Exam 3 - Unit 5 Neuro
For which common manifestation of acute meningococcal meningitis should the school nurse be assessing students? Chapter 16: Disorders of Brain Function - Page 434
A: Petechiae Meningococcal meningitis causes a petechial rash with palpable purpura in most people. The most common manifestations of acute bacterial meningitis are fever and chills; headache; stiff neck (nuchal rigidity) and back; abdominal and extremity pains; and nausea and vomiting.
The nurse is caring for a client admitted to the emergency room with suspected meningitis. The nurse prepares to perform which nursing intervention upon physician orders, while diagnostic testing is being completed? Administration of antibiotics Administration of TPN Administration of oxygen Administration of pain medication
Administration of antibiotics Chapter 16: Disorders of Brain Function, Meningitis, p. 433.
A 60-year-old male is being treated for significant denervation and muscle fiber atrophy. His movements are still smooth and he has no cognitive defects. Which likely diagnosis is associated with these clinical manifestations? Multiple sclerosis, an upper motor neuron (UMN) disorder Spinal muscular atrophy, a lower motor neuron (LMN) disorder Parkinson disease, a disorder of basal ganglia Amyotrophic lateral sclerosis, a mixed UMN/LMN disorder
Amyotrophic lateral sclerosis, a mixed UMN/LMN disorder Chapter 15: Disorders of Motor Function, Amyotrophic Lateral Sclerosis, p. 400.
The nurse caring for a client with a newly diagnosed intracranial tumor anticipates that the neoplasm will be: Meningioma Metastatic carcinoma Astrocytic neoplasms Oligodendroglioma
Astrocytic neoplasms Chapter 16: Disorders of Brain Function, Clinical Manifestations, p. 435.
An older adult is brought to the emergency department after experiencing some confusion, slurred speech, and a weak arm. Now the client is back to acting normally. Suspecting a transient ischemic attack (TIA), the health care provider prescribes diagnostic testing looking for which cause of this episode? Aneurysm leakage Minor residual deficits Diffuse cerebral electrical malfunctions Atherosclerotic lesions in cerebral vessels
Atherosclerotic lesions in cerebral vessels Chapter 16: Disorders of Brain Function, Transient Ischemic Attacks, p. 428.
A 38-year-old male client is brought to hospital by ambulance with mild hypothermia following a prolonged hike in the rain. Which set of vital signs would be most characteristic of the client's diagnosis? BP 178/102; RR 12; HR 58 BP 109/68; RR 9; HR 130 BP 160/99; RR 30; HR 66 BP 138/84; RR 28; HR 111
BP 138/84; RR 28; HR 111 Chapter 14: Somatosensory Function, Pain, Headache, and Temperature Regulation, Clinical Manifestations, pp. 375-376.
The nurse is conducting a community education program on concussions. The nurse evaluates that the participants understand the education when they state that which of these offers the brain protection from external forces? Blood-brain barrier Cerebrospinal fluid Cerebral cortex Reticular formation
Cerebrospinal fluid Chapter 16: Disorders of Brain Function, Manifestations and Mechanisms of Brain Injury, p. 413.
The nurse documents the results of a pain assessment. Which documentation is most complete? Obese client reporting back pain as 7 on a scale of 1 to 10 Client states the presence of abdominal pain that is 5 on a scale of 1 to 10; not relieved by passing gas Client is holding the wrist and sweating after a fall on ice and reporting sharp pain of 9 on a scale of 1 to 10; no relief since the fall Client was administered ibuprofen for knee pain of 4 on a scale of 1 to 10 and reports pain reduction to 2
Client is holding the wrist and sweating after a fall on ice and reporting sharp pain of 9 on a scale of 1 to 10; no relief since the fall Chapter 14: Somatosensory Function, Pain, Headache, and Temperature Regulation, Assessment of Pain, p. 357.
When initially assessing a client with verbalization of back pain, the nurse would prioritize rapid assessment for which client? -Client with lower back pain that improves when client moves to a sitting position -Client with acute onset of back pain after history of fall -Client with gradual onset of back pain and history of intravenous drug use. -Client with lower back pain after report of lifting heavy boxes on the job
Client with gradual onset of back pain and history of intravenous drug use Chapter 15: Disorders of Motor Function, Back Pain Emergencies, p. 395.
After a spinal cord injury at S2-S4, most people experience constipation. Why does this occur?
Defecation reflex is lost. Chapter 15: Disorders of Motor Function, Vertebral and Spinal Cord Injury, p. 402.
Regarding the pathophysiology of Parkinson disease, which statement is true? Degeneration of the nigrostriatal dopamine neurons occurs. The dopamine receptors increase from an alteration in neuronal basal ganglia. Failure of the cerebral cortex interferes with the use of acetylcholine. Acetylcholine levels rise and inhibit voluntary movement.
Degeneration of the nigrostriatal dopamine neurons occurs. Chapter 15: Disorders of Motor Function, Parkinson Disease, p. 397.
Which catecholamine may have a vasodilator effect on the renal blood vessels and be prescribed for clients in shock who are experiencing renal insufficiency manifestations?
Dopamine Dopamine, which is an intermediate compound in the synthesis of norepinephrine, also acts as a neurotransmitter. Chapter 13: Organization and Control of Neural Function, Autonomic Neurotransmission, p. 338.
Which catecholamine is formed in the adrenal gland? Epinephrine Norepinephrine Dopamine Acetylcholine
Epinephrine Chapter 13: Organization and Control of Neural Function, Autonomic Neurotransmission, p. 338.
A client experiencing increased temperature reports weakness and fatigue. Which explanation accurately accounts for these symptoms?
Epinephrine and norepinephrine shift the body metabolism to heat production rather than energy generation. Epinephrine and norepinephrine are used by the body to produce heat and not energy, which leaves the client feeling weak and fatigued. All the other options apply to heat loss rather than heat production. Chapter 14: Somatosensory Function, Pain, Headache, and Temperature Regulation - Page 368
A nurse who is providing a staff development in-service determines that the participants understand the information when they state that which bodily function aids heat conservation by reducing surface area for heat loss? Erection of pilomotor muscles Shivering Chattering Sweating
Erection of pilomotor muscles Chapter 14: Somatosensory Function, Pain, Headache, and Temperature Regulation, Mechanisms of Heat Loss, p. 368.
Excessive activity of the excitatory neurotransmitters and their receptor-mediated effects is the cause of which type of brain injury? Hypoxic Ischemic Excitotoxic Increased intercranial volume and pressure
Excitotoxic Chapter 16: Disorders of Brain Function, Excitotoxic Brain Injury, p. 417.
A client who is diagnosed with seizures describes feeling confused after experiencing a seizure. The family members report that the client has been smacking his lips prior to having a seizure. The client most likely experienced which type of seizure? Focal Myoclonic Clonic Atonic
Focal Chapter 16: Disorders of Brain Function, Focal Seizures, p. 438.
The spinal cord contains the basic factors necessary to coordinate function when a movement is planned. It is the lowest level of function. What is the highest level of function in planning movement? Frontal cortex Cerebral cortex Pons Cerebellum
Frontal cortex The highest level of function, which occurs at the level of the frontal cortex, is concerned with the purpose and planning of the motor movement. Chapter 15: Disorders of Motor Function, Organization of Movement, p. 380.
A client begins to exhibit manifestations of a stroke while attending a community health fair. What type of emergency care should the staff at the health fair implement first? Chapter 16: Disorders of Brain Function, Stroke, p. 427.
Going to the nearest stroke center Salvaging brain tissue, preventing secondary stroke, and minimizing long-term disability are the treatment goals for an acute ischemic stroke. The care of clients with stroke has shifted away from the "nearest hospital" to certified stroke centers. These are hospitals that have been certified by some external agency, most commonly the state or Joint Commission, the federal agency overseeing all facilities that care for Medicare clients.
A client in pain uses analgesic medications and heat for pain control. Which instructions should the nurse give the client about the safe application of heat? Select all that apply. Heat can loosen collagen fibers before therapy. Avoid heat on areas with vascular impairment. Alternate heat and ice for acute injuries. Use heat up to 115°F (46.1°C) Chapter 14: Somatosensory Function, Pain, Headache, and Temperature Regulation, Physical Agents, p. 358.
Heat can loosen collagen fibers before therapy. Avoid heat on areas with vascular impairment. Rationale: Heat relieves pain by dilating blood vessels and increasing local blood flow. Heat therapy can be used to loosen collagen in ligaments, tendons, and joints for a greater range of motion during physical therapy.
Which of the following types of pain is characterized by severe, brief, often repetitive pain? Neuropathic pain Neuralgia Tic douloureux Postherpetic neuralgia
Neuralgia Chapter 14: Somatosensory Function, Pain, Headache, and Temperature Regulation, Neuralgia, p. 361.
Guillain-Barré syndrome is characterized by which form of neuron damage? Chapter 15: Disorders of Motor Function - Page 393
Polyneuropathy - Polyneuropathies involve demyelination or axonal degeneration of multiple peripheral nerves that leads to symmetric sensory, motor, or mixed sensorimotor deficits. Guillain-Barre syndrome is an acute immune-mediated polyneuropathy.
A client asks the nurse when during embryonic growth the nervous system develops. The best response would be: Week 3 Week 12 Week 6 Week 15
Week 3 Chapter 13: Organization and Control of Neural Function, Embryonic Development, p. 314.
Which client most likely faces the highest risk of neuroleptic malignant syndrome? Neonate who has developed a worsening fever over the past several hours and who is grunting with each breath Client who is scheduled for a coronary artery bypass graft Young adult client who is taking antipsychotic medications for the treatment of schizophrenia Older adult client who has begun taking donepezil for the treatment of Alzheimer disease
Young adult client who is taking antipsychotic medications for the treatment of schizophrenia Chapter 14: Somatosensory Function, Pain, Headache, and Temperature Regulation, Neuroleptic Malignant Syndrome, p. 374
A nurse is assessing the pain level of an adult with the use of a visual analog scale. Select the response that best indicates the client's rating using this tool. Chapter 14: Somatosensory Function, Pain, Headache, and Temperature Regulation - Page 357
"My pain level falls above the 5-cm mark." -A visual analog scale is a straight 10-cm-long line with a word description associated with the length. The pain can be quantified by measuring the line in centimeters to correspond with the pain. The other options do not refer to the visual analog scale. Chp 14, pg 357
Diagnosing the primary cause is one of several methods used to treat fever. What are some other methods? Select all that apply.
-Modification of external environment to increase heat transfer from the internal to the external environment -Support of hypermetabolic state that accompanies fever -Protection of vulnerable body organs and systems Chapter 14: Somatosensory Function, Pain, Headache, and Temperature Regulation, Treatment, p. 372
The nurse caring for a client with an epidural hematoma recognizes the bleeding is associated with which physiological finding? Skull fracture Cerebral edema Berry aneurysm rupture Arterial tear
Arterial tear Chapter 16: Disorders of Brain Function, Epidural Hematoma, p. 424.
Following a traumatic head injury from a severe blow to the back of the head, a client is unable to maintain steady posture while in a standing position, although the client is steadier when walking. Which brain disorder most likely resulted from this injury? Cerebellar dystaxia Cerebellar tremor A lower motor neuron lesion A vestibulocerebellar disorder
A vestibulocerebellar disorder Chapter 15: Disorders of Motor Function, Disorders of the Cerebellum, p. 395.
Which cell types are responsible for repair and scar formation (also called gliosis) in the brain? Microglia Astrocytes Oligodendrocytes Schwann cells
Astrocytes Chapter 13: Organization and Control of Neural Function, Neuroglial Cells of the Central Nervous System, p. 308.
What part of the neuron is equipped for a high level of metabolic activity and is composed of proteins and other materials used by the axon synthesized? Chapter 13: Organization and Control of Neural Function - Page 306
Cell body, The cell body of the neuron is equipped for a high level of metabolic activity. This is necessary because the cell body must synthesize the cytoplasmic and membrane constituents required to maintain the function of the cell body plus the many proteins and other materials used by the axon and its synaptic terminals.
A client is brought to the emergency department after a bicycle accident. He landed on his back and has been unable to move since the accident, despite the absence of obvious head injuries. The physician will focus assessment of the client's neurologic status by testing which aspects of his body? Each spinal nerve His dermis Each dermatome His pupillary reflexes
Each dermatome Chapter 14: Somatosensory Function, Pain, Headache, and Temperature Regulation, Dermatomal Pattern of Dorsal Root Innervation, p. 344.
The nurse is suctioning a client with a C3 spinal cord injury when the client's heart rate drops from 86 bpm to 42 bpm. What intervention does the nurse understand should be provided prior to suctioning to prevent this vasovagal response from occurring? Administer a saline bolus of 500 mL prior to suctioning. Lower the head of the bed to a flat position prior to suctioning. Administer atropine 1.0 mg prior to suctioning. Hyperoxygenate prior to suctioning.
Hyperoxygenate prior to suctioning. Chapter 15: Disorders of Motor Function, Vasovagal Response, p. 407.
Neurotransmitters are small molecules that exert their actions through specific proteins, called receptors, embedded in the postsynaptic membrane. Where are neurotransmitters synthesized?
In the axon terminal Chapter 13: Organization and Control of Neural Function, Neurotransmitters, p. 313.
The nurse is assessing a client diagnosed with myasthenia gravis (MG). The nurse would expect the assessment to include: Inability to move eyes in multiple positions Absent deep tendon reflexes Loss of hearing on the affected side Impaired ability to move tongue laterally
Inability to move eyes in multiple positions Chapter 15: Disorders of Motor Function, Clinical Manifestations, pp. 390-391.
Following a head injury on the football field, the medical team is concerned because the athlete is showing this earliest sign of decreased level of consciousness? Stupor Lethargy Delirium Inattention
Inattention Any deficit in the level of consciousness, from mild confusion to stupor or coma, indicates injury to either the reticular activating system or to both cerebral hemispheres concurrently. Chapter 16: Disorders of Brain Function, Epidural Hematoma, p. 424.
When assessing neurologic response times, the nurse expects the fastest rate of transmission to be from fibers that have which characteristics? Small diameter, unmyelinated Small diameter, myelinated Large diameter, unmyelinated Large diameter, myelinated
Large diameter, myelinated Signal transmission is fastest in large diameter, myelinated fibers such as type A. Type B fibers are smaller in diameter and myelinated. Unmyelinated, small-diameter Type C fibers have the slowest conduction. Chapter 14: Somatosensory Function, Pain, Headache, and Temperature Regulation, The Sensory Unit, p. 344.
The brain stem contains gray matter that is made up of: Chapter 15: Disorders of Motor Function - Page 383
Neurons. The brain stem contains many groups of neurons that project from the spinal gray matter.
Which disease is thought to be caused by antibody-mediated loss of acetylcholine receptors in the neuromuscular junction? Parkinson syndrome Guillain-Barré syndrome Myasthenia gravis Huntington disease
Myasthenia gravis Chapter 15: Disorders of Motor Function, Myasthenia Gravis, p. 390.
Which is the primary component of white matter? Myelinated fibers Cell bodies Dendrites Demyelinated lesions
Myelinated fibers Chapter 13: Organization and Control of Neural Function, Neuroglial Cells, p. 307
A nurse in the emergency room is assessing a client who appears very drowsy but is able to follow simple commands and respond to painful stimuli appropriately. Which documentation is most accurate regarding this client's level of consciousness? Chapter 16: Disorders of Brain Function, TABLE 16-2, p. 414.
Obtundation Characteristics of obtundation include responding verbally with a word, arousable with stimulation, responds appropriately to painful stimuli, follows simple commands, and appears very drowsy.
Which cells are supporting cells of the central nervous system? Chapter 13: Organization and Control of Neural Function - Page 308
Oligodendrocytes, Astrocytes, Ependymal cells. Not Schwann cells The Schwann cells play a large role in supporting the peripheral nervous system. The other cells are involved in supporting the central nervous system.
The nurse is providing client education to a client newly diagnosed with Parkinson disease. The nurse most accurately describes the disease progression as: Parkinson's is an acute disorder that can be surgically corrected. Parkinson's is a chronic condition and treatment aims to manage symptoms. Parkinson's has no known effective treatment. Parkinson's disease, while chronic, will likely improve over time.
Parkinson's is a chronic condition and treatment aims to manage symptoms. Chapter 15: Disorders of Motor Function, Parkinson Disease, pp. 397-398.
The nurse planning interventions for a client with a brain tumor bases the intervention on the knowledge that the resultant brain injury is due to: Ischemia Excitation Trauma Pressure
Pressure The injury to the brain that stems from brain tumors is due to the pressure that leads to focal disturbances and increased intracranial pressure. Chapter 16: Disorders of Brain Function, Brain Tumors, p. 434.
While a nurse is taking a client's history, the client states that he had a fever 2 days ago that went away for a day and then returned. The nurse documents this as being which type of fever? Relapsing Remittent Continuous Intermittent
Relapsing Chapter 14: Somatosensory Function, Pain, Headache, and Temperature Regulation, Patterns, p. 370.
A client reports having three episodes of fever that have lasted several days, with periods of normal temperature in between the episodes for 2 or more days. Which type of fever is the client experiencing? Remittent fever Continuous fever Intermittent fever Relapsing fever
Relapsing fever Chapter 14: Somatosensory Function, Pain, Headache, and Temperature Regulation, Patterns, p. 370.
Which symptom is unique to amyotrophic lateral sclerosis (ALS) and is not observed in multiple sclerosis (MS)? Respiratory muscle impairment Optic nerve dysfunction Dysarthria Fatigue
Respiratory muscle impairment Chapter 15: Disorders of Motor Function, Clinical Manifestations, p. 400.
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 -Difficulty putting weight on soles of feet and tends to walk on tiptoes -Hyperactive leg motions like he just can't stand still -Takes large, exaggerated strides and swings arms/hands wildly
Slow to start walking and has difficulty when asked to "stop" suddenly. Chapter 15: Disorders of Motor Function, Parkinson Disease, p. 397.
The emergency department nurse is caring for a client who fell and has a head injury. Which assessment would be noted during the early stage of increased intracranial pressure?
Stable vital signs The vital signs remain unchanged in the early stage of increased intracranial pressure. The remaining options are characteristic of late signs. Chapter 16: Disorders of Brain Function - Page 418
The health care provider is assessing a client to differentiate a herniated disk from other causes of acute back pain. The most important test for the provider to perform would be: Straight-leg test Pain rating scale Deep tendon reflex test Apgar test
Straight-leg test Chapter 15: Disorders of Motor Function, Diagnosis, p. 394.
Bronchial smooth muscle relaxation and vascular smooth muscle constriction are caused by the direct actions of which system? Parasympathetic nervous system Sympathetic nervous system Somatic nervous system Central nervous system
Sympathetic nervous system Chapter 13: Organization and Control of Neural Function, Sympathetic nervous system, p. 335.
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 appearance of grimacing, guarding, or wincing The presence of changes in vital signs that correspond to pain The client's subjective report of the character and severity of pain The results of a detailed neurologic assessment
The client's subjective report of the character and severity of pain Chapter 14: Somatosensory Function, Pain, Headache, and Temperature Regulation - Page 357
What do deep tendon reflexes assess? Functioning of the "motor strip" Basic brain stem functions such as breathing The stretch reflex at different spinal cord segments Regulation of brain stem and cortical areas
The stretch reflex at different spinal cord segments. Chapter 15: Disorders of Motor Function, The Stretch and Deep Tendon Reflexes, p. 383.
A 20-year-old male has been experiencing frequent headaches that he describes as throbbing in time with his heart. He also reports worsening grades at college due to difficulty with learning new concepts. Upon cerebral angiography, he is found to have an arteriovenous malformation. The client's symptoms are most likely due to: increased tissue perfusion at the site of the malformation. hydrocephalus. high pressure and hemorrhage of the venous system. localized ischemia.
high pressure and hemorrhage of the venous system. Chapter 16: Disorders of Brain Function, Arteriovenous Malformations, p. 430.
