate the clinicians that she is in REM sleep? A) Rolling eye movements are observed, and she has moderate muscle activity. B) Her motor movements are suppressed, and muscle tone is flaccid. C) Delta waves are evident on her EEG, and the heart and respiration rates are slowed. D) She has a low level of cerebral activity, and her EEG indicates low voltage and mixed frequencies.
B
Which of the following statements best conveys an aspect of the role of cerebrospinal fluid (CSF)? A) It provides physical protection for the brain and ensures that leukocytes and erythrocytes are evenly distributed in the CNS. B) CSF cushions the brain and provides a near-water medium for diffusion of nutrients. C) CSF distributes plasma proteins throughout the superficial gray matter of the CNS. D) It ensures that the high metabolic and oxygenation needs of the brain are met, as well as absorbing physical shocks.
B
Which of the following statements on the final diagnostic report regarding a computerized tomography (CT) of the head with contrast would lead health care providers to diagnose a patient with Alzheimer disease? A) Large area of ischemia noted in the temporal lobe B) Too numerous to count beta-amyloid (βA) deposits noted C) Ninety percent obstruction in the posterior cerebral artery D) Mural thrombus of vertebrobasilar arteries
B
While assessing a critically ill patient in the emergency department, the nurse notes on the cardiac monitor an R-on-T premature ventricular beat that develops into ventricular tachycardia (VT). Immediately, the patient became unresponsive. The nurse knows that based on pathophysiologic principles, the most likely cause of the unresponsiveness is A) metabolic acidosis that occurs spontaneously following any dysrhythmias. B) interruption of the blood/oxygen supply to the brain. C) massive cerebrovascular accident (CVA) resulting from increased perfusion. D) a blood clot coming from the heart and occluding the carotid arteries.
B
While working for a neurologist who is assessing a patient experiencing restless legs syndrome (RLS), the nurse should be prepared to answer the question about why the patient needs to have his iron level drawn? The nurse response should include, A) "Many of the drugs we give for RLS can cause drastic decreases in your iron level." B) "Many patients with RLS also have an iron deficiency anemia as well." C) "You just look a little pale, and so we want to make sure you have normal blood levels." D) "People with low iron levels do not have enough oxygen circulating to their legs."
B
Which of the following characteristics describe stage 2 non-REM sleep? Select all that apply. A) It occurs at the onset of sleep and lasts approximately 7 minutes. B) During this stage, theta waves are primarily seen on EEG. C) This stage is known as deep sleep where heart rate and BP are decreased. D) This stage has interruptions of spindle activity that helps with integration of new memories. E) Muscles of the body are relaxed
B D
Following an injury where a child hit his head from a fall, the CT scan reveals a contusion that the doctor classifies as a moderate brain injury. Which of the following manifestations will the nurse more than likely assess on this child that support this diagnosis? Select all that apply. A) Coma with total paralysis B) Periods of unconsciousness C) Aphasia at times D) Nuchal rigidity E) Weakness or slight paralysis affecting one side of the body
B C E
A 47-year-old woman was diagnosed with amyotrophic lateral sclerosis 3 years ago and has experienced a progressive onset and severity of complications. She has been admitted to a palliative care unit due to her poor prognosis? What assessments and interventions should the nursing staff of the unit prioritize in their care? A) Assessment and documentation of cognitive changes, including confusion and restlessness B) Regular pain assessment and administration of opioid analgesics as needed C) Assessment of swallowing ability and respiratory status D) Cardiac monitoring and administration of inotropic medications
C
Which of the following statements best captures the current understanding of the etiology of mental illness? A) The role of "nurture," experiences, and relationships has been largely disproven. B) Mental illness can be attributed to organic brain changes and pathophysiological processes. C) Mental illness exists from the interplay of biologic factors and psychosocial influences. D) Current understanding of mental illness has shown that both biologic psychiatry and psychosocial psychiatry are incorrect.
C
A 57-year-old female has presented to a clinic exasperated by the effect that restless legs syndrome is having on her sleep. The clinician has performed client teaching prior to choosing a treatment plan. Which of the following responses by the client demonstrates a sound understanding of her condition? A) "Increasing my calcium intake is something simple that might help." B) "Transcutaneous electrical nerve stimulation might be a treatment that can help me avoid needing drugs for this." C) "This could be something that I'm simply prone to genetically." D) "I'll try to get more exercise, since there aren't really any effective medications for restless legs syndrome."
C
A 9-year-old girl has a diffuse collection of symptoms that are indicative of deficits in endocrine and autonomic nervous system control. She also suffers from persistent fluid and electrolyte imbalances. The nurse knows which of the following aspects of the nervous system listed below would her health care providers focus their diagnostic efforts on? A) Her afferent and efferent cranial nerve function B) Possible damage to her pons and medulla C) Impaired function of her hypothalamus D) Potential damage to the girl's cerebellum
C
A baseball player was hit in the head with a bat during practice. In the emergency department, the physician tells the family that he has a "coup" injury. How will the nurse explain this to the family so they can understand? A) "It's like squeezing an orange so tight that the juice runs out of the top." B) "Your son has a huge laceration inside his brain where the bat hit his skull." C) "Your son has a contusion of the brain at the site where the bat hit his head." D) "When the bat hit his head, his neck jerked backward causing injury to the spine."
C
A child is experiencing difficulty with chewing and swallowing. The nurse knows that which of the following cells may be innervating specialized gut-related receptors that provide taste and smell? A) Special somatic afferent fibers B) General somatic afferents C) Special visceral afferent cells D) General visceral afferent neurons
C
A college student has been experiencing frequent headaches that he describes as throbbing and complaining of difficulty concentrating while studying. Upon cerebral angiography, he is found to have an arteriovenous malformation. Which of the following pathophysiological concepts is likely responsible for his symptoms? A) Increased tissue perfusion at the site of the malformation B) Hydrocephalus and protein in the cerebral spinal fluid C) High pressure and local hemorrhage of the venous system D) Localized ischemia with areas of necrosis noted on CT angiography
C
A geriatrician and social worker are facilitating a family meeting for the children and wife of a 79-year-old man who has been diagnosed with Alzheimer disease. What goal of treatment will the clinicians most likely prioritize in their interactions with the family? A) Modest reversal of brain plaque formation and improved symptomatology through cholinesterase inhibitors B) Surgical treatment of the underlying ischemic changes that underlie the manifestations of the man's disease C) The use of medications such as donepezil and rivastigmine to slow the progression of the disease D) Cognitive and behavioral therapy to counteract the agitation, depression, and suspiciousness associated with Alzheimer disease
C
A nurse at a long-term care facility provides care for an 85-year-old man who has had recent transient ischemic attacks (TIAs). Which of the following statements best identifies future complications associated with TIAs? TIAs A) are an accumulation of small deficits that may eventually equal the effects of a full CVA. B) are a relatively benign sign that necessitates monitoring but not treatment. C) resolve rapidly but may place the client at an increased risk for stroke. D) are caused by small bleeds that can be a warning sign of an impending stroke.
C
A nurse working in a busy orthopedic clinic is asked to perform the Tinel sign on a patient having problems in his hand/wrist. In order to test Tinel sign, the nurse should give the patient which of the following directions? A) "Stand tall, arms at your side, shut your eyes; place the tip of your index finger to your nose." B) "Hold your wrist in complete flexion; keep it in this position for 60 seconds; how does your hand feel after placing it in a neutral position?" C) "I'm going to tap (percuss) over the median nerve in your wrist; tell me what sensation you feel while I am doing this. Does the sensation stay in the wrist or go anywhere else?" D) "I'm going to tap this tuning fork and place it on the side of your thumb; then tell me what you are feeling in your hand and wrist."
C
A patient is asked to stand with feet together, eyes open, and hands by the sides. Then the patient is asked to close his eyes while the nurse observes for a full minute. What assessment is the nurse performing? A) Segmental reflex B) Posture C) Proprioception D) Crossed-extensor reflex
C
A teenager, exposed to West Nile virus a few weeks ago while camping with friends, is admitted with headache, fever, and nuchal rigidity. The teenager is also displaying some lethargy and disorientation. The nurse knows which of the following medical diagnoses listed below may be associated with these clinical manifestations? A) Rocky Mountain spotted fever B) Lyme disease C) Encephalitis D) Spinal infection
C
A toddler brought up in a chaotic, nonnurturing environment may suffer neurological consequences if the parent does not achieve attachment with the child. The nurse knows that which of the following nervous systems listed below is the first to respond to the safety needs of the child? A) Parasympathetic nervous system B) Autonomic nervous system C) Sympathetic nervous system D) Limbic system
C
A toddler is displaying signs and symptoms of weakness and muscle atrophy. The pediatric neurologist suspects it may be a lower motor neuron disease called spinal muscular atrophy (SMA). The patient's family asks how he got this. The nurse will respond A) "This could result from playing in soil and then ingesting bacteria that are now attacking his motor neurons." B) "No one really knows how this disease is formed. We just know that in time, he may grow out of it." C) "This is a degenerative disorder that tends to be inherited as an autosomal recessive trait." D) "This is a segmental demyelination disorder that affects all nerve roots and eventually all muscle groups as well."
C
After being thrown off the back of a bull, the bull rider can move his arms but has loss of motor function in the lumbar and sacral segments of the spinal cord. This is usually referred to as A) tetraplegia. B) quadriplegia. C) paraplegia. D) anterior cord syndrome.
C
An adult male has a new diagnosis of Guillain-Barré syndrome. The nurse knows which of the following pathophysiological processes underlie the deficits that accompany the degeneration of myelin in his peripheral nervous system (PNS)? A) The destruction of myelin causes fewer Schwann cells to be produced in the client's PNS. B) The axonal transport system is compromised by the lack of myelin surrounding nerve cells. C) Unless remyelination occurs, the axon will eventually die. D) A deficit of myelin predisposes the client to infection by potential pathogens.
C
Following a spinal cord injury suffered in a motor vehicle accident, a 22-year-old male has lost fine motor function of his fingers and thumb but is still able to perform gross motor movements of his hand and arm. Which of the following components of his white matter has most likely been damaged? A) The inner layer (archilayer) B) The middle layer (paleolayer) C) The outer layer (neolayer) D) The reticular formation
C
Parents of a 16-year-old male who has been behaving in increasingly bizarre ways in recent months are distraught that he has been diagnosed with schizophrenia. Which of the mother's following statements about her son's diagnosis demonstrates an accurate understanding of the disease? A) "It's disturbing to know that what I did when I was pregnant and the way we raised him contributed to this." B) "We are somewhat relieved that psychotherapy and a supportive environment will resolve most of the positive and negative symptoms." C) "This makes us even more worried about his younger brother and whether he might develop schizophrenia." D) "We're committed to lovingly but firmly convincing him that his delusions aren't based in reality"
C
The geriatrician providing care for a 74-year-old man with diagnosis of Parkinson disease has recently changed the client's medication regimen. What is the most likely focus of the pharmacologic treatment of the man's health problem? A) Maximizing acetylcholine release from synaptic vesicles at neuromuscular junctions B) Preventing demyelination of the efferent cerebellar pathways C) Increasing the functional ability of the underactive dopaminergic system D) Preventing axonal degradation of motor neurons
C
The neurotransmitter GABA mainly functions to trigger inhibitory postsynaptic potentials (IPSPs). Therefore, when explaining this to a group of nursing students, the nurse will state that A) it takes at least three chemical substances (amino acids, neuropeptides, and monoamines) to stimulate any activity between the cells. B) there is a symbiotic relationship; therefore, the end result will be depolarization of the postsynaptic membrane. C) the combination of GABA with a receptor site is inhibitory since it causes the local nerve membrane to become hyperpolarized and less excitable. D) the neurotransmitters will interact with cholinergic receptors to bind to acetylcholine in order to produce hypopolarization within the cell.
C
The nurse should anticipate she will need to teach the newly diagnosed multiple sclerosis patient how to give injections if he is prescribed which medication to modify the course of the disease by reducing exacerbations? A) Corticosteroids B) Plasmapheresis C) Interferon beta D) Mitoxantrone
C
The parents of a 3-year-old boy have brought him to a pediatrician for assessment of the boy's late ambulation and frequent falls. Subsequent muscle biopsy has confirmed a diagnosis of Duchenne muscular dystrophy. Which of the following teaching points should the physician include when explaining the child's diagnosis to his parents? A) "Your son's muscular dystrophy is a result of faulty connections between muscles and the nerves that normally control them." B) "He'll require intensive physical therapy as he grows up, and there's a good chance that he will outgrow this problem as he develops." C) "Your son will be prone to heart problems and decreased lung function because of this." D) "His muscles will weaken and will visibly decrease in size relative to his body size throughout his childhood."
C
Which of the following clients may be experiencing a sensory focal seizure that has sent an abnormal cortical discharge to the autonomic nervous system (ANS)? A) A 44-year old patient complaining of constant movement and pain in the legs that gets worse when he tries to sleep B) An 85-year-old patient experiencing drooping of the right side of the face and numbness in the right arm and leg C) A 56-year-old complaining of tingling sensations and has both an elevated pulse and BP D) A 22-year-old complaining of a stiff neck and achiness, along with some nausea and vomiting
C
Which of the following individuals is likely to have the best prognosis for recovery from his or her insult to the peripheral nervous system? An adult A) who developed rhabdomyolysis and ischemic injury after a tourniquet application. B) who suffered a bone-depth laceration to the shoulder during a knife attack. C) who had his forearm partially crushed by gears during an industrial accident. D) who had nerves transected during surgery to remove a tumor from the mandible
C
Which of the following individuals would be expected to have the highest risk of developing sleep apnea? A) A woman with restless legs syndrome and chronic obstructive pulmonary disease B) A male client with a diagnosis of unstable angina and peripheral arterial disease C) A man with poorly controlled diabetes and hypertension D) A female with chronic insomnia and atrial fibrillation that is treated with warfarin
C
Which of the following individuals would most likely experience global ischemia to his or her brain? A) A male client who has just had an ischemic stroke confirmed by CT of his head B) A woman who has been admitted to the emergency department with a suspected intracranial bleed C) A man who has entered cardiogenic shock following a severe myocardial infarction D) A woman who is being brought to hospital by ambulance following suspected carbon monoxide poisoning related to a faulty portable heater
C
Which of the following motor disorders of sleep can be life threatening? A) Narcolepsy B) Periodic limb movement disorder C) Obstructive apnea D) Restless legs syndrome
C
Which of the following statements about over-the-counter (OTC) melatonin is accurate? A) It has received the FDA approval for effectiveness as a sleep aid. B) Long-term studies of melatonin conclude that it is nonaddicting. C) It produces phase-shifting changes in the circadian rhythm. D) Under strict clinical testing, potency and purity of melatonin have been shown to be consistent.
C
Which of the following statements most accurately characterizes an aspect of the neurobiology of sleep? A) The hypothalamus stimulates the anterior and posterior pituitary to modulate sleeping-waking cycles. B) The pituitary releases melatonin at predictable points in the circadian rhythm in order to facilitate sleep. C) The reticular formation, thalamus, and cerebral cortex interact to integrate the sleep-wake cycle. D) Input from the retinas is interpreted by the cerebellum and contributes to maintenance of the circadian rhythm.
C
A middle-aged woman is brought to the emergency room after a minor auto accident. Her gait is staggering and unsteady; her speech is slurred; and she displays slight nystagmus. The police officer who brought her in says she has not been drinking. Her blood pressure is very high. Which of the following health problems most likely underlies her present state? A) Multiple sclerosis B) Guillain-Barré syndrome C) Myasthenia crisis D) Cerebellar damage caused by a cerebrovascular accident
D
A nursing student having trouble moving his head from side to side is likely experiencing a problem with which type of neurons? A) General visceral efferent neurons B) Preganglionic neurons C) Parasympathetic postganglionic neurons D) Pharyngeal efferent neurons
D
A patient in the intensive care unit who has a brain tumor has experienced a sharp decline. The care team suspects that water and protein have crossed the blood-brain barrier and been transferred from the vascular space into the client's interstitial space. Which of the following diagnoses best captures this pathophysiology? A) Focal hypoxia B) Cytotoxic edema C) Hydrocephalus D) Vasogenic edema
D
A 17-year-old female is suspected of having narcolepsy. Which of the following aspects of her medical history and sleep analysis would contribute to a confirmation of the diagnosis? Select all that apply. A) She repeatedly moves her large toe, ankle, and knee during sleep. B) She complains of a powerful urge to move her legs when in bed at night. C) She has frequently awakened unable to move or speak. D) She believes that she experiences auditory hallucinations when she awakens. E) Her sleep latency is normally around 1 hour.
C D
Following a car accident of a male teenager who did not have his seatbelt on, he arrived in the emergency department with a traumatic brain injury. He has severe cerebral edema following emergent craniotomy. Throughout the night, the nurse has been monitoring and reporting changes in his assessment. Which of the following assessments correspond to a supratentorial herniation that has progressed to include midbrain involvement? Select all that apply. A) Clouding of consciousness B) Decorticate posturing with painful stimulation C) Pupils fixed at approximately 5 mm in diameter D) Respiration rate of 40 breaths/minute E) Decerebrate posturing following painful stimulation of the sternum
C D E
A 60-year-old male office worker presents to a clinic complaining of new onset of lower back pain that has been worsening over the last 6 weeks. The nurse knows which of the following components of his physical assessment and history is most indicative of a serious pathological process (like aortic aneurysm or cancer)? A) His pain is relieved by extended bed rest. B) When supine, passive rising of his leg to 90 degrees results in hamstring pain. C) He has needed regular nonsteroidal anti-inflammatory drugs to control the pain in recent weeks. D) His onset of pain has been gradual, and he has no prior history of lower back problems.
D
A 70-year-old male has been diagnosed with a stroke that resulted in an infarct to his cerebellum. Which of the following clinical findings would be most closely associated with cerebellar insult? A) Flaccid loss of muscle tone B) Difficulty in starting movement, stopping movement, and maintaining rhythmic movements. C) Tremor, rigidity, and bradykinesia D) Unsteady gait and difficulty in speaking and swallowing
D
A 77-year-old woman is concerned because she has occasionally found her husband sleepwalking in the last several weeks. What is her care provider's most appropriate response to her concerns? A) "This is not an uncommon event that often accompanies older age." B) "I'll likely prescribe a benzodiazepine for this when I next see your husband." C) "This is understandably upsetting for you, but as long as the environment is safe, it's likely not significant." D) "There may be something else going on with your husband such as delirium or a problem with his medications.
D
A Tae Kwon Do (TKD) master is applying downward pressure just above the elbow joint on an attacker who immediately collapses to the ground. The TKD master knows the elbow joint can bend inward toward the body but not in the opposite direction. Which of the following reflexes is applicable to this example? A) Knife-clasp B) Withdrawal C) Myotatic D) Inverse myotatic
D
A business traveler has just arrived in Japan from the United States. During a meeting with his customer, he begins to experience yawning and stretching with an inability to stay focused on the meeting. He also has some eye irritation and has developed a headache. Based on these clinical manifestations, what diagnosis would most likely be causing these symptoms? A) Advanced sleep phase syndrome B) Delayed sleep phase syndrome C) Free-running sleep disorder D) Time zone change syndrome
D
A client with a diagnosis of depression has been prescribed a medication that ultimately increases the levels of the neurotransmitter serotonin between neurons. Which of the following processes will accompany the actions of the neurotransmitter in a chemical synapse? A) Two-way communication between neurons is permitted in contrast to the one-way communication in electrical synapses. B) Communication between a neuron and the single neuron it is connected with will be facilitated. C) The neurotransmitter will cross gap junctions more readily. D) More neurotransmitters will cross the synaptic cleft and bond with postsynaptic receptors.
D
A woman has a long-running compulsion to repeatedly check if the doors of her home are locked and has received a diagnosis of obsessive-compulsive disorder (OCD). Her husband is at a loss to understand her irrational behavior and has sought help from a therapist himself to deal with the effect that his wife's OCD is having on their daily lives. Which of the husband's following statements would require correction? A) "It's a relief to know that this can be changed if she continues with therapy and the medications she's been prescribed." B) "It's odd that someone like her and someone who's depressed might both respond positively to the same drugs." C) "I thought that this was something exceedingly rare, but I'm actually a bit relieved to learn that others have this disorder as well." D) "I'm glad that this is something that's a result of life stressors and is not associated with any dysfunction in her brain."
D
After surviving an ischemic stroke, a 79-year-old male has demonstrated significant changes in his emotional behavior, with his family noting that he now experiences wide mood swings with exaggerated responses of empathy, anger, and sadness to situations. His care team would most likely attribute these responses to ischemic changes in which of the following brain structures? A) The man's occipital lobe B) The client's temporal lobe in general and Wernicke area in particular C) The man's parietal lobe D) The components of the client's limbic system
D
An adult client is experiencing chronic insomnia related to a recent divorce and child custody proceedings. The client is requesting a renewable prescription for "sleeping pills." The nurse knows that which of the following interventions listed below will provide the most beneficial treatment for this client? A) Sedatives and hypnotic drugs will not provide safe relief of the client's health problem. B) The client is suffering from primary insomnia. C) Melatonin supplements will be the safest and most effective long-term pharmacological treatment. D) Behavioral therapies and education regarding sleep hygiene will provide assistance for the client.
D
As part of a diagnostic workup of a 22-year-old male with recently diagnosed schizophrenia, a neurologist wants to examine the levels of metabolic activity in particular areas of the client's brain. Which of the following diagnostic procedures is the physician most likely to order? A) Computed tomography (CT) B) Electroencephalography (EEG) C) Magnetic resonance imaging (MRI) D) Positron emission tomography (PET)
D
During a late night study session, a pathophysiology student reaches out to turn the page of her textbook. Which of the following components of her nervous system contains the highest level of control of her arm and hand action? A) Cerebellum B) Thalamus C) Basal ganglia D) Frontal lobe
D
Not realizing that its surface was hot, a woman has quickly withdrawn her hand from the surface of a bowl that she was removing from a microwave. Which of the following phenomena has facilitated the rapid movement of her hand in response to the painful stimulus? A) Her midbrain has rapidly responded to the nociceptive stimuli and induced arm flexion. B) The withdrawal reflex of her peripheral nervous system has quickly mediated between afferent and effector neurons. C) The forebrain has mediated a protective spinal cord reflex. D) Her CNS has enacted a protective response received by neurons that innervate her arm muscles
D
Several months ago, a 20-year-old male suffered a spinal cord injury brought about by a snowboard trick gone wrong. The lasting effects of his injury include a flaccid bowel and bladder and the inability to obtain an erection. While sensation has been completely preserved in his legs and feet, his motor function is significantly impaired. What type of incomplete spinal cord injury has the man most likely experienced? A) Anterior cord syndrome B) Brown-Séquard syndrome C) Central cord syndrome D) Conus medullaris syndrome
D
The nurse knows that which of the following observations of a client during a sleep study would be most likely considered a pathological finding? A) The client experiences periods of apnea of 5 to 15 seconds in duration. B) The client's intrinsic clock involves a sleep-wake cycle that is consistently 2 hours longer than the actual length of a day. C) The client's PCO2 level is increased, and his PO2 level decreased during deep sleep. D) The client spends the majority of his sleeping hours in deep REM sleep.
D
The nurse knows that which of the following treatment plans listed below is most likely to be prescribed after a computed tomography (CT) scan of the head reveals a new-onset aneurysmal subarachnoid hemorrhage? A) Stat administration of tissue plasminogen activator (tPA) B) Administration of a diuretic such as mannitol to reduce cerebral edema and ICP C) Monitoring in the ICU for signs and symptoms of cerebral insult D) Craniotomy and clipping of the affected vessel
D
Which of the following is a negative symptom of schizophrenia? A) Hallucinations B) Incoherence C) Word salad D) Affective flattening
D
