N520 Hesi Neuro

Which anatomical area in the brain regulates a client's verbal expression? 1 Broca's area 2 Wernicke's area 3 Association area 4 Supplemental area

1 Broca's area ---------------------- Broca's area in the cerebrum regulates verbal expression. Wernicke's area integrates auditory language. Association areas have many functions like sensory input, integration of visual and auditory inputs, past experiences, judgment, and reasoning. Supplemental areas facilitate proximal muscle activity.

Which cranial nerve damage may lead to a decrease in the client's olfactory acuity? 1 Cranial nerve I 2 Cranial nerve X 3 Cranial nerve V 4 Cranial nerve VIII

1 Cranial nerve I -------------------- Cranial nerve I, also known as the olfactory nerve, originates at the olfactory bulb and assists with the perception of smell. Damage to this nerve may cause a decrease in olfactory acuity. Cranial nerve X, also known as the vagus nerve, has both sensory and motor functions. Cranial nerve V, also known as the trigeminal nerve, has both sensory and motor functions. Cranial nerve VIII, also known as the vestibulocochlear nerve, assists with sensory functions such as auditory acuity.

Which lobe of the cerebrum includes the client's Broca's speech center? 1 Frontal lobe 2 Parietal lobe 3 Occipital lobe 4 Temporal lobe

1 Frontal lobe -------------------- Broca's speech center is located in the frontal lobe and is responsible for the formation of words into speech. The parietal lobe aids in processing of spatial awareness and receiving and processing information about temperature, taste, and touch. The primary visual center is in the occipital lobe. The auditory center for interpreting sound is present in the temporal lobe.

A nurse is caring for a client who has paraplegia. Which behavior indicates understanding about the nursing team's responsibility in relation to pressure ulcers? 1 Inspecting the skin daily 2 Providing a rubber cushion on which to sit 3 Massaging body lotion over reddened areas 4 Applying a heating pad to bony prominences

1 Inspecting the skin daily ------------------------------ Because the client is paralyzed and movement is compromised, daily inspection to determine the presence of reddened areas or lesions is necessary so that treatment can be initiated quickly. Providing a rubber cushion on which to sit may contribute to circumscribed pressure, which can lead to skin breakdown. Rubber promotes perspiration, which increases the risk of pressure ulcers. Massage of reddened areas may cause further damage and should be avoided. Because sensation may be compromised, a heating pad should not be used.

A client with hemiparesis is reluctant to use a cane. How does the nurse explain the cane's purpose to the client? 1 Maintain balance to improve stability 2 Relieve pressure on weight-bearing joints 3 Prevent further injury to weakened muscles 4 Aid in controlling involuntary muscle movements

1 Maintain balance to improve stability ------------------------ Hemiparesis creates instability. Using a cane provides a wider base of support and, therefore greater stability. Hemiparesis affects muscle strength on one side of the body; the joints are not directly affected. Activity should strengthen, not injure, weakened muscles. The use of a cane will not prevent involuntary movements if they are present. Test-Taking Tip: Identify option components as correct or incorrect. This may help you identify a wrong answer. Example: If you are being asked to identify a diet that is specific to a certain condition, your knowledge about that condition would help you choose the correct response (e.g., cholecystectomy = low-fat, high-protein, low-calorie diet).

A client is admitted to the hospital for observation after an accident. The client is oriented to person, place, and time, and vital signs are within normal ranges. When performing an assessment, the nurse observes a clear, watery drainage oozing from the client's ear. What should be the nurse's first action? 1 Test the fluid for glucose and apply a sterile dressing. 2 Position the client so that the unaffected ear is dependent. 3 Cover the area with sterile gauze while applying slight pressure. 4 Clean the client's outer ear with normal saline and insert a clean cotton ball/

1 Test the fluid for glucose and apply a sterile dressing --------------------------------------- The presence of glucose indicates that the drainage is cerebrospinal fluid (CSF); a sterile dressing prevents microbial contamination. Positioning the client so that the unaffected ear is dependent may cause retention of CSF and increase intracranial pressure. Pressure will promote retention of CSF and increase intracranial pressure. Attempts to clean the ear may cause microbial contamination; clean cotton balls are not sterile.

Arrange the order of tests chronologically to be performed to determine the neurologic status of a client. 1. Speak in loud voice 2. Apply painful stimuli 3. Speak in normal voice 4. Shake the client gently

1. Speak in normal voice 2. Speak in loud voice 3. Shake the client gently 4. Apply painful stimuli -------------------------------- The assessment of neurologic status should start with speaking to the client in a normal voice. If the client does not respond, the nurse should speak loudly. If the client does not respond to this, the nurse should gently shake the client. The degree of shaking should be similar to that used in waking a child. If the client does not respond to this, painful stimuli can be applied. Test-Taking Tip: In this Question Type, you are asked to prioritize (put in order) the options presented. For example, you might be asked the steps of performing an action or skill such as those involved in medication administration.

A nurse observes dorsiflexion of the big toe and fanning of other toes when the lateral side of a client's foot is stroked with an applicator stick during a neurologic examination. What should the nurse document in the client's medical record? 1 "Has intact plantar reflexes" 2 "Exhibits a positive Babinski sign" 3 "Demonstrates normal sensory function" 4 "Able to perform active range of motion"

2 "Exhibits a positive Babinski sign" --------------------------------------------- This is a positive Babinski sign; it is expected in infants but suggests upper motor neuron disease of the pyramidal tract in adults. The plantar reflex involves flexion of the toes and plantar flexion of the feet. "Demonstrates normal sensory function" is incorrect; positive Babinski is not an indication of normal sensation. "Able to perform active range of motion is inaccurate"; a Babinski is not caused by intentional movement. Active range of motion is a type of exercise, not reflex.

A nurse uses a dull object to stroke the lateral side of the underside of a client's left foot and moves upward to the great toe. What reflex is the nurse testing? 1 Moro 2 Babinski 3 Stepping 4 Cremasteric

2 Babinski ---------------- This is the description of how to elicit the Babinski reflex. If it is present in adults it may indicate a lesion of the pyramidal tract. The Babinski reflex is expected in newborns and disappears after one year. The Moro (startle) reflex is expected in newborns. It disappears between the third and fourth months; if present after four months, neurologic disease is suspected. The stepping reflex is expected in newborns. It disappears at about three to four weeks after birth and is replaced by more deliberate action. The cremasteric is a superficial reflex that tests lumbar segments 1 and 2. Stimulation of this reflex is useful in initiating reflex emptying of the spastic bladder after a spinal cord disruption above the second, third, or fourth sacral segment.

A client has inflammation of the facial nerve, causing facial paralysis on one side. Which diagnosis will the nurse most likely observe written in the medical record? 1 Botulism 2 Bell palsy 3 Trigeminal neuralgia 4 Guillain-Barré syndrome

2 Bell palsy ------------------ Bell palsy is a cranial nerve disorder characterized by inflammation of the facial nerve on one side of the face. Botulism is a type of polyneuropathy caused by food poisoning due to Clostridium botulinum that can be fatal. Trigeminal neuralgia is a cranial nerve disorder characterized by pain in the distribution of the trigeminal nerve. Guillain-Barré syndrome is an acute, rapidly progressing, potentially fatal polyneuritis.

Which part of the client's brain is primarily associated with life support and basic functions of the body? 1 Cerebrum 2 Brain stem 3 Cerebellum 4 Cerebral cortex

2 Brain stem ---------------------------------- The brainstem, which connects the brain to the CNS, is concerned primarily with life support and basic functions, such as breathing and movement. The cerebrum controls intelligence, creativity, and memory. The cerebellum is concerned with coordination of movement. The cerebral cortex is part of the cerebrum, which is involved with almost all of the higher functions of the brain.

How is the brachioradialis reflex elicited? 1 By striking the triceps tendon above the elbow 2 By striking the radius 3 to 5 cm above the wrist 3 By striking the patellar tendon just below the patella 4 By striking the Achilles tendon when the client's leg is flexed

2 By striking the radius 3 to 5 cm above the wrist ---------------------------------------------------- The brachioradialis reflex can be elicited by striking the radius 3 to 5 cm above the wrist while the client's arm is relaxed. Striking the triceps tendon above the elbow elicits the triceps reflex. Striking the patellar tendon just below the patella elicits the patellar reflex. Striking the Achilles tendon elicits the Achilles tendon reflex when the client's leg is flexed.

Which part of the client's brain primarily regulates muscle functioning and coordinates movement? 1 Cerebrum 2 Cerebellum 3 Epithalamus 4 Hypothalamus

2 Cerebellum -------------------------------------- The cerebellum regulates motor movements resulting in smooth and balanced muscular activity. The cerebrum is associated with higher brain functions, such as thought and action. The epithalamus acts as a connection between the motor pathways and regulates emotions. The hypothalamus regulates the body temperature and secretions of the endocrine gland.

A client who just has been diagnosed with primary open-angle glaucoma (POAG) refuses therapy. The nurse reinforces that it is important for the client to seek treatment. Which goal is the nurse trying to achieve? 1 Prevent cataracts 2 Prevent blindness 3 Prevent retinal detachment 4 Prevent blurred distance vision

2 Prevent blindness ---------------------------- POAG progresses gradually without symptoms; if untreated, blindness occurs. Peripheral vision slowly disappears until tunnel vision occurs in which there is only a small center field. Without treatment, eventually all vision is lost. POAG is not related to the development of cataracts, retinal detachment, or blurred distance vision.

Which client eye movement does the superior oblique muscle control? 1 Pulls the eye upward 2 Pulls the eye downward 3 Turns the eye towards the nose 4 Turns the eye towards the side of the head

2 Pulls the eye downward -------------------------------- The superior oblique muscle contracts alone and pulls the eye downward. The inferior oblique muscle helps in pulling the eye upwards. The medial rectus muscle contracts alone and turns the eye towards the nose. The lateral rectus muscle turns the eye towards the side of the head.

A nurse is assessing a client's eye and finds the following (see image). Which condition can be identified from the given figure? 3204060505 1 Strabismus 2 Keratoconus 3 Corneal ulcer 4 Retinal detachment

3 Corneal ulcer ------------------ The condition depicted in the figure is a corneal ulcer. Tissue loss due to an infection of the cornea causes corneal ulcers; the infection can be due to bacteria, a virus, or fungi. Strabismus is a condition of double vision; it can be due to neuromuscular problems of the eye. Keratoconus is a noninflammatory disease, where the anterior cornea thins and protrudes forward, taking on a cone shape. Retinal detachment is separation of the sensory retina and the underlying pigment epithelium with fluid accumulation between the two layers.

Which is the priority assessment for the client with Guillain-Barré syndrome with rapidly ascending paralysis? 1 Monitoring urinary output 2 Assessing nutritional status 3 Monitoring respiratory status 4 Assessing communication needs

3 Monitoring respiratory status ---------------------------------- The most serious complication of Guillain-Barré syndrome is respiratory failure caused by respiratory muscle paralysis. Urinary retention is common in Guillain-Barré, but monitoring urinary output is of lower priority than monitoring respiratory status. If ascending paralysis impairs the gag reflex, clients may require tube feedings or parenteral nutrition. Assessing nutritional status, however, is of lower priority than monitoring respiratory status. If ascending paralysis impairs cranial nerve functioning, or if the client is intubated, verbal communication abilities are lost.

A client with multiple sclerosis is admitted to the hospital. The client's exacerbations have become more frequent and more severe. One day, the client's partner confides to the nurse, "Life is getting very hard and depressing, and I am upset with myself for thinking about a nursing home." After listening to the partner's concerns, which is the best response by the nurse? 1 "You may be able to lessen your feelings of guilt by seeking counseling." 2 "It would be helpful if you become involved in volunteer work at this time." 3 "I recognize it's hard to deal with this, but try to remember that this too shall pass." 4 "Joining a support group of people who are coping with this problem may be helpful."

4 "Joining a support group of people who are coping with this problem may be helpful." ----------------------------------------------- Talking with others in similar circumstances provides support and allows for sharing of experiences. The response "You may be able to lessen your feelings of guilt by seeking counseling" is inappropriate because the feeling of guilt was not expressed directly and is too early for this intervention. The response "It would be helpful if you become involved in volunteer work at this time" avoids the partner's concerns and makes a recommendation for which the partner may not have the energy. Also, it cuts off communication. Although the response "I recognize it's hard to deal with this, but try to remember that this too shall pass" identifies feelings, it offers false reassurance.

A client has a tonic-clonic seizure at work and is admitted to the emergency department. Which question is most useful when planning nursing care related to the client's seizure? 1 "Is your job demanding or stressful most of the time?" 2 "Do you participate in any strenuous sports activities on a regular basis?" 3 "Does anyone in your family have a history of central nervous system problems?" 4 "Were you aware of anything different or unusual just before your seizure began?"

4 "Were you aware of anything different or unusual just before your seizure beg ------------------------- Identification of a sensation that occurs before each seizure [1] [2] (aura) is helpful in identifying the cause of the seizure and planning how to identify and avoid a future seizure. Although the response "Is your job demanding or stressful most of the time?" may provide some information, it is not the most inclusive question the nurse can ask; also, it limits the client's reply. Although the response "Do you participate in any strenuous sports activities on a regular basis?" may provide some information, it is not the most inclusive question the nurse can ask; also, it limits the client's reply. Although the response "Does anyone in your family have a history of central nervous system problems?" may provide some information, it is not the most inclusive question the nurse can ask; also, it limits the client's reply.

A nurse assesses a client and observes the condition depicted in the image. How will the nurse chart this finding? 1 Otorrhea present 2 Halo sign present 3 Rhinorrhea present 4 Battle's sign present

4 Battle's sign present -------------------------------- The condition depicted in the figure is Battle's sign, which is characterized by postauricular ecchymosis. Otorrhea is the leakage of cerebrospinal fluid from the ear. A halo sign indicates the presence of blood in the cerebrospinal fluid. Rhinorrhea is the leakage of cerebrospinal fluid from the nose. Test-Taking Tip: Some clinical manifestations are also seen after several hours of fractures, which may be due to cranial nerve defects. Observe clearly for the indication in the figure to choose a correct answer option.

Which part of the brain contains the client's "central switchboard" of the central nervous system? 1 Cerebrum 2 Brain stem 3 Cerebellum 4 Diencephalon

4 Diencephalon ------------------------ The thalamus is considered to be the major relay station or "central switchboard" for the central nervous system (CNS). The thalamus, along with the hypothalamus and epithalamus, are located in the diencephalon of the brain. The cerebrum is the largest part of the brain, which has right and left lateral ventricles deep inside and has basal ganglia at its base. The brainstem connects the rest of the brain with the CNS. It is associated with life support and basic functions, such as movement. The cerebellum is concerned with coordination of movement and works together with the brainstem to focus on the functionality of the muscles. This structure is found below the occipital lobe and adjacent to the brainstem.

A client with parkinsonism is taking an anticholinergic medication for morning stiffness and tremors in the right arm. During a visit to the clinic, the client complains of some numbness in the left hand. What is the nurse's priority intervention? 1 Refer the client to the primary healthcare provider only if other neurologic deficits are present. 2 Ask the primary healthcare provider to increase the client's dosage of the anticholinergic medication. 3 Stress the importance of having the client call the primary healthcare provider as soon as possible. 4 Make arrangements immediately for further medical evaluation by the client's primary healthcare provider.

4 Make arrangements immediately for further medical evaluation by the client's primary healthcare provider. ----------------------------------------- Numbness, a sensory deficit, is inconsistent with parkinsonism; further medical evaluation is necessary. Numbness, even in the absence of other problems, may be indicative of an impending brain attack (cerebrovascular accident, CVA). This symptom is not caused by parkinsonism; increasing the dosage of the anticholinergic medication will not be helpful. Stressing the importance of having the client call the primary healthcare provider as soon as possible can cause a delay in the client's receiving immediate medical attention.

A client sustains a crushing injury of the spinal cord above the level of origin of the phrenic nerve. As a result of this injury, the nurse expects what client response? 1 Ventricular fibrillation 2 Dysfunction of the vagus nerve 3 Retention of sensation but paralysis of the lower extremities 4 Respiratory paralysis and cessation of diaphragmatic contractions

4 Respiratory paralysis and cessation of diaphragmatic contractions ---------------------------------- The phrenic nerve innervates the diaphragm. Therefore a crushing spinal cord injury above the cervical plexuses, the level of phrenic nerve origin, results in respiratory paralysis. Cardiac activity will not be affected; the heart is regulated by the autonomic nervous system fibers originating in the medulla. Activities regulated by the vagus nerve will be unaffected; it originates in the medulla, which is superior to the cervical region; the phrenic nerves originate from the cervical plexuses. In a crushing spinal cord injury, both motor and sensory conduction are affected.

A client is having a tonic-clonic seizure. Which is a priority nursing action? 1 Elevating the head of the bed 2 Restraining the client's arms and legs 3 Placing a tongue blade in the client's mouth 4 Taking measures to prevent injury

4 Taking measures to prevent injury ------------------------------------------ Protecting the client from injury is the immediate priority during a seizure. Elevating the head of the bed would have no effect on the client's condition or safety. Restraining the client's arms and legs could cause injury. Placing a tongue blade or other object in the client's mouth could damage the teeth.