Ch 44, 45, 47, 51, 52

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

B) amyotrophic lateral sclerosis.

Autonomic dysreflexia is characterized by A) hypertension and bradycardia. B) hypotension and shock. C) pallor and vasoconstriction above the level of injury. D) extreme pain below the level of injury.

A) hypertension and bradycardia.

Dopamine precursors and anticholinergics are all used in the management of Parkinson disease, because they A) increase dopamine activity in the basal ganglia. B) induce regeneration of neurons in the basal ganglia. C) prevent progression of the disease. D) produce excitation of basal ganglia structures.

A) increase dopamine activity in the basal ganglia.

It is true that scleroderma involves A) inflammation and fibrosis of connective tissue. B) autoantibodies against acetylcholine receptors. C) infection by beta-hemolytic streptococcus. D) inflammation caused by antigenic fragments of dead organisms.

A) inflammation and fibrosis of connective tissue.

A level of ____ on the Glasgow Coma Scale indicates likely fatal damage. A) 3 B) 8 C) 12 D) 15

A) 3

What type of fracture generally occurs in children? A) Greenstick B) Stress C) Nightstick D) Colles

A) Greenstick

________ occurs when a brainstem impaired patient exhibits a persistent rhythmic or jerky movement in one or both eyes. A) Nystagmus B) Dysconjugate movement C) Ocular palsy D) Doll's eye

A) Nystagmus

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

A) Osteomalacia

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

A) Slower rate of action potential conduction

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

A) The age of onset ranges from 20 to 50 years.

Pain is thought of as A) a subjective experience that is difficult to measure objectively. B) associated with changes in vital signs reflecting its intensity. C) experienced in the same way by all individuals. D) always the result of tissue damage that activates nociceptors.

A) a subjective experience that is difficult to measure objectively.

The most common source of osteomyelitis is A) an infection that migrates via the bloodstream. B) direct invasion from a fracture. C) surgical contamination. D) a joint prosthesis.

A) an infection that migrates via the bloodstream.

The physiologic change most likely to lead to an increase in intracranial pressure is A) cerebral vasodilation. B) hypernatremia. C) respiratory hyperventilation. D) REM sleep.

A) cerebral vasodilation.

Subarachnoid hemorrhage is usually managed with volume expansion and blood pressure support to enhance cerebral perfusion. This is necessary because subarachnoid hemorrhage predisposes to A) cerebral vasospasm. B) hypotension. C) excessive volume loss. D) increased intracranial pressure.

A) cerebral vasospasm.

A fracture in which bone breaks into two or more fragments is referred to as A) comminuted. B) open. C) greenstick. D) stress.

A) comminuted.

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

A) delayed healing.

The dementia of Alzheimer disease is associated with structural changes in the brain, including A) deposition of amyloid plaques in the brain. B) degeneration of basal ganglia. C) hypertrophy of frontal lobe neurons. D) significant aluminum deposits in the brain.

A) deposition of amyloid plaques in the brain.

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

A) development of a blood clot beneath the periosteum.

Muscular dystrophy includes a number of muscle disorders that are A) genetically transmitted. B) easily prevented and managed. C) autoimmune in nature. D) demyelinating focused.

A) genetically transmitted.

The most common type of osteomyelitis is A) hematogenous. B) contiguous focus. C) Brodie abscess. D) direct invasion.

A) hematogenous.

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

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

Ankylosing spondylitis causes A) intervertebral joint fusion. B) instability of synovial joints. C) costal cartilage degeneration. D) temporomandibular joint degeneration.

A) intervertebral joint fusion.

The initial treatment of an individual experiencing a seizure is concentrated on A) maintaining an airway. B) administering anticonvulsant medication. C) documenting the seizure pattern. D) obtaining an EEG.

A) maintaining an airway.

Healing of a fractured bone with a poor alignment is called A) malunion. B) nonunion. C) disunion. D) delayed union.

A) malunion.

The disease that is similar to osteomalacia and occurs in growing children is A) rickets. B) osteosarcoma. C) Paget disease. D) osteopenia.

A) rickets.

The displacement of two bones in which the articular surfaces partially lose contact with each other is called A) subluxation. B) subjugation C) sublimation. D) dislocation.

A) subluxation.

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

A) systemic manifestations of inflammation.

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

A) tophaceous gout.

Ascending paralysis with no loss of sensation is characteristic of A) multiple sclerosis. B) Guillain-Barré syndrome. C) myasthenia gravis. D) amyotrophic lateral sclerosis.

B) Guillain-Barré syndrome.

_________ is a form of spina bifida in which a saclike cyst filled with CSF protrudes through the spinal defect but does not involve the spinal cord. A) Spina bifida occulta B) Meningocele C) Myelomeningocele D) Meningomyelocele

B) Meningocele

Most muscle strains are caused by A) a tear in an adjoining tendon. B) abnormal muscle contraction. C) muscle asymmetry. D) bleeding into the muscle.

B) abnormal muscle contraction.

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

B) an autoimmune process.

A severe complication of elevated intracranial pressure is A) Cushing reflex. B) brain herniation. C) burr hole. D) hydrocephalus.

B) brain herniation.

The gate control theory of pain transmission predicts that activity in touch receptors will A) enhance perception of pain. B) decrease pain signal transmission in the spinal cord. C) activate opioid receptors in the CNS. D) increase secretion of substance P in the spinal cord.

B) decrease pain signal transmission in the spinal cord.

Steroids may be used in the management of acute exacerbation of symptoms in patients with multiple sclerosis, because A) viral damage can be inhibited. B) demyelination is mediated by immune mechanisms. C) steroids reverse the progression of the disease. D) steroids inhibit synaptic degradation of neurotransmitters.

B) demyelination is mediated by immune mechanisms.

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

B) deposits of urate crystals in tissues.

In older women, osteoporosis is thought to be primarily because of A) dietary inadequacies. B) estrogen deficiency. C) malabsorption syndrome. D) inactivity.

B) estrogen deficiency.

Paget's disease is characterized by A) overactivity of osteoblasts leading to multiple bone tumors. B) excessive bone resorption followed by excessive formation of fragile bone. C) inflammatory disorder resulting in fusion of spine joints. D) failure of resorption by osteoclasts resulting in hard bones.

B) excessive bone resorption followed by excessive formation of fragile bone.

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

B) initiate action to have the cast split or removed.

A patient presenting with a severe, pounding headache accompanied by nausea and photophobia is likely experiencing a ________ headache. A) tension B) migraine C) sinus D) chronic

B) migraine

Anticholinesterase inhibitors may be used to manage A) muscular dystrophy. B) myasthenia gravis. C) fibromyalgia. D) rheumatoid arthritis.

B) myasthenia gravis.

Bone healing may be impaired by A) excessive vitamin C. B) nicotine use. C) a high-protein diet. D) immobilization.

B) nicotine use.

The most common presenting sign/symptom with rheumatic fever is A) cardiac murmur. B) polyarthritis. C) rash. D) painless nodules.

B) polyarthritis.

Most sensory afferent pain fibers enter the spinal cord by way of the ________ nerve roots. A) anterior B) posterior C) C fiber D) anterolateral

B) posterior

Compartment syndrome occurs secondary to A) bone infarction. B) soft-tissue damage. C) muscle necrosis. D) breakdown of RBCs.

B) soft-tissue damage.

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

B) the callus has been completely replaced with mature bone.

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

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

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

C) Anticonvulsants

The disorders characterized by softening and then enlargement of bones is referred to as A) osteomyelitis. B) osteoporosis. C) Paget disease. D) rickets.

C) Paget disease.

The stage of spinal shock that follows spinal cord injury is characterized by A) reflex urination and defecation. B) autonomic dysreflexia. C) absent spinal reflexes below the level of injury. D) motor spasticity and hyperreflexia below the level of injury.

C) absent spinal reflexes below the level of injury.

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

C) air embolus.

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

C) autoimmune injury.

Leakage of CSF from the nose or ears is commonly associated with A) epidural hematoma. B) temporal skull fracture. C) basilar skull fracture. D) cerebral aneurysm.

C) basilar skull fracture.

The most common symptom of multiple myeloma is A) pathologic fracture. B) fever. C) bone pain. D) osteomyelitis.

C) bone pain.

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

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

Prosthetic joint infection is most often because of A) defective replacement material. B) injury to the joint. C) hematogenous transfer. D) arthritis.

C) hematogenous transfer.

An example of inappropriate treatment for head trauma would be A) head elevation. B) free water restriction. C) hypoventilation. D) bed rest.

C) hypoventilation.

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

C) intervention.

The most important determinant for prescribing therapy for acute stroke is A) location of ischemia. B) thrombotic versus embolic cause. C) ischemic versus hemorrhagic cause. D) age of the patient.

C) ischemic versus hemorrhagic cause.

A bone disorder that results from insufficient vitamin D is referred to as A) rickets. B) osteoporosis. C) osteomalacia. D) subluxation.

C) osteomalacia.

A malignant bone-forming tumor is referred to as a(n) A) rhabdosarcoma. B) liposarcoma. C) osteosarcoma. D) chondrosarcoma.

C) osteosarcoma.

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

C) other potential causes of dementia must be ruled out.

It is true that Bell palsy is a A) permanent facial paralysis after stroke. B) painful neuropathic pain affecting the trigeminal nerve. C) paralysis of the muscles innervated by the facial nerve. D) herpetic outbreak in a facial dermatome.

C) paralysis of the muscles innervated by the facial nerve.

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

C) sluggish pupil response to light.

Slow pain sensation is transmitted primarily by A) group Ia afferents. B) α motor neurons. C) unmyelinated C fibers. D) Aδ fibers.

C) unmyelinated C fibers.

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

C) within the same dermatome.

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

D) Absence

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

D) Cytotoxic

The earliest manifestation of scleroderma is A) thick, tight, shiny skin. B) skin hyper/hypopigmentation. C) renal impairment. D) Raynaud phenomenon.

D) Raynaud phenomenon.

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

D) a butterfly pattern rash on the face across the bridge of the nose.

Parkinson disease is associated with A) demyelination of CNS neurons. B) a pyramidal nerve tract lesion. C) insufficient production of acetylcholine in the basal ganglia. D) a deficiency of dopamine in the substantia nigra.

D) a deficiency of dopamine in the substantia nigra.

Systemic lupus erythematosus (SLE) is a rheumatic disease attributed to A) wear and tear on weight-bearing joints. B) septic joint inflammation and necrosis. C) unknown etiologic factors. D) autoimmune mechanisms.

D) autoimmune mechanisms.

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

D) broken and protruding through the skin.

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

D) changes in pain transmission in the spinal cord.

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

D) characterized by a lucid interval immediately after injury.

The pain of nonarticular rheumatism ("growing pain") is worse A) during activity. B) following strenuous exercise. C) upon awakening. D) during the night.

D) during the night.

Seizures that involve both hemispheres at the outset are termed A) partial. B) complex. C) focal. D) generalized.

D) generalized.

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

D) inadequate mineralization in the osteoid.

Systemic disorders include A) adhesive capsulitis. B) verrucae. C) osteoarthritis. D) rheumatoid arthritis.

D) rheumatoid arthritis.

Rupture of a cerebral aneurysm should be suspected if the patient reports A) ringing in the ears. B) transient episodes of numbness. C) transient episodes of vertigo. D) sudden, severe headache.

D) sudden, severe headache.

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

D) systemic aching in the musculoskeletal system.

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

D) vitamin D.