NCLEX Questions Chapter 23

An area of the body that is supplied mainly from one spinal segment through a particular spinal nerve is identified as a: A. dermatome. B. dermal segmentation. C. hemisphere. D. crossed representation.

A A dermatome is a circumscribed skin area that is supplied mainly from one spinal cord segment through a particular spinal nerve. Dermal segmentation is the cutaneous distribution of the various spinal nerves. Each half of the cerebrum is a hemisphere. Crossed representation is a feature of the nerve tracts; the left cerebral cortex receives sensory information from and controls motor function to the right side of body, whereas the right cerebral cortex likewise interacts with the left side of the body.

Automatic associated movements of the body are under the control and regulation of: A. the basal ganglia. B. the thalamus. C. the hypothalamus. D. Wernicke's area.

A The basal ganglia controls automatic associated movements of the body. The thalamus is where sensory pathways of the spinal cord, cerebellum, and brainstem form synapses on their way to the cerebral cortex. The hypothalamus is a major respiratory center with basic vital functions: temperature, appetite, sex drive, heart rate, and blood pressure control; sleep center; anterior and posterior pituitary gland regulation; and coordination of autonomic nervous system activity and stress response. Wernicke's area in the temporal lobe is associated with language comprehension.

The presence of primitive reflexes in a newborn infant is indicative of: A. immaturity of the nervous system. B. prematurity of the infant. C. mental retardation. D. spinal cord alterations.

A The nervous system is not completely developed at birth, and motor activity in the newborn is under the control of the spinal cord and medulla. The neurons are not yet myelinated. Movements are directed primarily by primitive reflexes. As the cerebral cortex develops during the first year, it inhibits these reflexes, and they disappear at predictable times. Persistence of the primitive reflexes is an indication of central nervous system dysfunction.

Clonus that may be seen when testing deep tendon reflexes is characterized by a(n): A. additional contraction of the muscle that is of greater intensity than the first contraction. B. set of rapid, rhythmic contractions of the same muscle. C. parallel response in the opposite extremity. D. contraction of the muscle that appears after the tendon is hit the second time.

B Clonus is a set of rapid, rhythmic contractions of the same muscle.

The ______ reflex is an example of a _________ reflex. A. plantar; deep tendon B. abdominal; superficial C. quadriceps; pathologic D. corneal light; visceral

B Superficial reflexes test the sensory receptor in the skin; the motor response is a localized muscle contraction. Superficial reflexes include abdominal, cremasteric, and plantar (or Babinski) reflexes. Deep tendon reflexes test the reflex arc at the spinal level and include the biceps, triceps, brachioradialis, quadriceps, and Achilles. The quadriceps reflex is a deep tendon reflex and is normal. The corneal light reflex assesses the parallel alignment of the eye (cranial nerves III, IV, and VI).

The _____________ coordinates movement, maintains equilibrium, and helps maintain posture. A. extrapyramidal system B. cerebellum C. upper and lower motor neurons D. basal ganglia

B The cerebellum controls motor coordination of voluntary movements, equilibrium (i.e., posture balance of the body), and muscle tone. The extrapyramidal system maintains muscle tone and controls body movements, especially gross automatic movements such as walking. The upper motor neurons are located within the central nervous system; influence or modify the lower motor neurons; and include the corticospinal, corticobulbar, and extrapyramidal tracts. The lower motor neurons are located mostly in the peripheral nervous system and extend from the spinal cord to the muscles; examples include the cranial nerves and spinal nerves. The basal ganglia control automatic associated movements of the body.

Cerebellar function is tested by: A. muscle strength assessment. B. performance of rapid alternating movements. C. the Phalen maneuver. D. superficial pain and touch assessment.

B The cerebellum controls motor coordination of voluntary movements, equilibrium, and muscle tone. Cerebellar function is tested by balance tests (e.g., gait, Romberg test) and coordination and skilled movements (e.g., rapid alternating movements, finger-to-finger test, finger-to-nose test, heel-to-shin test). Muscle strength assessment examines the intactness of the motor system. The Phalen maneuver reproduces numbness and burning in a patient with carpal tunnel syndrome. Superficial pain and touch assessment examines intactness of the spinothalamic tract.

What term is used to describe involuntary muscle movements? A. Ataxia B. Flaccid C. Athetosis D. Vestibular function

C Athetosis is slow, writhing, continuous, and involuntary movements of the extremities. Ataxia is an impaired ability to coordinate movement, often characterized by a staggering gait and postural imbalance. Flaccid is weak, soft, and flabby; lacking normal muscle tone. Vestibular function is the sense of balance.

Testing the deep tendon reflexes gives the examiner information regarding the intactness of the: A. corticospinal tract. B. medulla. C. reflex arc at specific levels in the spinal cord. D. upper motor and lower motor neuron synaptic junction.

C Measurement of the deep tendon reflexes reveals the intactness of the reflex arc at specific spinal levels. The corticospinal tract is the higher motor system that permits very skilled and purposeful movements such as writing. The medulla contains all ascending and descending fiber tracts; it has vital autonomic centers for respiration, heart, and gastrointestinal function as well as nuclei for cranial nerves VIII through XII. The upper motor neurons are located within the central nervous system and influence or modify the lower motor neurons and include the corticospinal, corticobulbar, and extrapyramidal tracts. The lower motor neurons are located mostly in the peripheral nervous system and extend from the spinal cord to the muscles; examples include the cranial nerves and spinal nerves.

During assessment of extraocular movements, two back-and-forth oscillations of the eyes in the extreme lateral gaze occurs. This response indicates: A. that the patient needs to be referred for a more complete eye examination. B. a disease of the vestibular system, further evaluation is needed. C. an expected movement of the eyes during this procedure. D. this assessment should be repeated in 15 minutes to allow the eyes to rest.

C Nystagmus is a back-and-forth oscillation of the eyes. End-point nystagmus, a few beats of horizontal nystagmus at extreme lateral gaze, occurs normally.

An abnormal sensation of burning or tingling is best described as: A. paralysis. B. paresis. C. paresthesia. D. paraphasia.

C Paresthesia is an abnormal sensation such as burning or tingling. Paralysis is a loss of motor function as a result of a lesion in the neurologic or muscular system or loss of sensory innervation. Paresis is a partial or incomplete paralysis. Paraphasia is a condition in which a person hears and comprehends words but is unable to speak correctly; incoherent words are substituted for intended words.

The extrapyramidal system is located in the: A. hypothalamus. B. cerebellum. C. basal ganglia. D. medulla.

C The basal ganglia are large bands of gray matter buried deep within the two cerebral hemispheres that form the subcortical associated motor system (the extrapyramidal system).