Chapters 10 & 12

In contrast to acute pain, persistent chronic pain indicates which purpose?

Imposes physiological stress

Reflexes are basically "hard-wired" into the CNS. Anatomically, the basis of a reflex is an afferent neuron that synapses directly with an effector neuron to cause muscle movement. Sometimes the afferent neuron synapses with what intermediary between the afferent and effector neurons?

Interneuron

For which common manifestation of acute meningococcal meningitis should the school nurse be assessing students?

Petechiae

Which visual deficit is a clinician justified in attributing to the normal aging process?

Presbyopia

With aging, progressive inelasticity and thickening of the lens causes which accommodation disorder?

Presbyopia

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

A client has been brought to the emergency department following an overdose of insulin that resulted in unconsciousness. When explaining the rationale for this to the family, the nurse will emphasize that neurons:

must rely on glucose from the blood to meet their energy needs.

Which stimulus would be used to elicit the withdrawal reflex when testing response to nociceptive stimuli?

pressure from a sharp object

Which of these clients' statements would be most suggestive of retinal detachment?

"I feel like theres a shadow blocking my vision"

Which hearing test would be prescribed to help differentiate conductive from sensorineural hearing loss?

A Weber (tuning fork) test

Which client may be experiencing the effects of neuropathic pain?

A man with pain secondary to his poorly controlled diabetes

The nurse is caring for a group of clients with visual impairment. Which clients does the nurse recognize as being at greatest risk for developing glaucoma? (Select all that apply.)

African American male Female with diabetes mellitus Male with a history of eye trauma Older adult with long-term use of corticosteroids

Although both vertigo and dizziness can result from peripheral or central vestibular disorders, vertigo is distinctly different because it causes:

An illusion of motion

A client presents with copious amounts of yellow-green drainage, conjunctival redness, and chemosis to the right eye. A culture of the eye drainage reveals S. pneumoniae. The client most likely developed:

Bacterial conjunctivitis

A client reveals that, when in bed, changes in head position cause brief periods of vertigo, usually lasting less than 1 minute. Which condition is the client most likely experiencing?

Benign paroxysmal positional vertigo

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

The cerebellum, separated from the cerebral hemispheres by the tentorium cerebelli, lies in the posterior fossa of the cranium. What is one of the functions of the cerebellum?

Coordinates smooth and accurate movements of the body

Which area of the brain is responsible for respiration?

Brain stem

Which intracranial volume is most capable of compensating for increasing intracranial pressure?

Cerebrospinal fluid

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

Select the function of the occipital lobe.

Color, motion, and depth perception

Which statement best describes the pathophysiology of Parkinson disease?

Degeneration of the nigrostriatal dopamine system

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

Peripheral neuropathy occurs most commonly with which disorder?

Diabetes

Neurons that connect sensory and motor neurons are known as which of the following?

Interneurons

A client has started having uncontrolled seizures that are not responding to usual medications. Nurses working with the client must pay special attention to which priority aspects of this client's care? Assessment of:

Respiratory status and oxygen saturation

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 nerve (CN X). Which assessment finding is most likely to lead the physician to this conclusion?

The client has difficulty swallowing and has had recent constipation and hypoactive bowel sounds.

A client has been diagnosed with sensorineural hearing loss. What should the care team assess to determine a plausible cause?

The client's recent medication use

A client with a diagnosis of lung cancer has developed bone metastases resulting in severe and protracted pain. Which assessment components should the nurse prioritize when assessing the client's pain?

The client's subjective report of the character and severity of pain

Which pain disorder is a manifestation of a disruption of cranial nerve function?

Trigeminal neuralgia

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.

What is ocular muscle imbalance resulting in "lazy eye" called?

amblyopia

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.

A soccer player has been diagnosed with a brain contusion after being injured in a game. The best explanation of the injury by the nurse would be that:

bruising on the surface of the brain occurred.

A client has developed global ischemia of the brain. The nurse determines this is:

inadequate to meet the metabolic needs of the entire brain.

A 55-year-old client has been diagnosed with acute angle-closure glaucoma. The client's ophthalmologist is recommending immediate and aggressive drug treatment because the:

increase in intraocular pressure will cause degradation of the optic nerve.

A client with a diagnosis of myasthenia gravis underwent a mastectomy. The surgery was a success, but the client has gone into a myasthenic crisis on postoperative day 1. Which priority measure should the care team initiate immediately?

Respiratory support and protection of the client's airway

A client expresses concern about feeling fullness in the ear. Which additional manifestation leads the health care provider to suspect Menière disease?

Rotary vertigo and tinnitus

An older adult client is scheduled for outpatient cataract surgery. While taking a presurgery history, which statement by the client correlates to the manifestations of cataracts, thereby verifying the client has received information about the condition?

"I have blurred vision in both my eyes and my vision is distorted."

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 is one of the things you experience when you get old"

The nurse is working with a client who has been diagnosed with recurring migraine headaches. Which advice by the nurse is most appropriate?

"Many people find that maintaining regular eating and sleeping habits is beneficial."

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."

A hospital client has been reluctant to accept morphine sulfate despite visible signs of pain. Upon questioning, the client reveals that he is afraid of becoming addicted to the drug. How should the nurse respond to the client's concern?

"There's only a minute chance that you will become addicted to these painkillers when used for acute pain."

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?

"Your son has a contusion of the brain at the site where the bat hit his head."

A 26 year-old female is resting after a 1-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 tonic-clonic seizure

Which intervention is usually the first line of therapy when treating moderate pain in the older adult population?

Nonopioids such as acetaminophen

A client has sustained damage to cranial nerve VIII. The nurse recognizes that the client may experience difficulty with:

Hearing

A client's recent diagnosis of Parkinson disease has prompted the care provider to promptly begin pharmacologic therapy. The drugs prescribed will likely influence the client's levels of which substance?

Dopamine

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 pain assessment tool is best to utilize when caring for children between ages 3 to 8 years?

FACES pain scale

The underlying causative problem in Parkinsonism is:

Failure of dopamine release

A high school student sustained a concussion during a football game. The school nurse will educate the family about postconcussion syndrome and ask them to watch for and report which manifestations of its presence?

Headaches and poor concentration

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

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 conducting a health promotion class on the prevention of blindness and vision impairment. The nurse determines that participants understand the information when they identify which vision disorder as most likely to have an infectious etiology?

Keratitis

The health care provider is performing a spinal tap on a client with suspected infection. The provider would perform the procedure at:

L3 or L4

The region of the brain involved in emotional experience and control of emotional behavior is the:

Limbic system

Select the statement that best describes Meniere disease

Meniere disease is a disorder of the inner ear due to distention of the endolymphatic compartment of the inner ear, causing hearing loss, vertigo, and tinnitus.

Since catecholamines can be degraded by enzymes, which medication category—usually prescribed to treat a Parkinson disease client—can increase the levels of neurotransmitters by decreasing their enzymatic degradation?

Monoamine oxidase (MAO) inhibitor

While on an ocean cruise, a person develops malaise and nausea/vomiting. The nurse notes the client's blood pressure is 88/52 mm Hg; pulse is 110 bpm; and skin is moist with perspiration. Which diagnosis is associated with these clinical manifestations?

Motion sickness

A client diagnosed with Parkinson disease is displaying the following manifestations: tremor, rigidity, and slowness of movement. The nurse would interpret these as:

Normal manifestations of Parkinson disease

Disorders of the pyramidal tracts, such as a stroke, are characterized by which physical finding?

Paralysis

After being thrown off the back of a bull, a bull rider can move his arms but has loss of motor function in the lumbar and sacral segments of the spinal cord. This is referred to as:

Paraplegia

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

A family brings their father to his primary care physician for a checkup. Since their last visit, they note their dad has developed a tremor in his hands and feet. He also rolls his fingers like he has a marble in his hand. The primary physician suspects the onset of Parkinson disease when he notes which abnormality in the client's gait?

Slow to start walking and has difficulty when asked to "stop" suddenly

Through what specific component do neurotransmitters exert their action?

Specific proteins

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

If a client is experiencing acute pain, which clinical manifestation will the nurse assess?

Tachycardia

The nurse is performing an eye assessment on a client who presents with a red eye. The nurse determines that the redness is related to bacterial conjunctivitis based on which additional symptom(s)?

Tearing, itching, and burning

During physiology class, the instructor asks students to explain the pathology behind development of multiple sclerosis. Which student gave the most accurate description?

The demyelination and subsequent degeneration of nerve fibers and decreased oligodendrocytes, which interfere with nerve conduction

A nurse working in an outpatient pediatric clinic notes a large number of ear infections among children. What is the nurse's understanding of this increased rate?

The eustachian tube is narrower in children.

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

The health care provider is assessing the functional integrity of all spinal nerves utilizing a pinpoint pressed against the skin. A normal response would be interpreted as:

The withdrawal reflex is activated.

A client who is being seen in the outpatient clinic reports a single episode of unilateral arm and leg weakness and blurred vision that lasted approximately 45 minutes. The client is most likely experiencing:

Transient ischemic attack (TIA)

Which characteristic differentiates a migraine with aura from a migraine without aura?

Visual symptoms such as flickering lights precede the headache

The nurse is caring for client who has been living with Parkinson disease for the past 10 years and is being treated with levodopa-carbidopa. The client often leaves the unit with family for extended periods. What should the nurse prioritize when teaching the client?

Your medication needs to be taken at equal intervals to reduce symptom fluctuation.

The nurse documents the presence of nystagmus when assessing a client. This can be interpreted as:

involuntary eye movements that preserve eye fixation on stable objects in the visual field.

The nurse is aware that the primary function of the sympathetic nervous system is:

maintenance of vital functions and responding when there is a critical threat to the integrity of the individual.

The nurse is caring for a client with visual impairment who states recent difficulty seeing clearly at night. Which condition does the nurse suspect the client may suffer from?

Vitamin A deficiency