Neurology

What effect do demyelinating disorders such as multiple sclerosis have on neurotransmission? ~Slow rate of action potential conduction ~Increased rate of action potential conduction ~Facilitation of action potential initiation ~Faster rate of repolarization

Slow rate of action potential conduction

All of the following are potential sources for the development of meningitis EXCEPT ~Neisseria meningitidis ~Streptococcus pyogenes ~Group B, â-hemolytic streptococcus ~Streptococcus pneumonia ~Haemophilus influenzae

Streptococcus pyogenes

A patient presents to a primary care provider reporting fever, headache, nuchal rigidity, and decreased consciousness. History includes a previously treated sinusitis. Which medical diagnosis is best supported by this assessment data? ~Aseptic meningitis ~Bacterial meningitis ~Fungal meningitis ~Nonpurulent meningitis ~None of the above

Bacterial meningitis

Patient teaching is considered successful regarding ALS when the patient identifies its cause as being: ~Viral infection ~Autoimmune ~Atrophy of the spinal cord and lateral column ~Damage of the upper and lower motor neurons ~Single gene defect

Damage of the upper and lower motor neurons

All of the following apply to CVA EXCEPT: ~The common cause is an atheroma with thrombus ~Death is imminent ~Warning signs may appear with partial obstruction of the artery ~Increasing neurological deficits usually develop during the first few days

Death is imminent

Steroids may be used in the management of acute exacerbation of symptoms in patients with multiple sclerosis, because ~Viral damage can be inhibited ~Demyelination is mediated by immune mechanisms ~Steroids reverse the progression of the disease ~Steroids inhibit synaptic degradation of neurotransmitters

Demyelination is mediated by immune mechanisms

A patient is newly diagnosed with multiple sclerosis (MS). What physiological change is causing the patient's symptoms? ~Depletion of dopamine in the central nervous system (CNS) ~Demyelination of nerve fibers in the CNS ~Reduced amounts of acetylcholine at the neuromuscular junction ~The development of neurofibril webs in the CNS

Demyelination of nerve fibers in the CNS

Parkinson disease is associated with ~Demyelination of CNS neurons ~Insufficient production of acetylcholine in the basal ganglia ~A pyramidal nerve tract lesion ~A deficiency of dopamine in the substantia nigra

A deficiency of dopamine in the substantia nigra

A 62 year old male was recently diagnosed with a transient ischemic attack (TIA). As the charge nurse, you are responsible for providing education to this patient. Which of the following statements by the patient indicates that he understands the information? ~"TIAs are usually caused by large bleeds in the brain that resolve on their own" ~"Because TIAs don't cause permanent damage, I do not need to worry if I have another one" ~"It is important to seek medical attention immediately if I am experiencing these symptoms again because they could mean that I am having a stroke" ~"Transient ischemic attacks (TIAs) are often caused by small bleeds in the brain that resolve on their own"

"It is important to seek medical attention immediately if I am experiencing these symptoms again because they could mean that I am having a stroke"

A 62 year old female presents to her primary for her annual examination. On this visit, she states that she's noticing tremor of the right hand greater than the left hand. The tremors disappears if she's holding an object. She states that her husband of 30 years noted that her gait has changed and her walking is more like a shuffle. Physical examination was significant for resting tremor, masked facies, and mild muscular rigidity. When asked about her condition, which of the following statements is most appropriate to share with the patient? ~"Your disease will not worsen/progress if you do not take your medication(s) as directed" ~"This disease results from an access accumulation of dopamine, a neurotransmitter." ~"This is a progressive disease and medications are designed to slow the disease process." ~Only B and C

"This is a progressive disease and medications are designed to slow the disease process."

Which of the following tests is used to assist in the diagnosis of multiple sclerosis? ~Genetic test ~Karyotyping ~Blood test ~MRI ~Ultrasound

MRI

A 70 year old man has a two-day history of worsening generalized headache and increasing obtundation. He now complains of stiffness in his neck. Vital sign was significant for fever. A CBC reveals a WBC count of 16,850/microliter (N < 10,000/microliter). A lumbar puncture yields cloudy cerebrospinal fluid with a glucose of 32mg/dL, protein 146 mg/dL, and cell count of 3800 WBCs (95% neutrophils and 5% monuclear) and 2 RBCs. The patient was diagnosed with meningitis. He receives antibiotic therapy and improves. Which of the following statements is true for this bacterial meningitis? ~Treatment includes glucocorticoids ~Complications include Waterhouse-Friderichsen syndrome (adrenal gland hemorrhage) or hydrocephalus ~Streptococcus pneumoniae is the major cause in this age group ~Signs and symptoms associated with this condition include headaches, stupor, seizures, photophobia ~All of the above

All of the above

Which of the following is an unmodifiable risk factor for stroke? ~Age ~Sex ~Race ~All of the above are unmodifiable risk factor for stroke

All of the above are unmodifiable risk factor for stroke

Causes for meningitis include ~Viral ~Bacterial ~Fungal ~Protozoa ~All the listed microorganisms can cause meningitis

All the listed microorganisms can cause meningitis

Which of the following proteins is most likely defective and is associated with Parkinson's disease? ~SOD-1 ~Tau proteins ~Beta amyloid protein ~Alpha synuclein

Alpha synuclein

A 42 year old former major league baseball player develops progressive, symmetric muscular weakness of his upper extremities along with fasciculation over the course of 3 year. Then he develops difficulty speaking and swallowing. He does not have myalgia or arthralgia. He is afebrile. His mental function has not become diminished. Which of the following is his most likely diagnosis? ~Amyotrophic lateral sclerosis ~Parkinson disease ~Huntington disease ~Neimann-Pick disease ~Myasthenia gravis

Amyotrophic lateral sclerosis

Upper extremity weakness in association with degeneration of CNS neurons is characteristic of ~Multiple sclerosis ~Myasthenia gravis ~Amyotrophic lateral sclerosis ~Dementia

Amyotrophic lateral sclerosis

Which of the following is the most likely etiology for multiple sclerosis? ~Autoimmune ~Autosomal dominant ~Autosomal recessive ~X-linked ~Incomplete penetrance

Autoimmune

When a patient asks, "What is the cause of multiple sclerosis?" The nurse bases the answer on the interaction between: ~Vascular and metabolic factors ~Bacterial infection and the inflammatory response ~Neurotransmitters and inherited genes ~Randomness ~Autoimmunity and genetic susceptibility

Autoimmunity and genetic susceptibility

A 50 year old African American man has had headaches for the past month.On physical examination his blood pressure is 190/110 mm Hg (N = 120/80 mm Hg). He cannot afford to take any medications. He is admitted to the hospital after suddenly losing consciousness. When he is aroused, he cannot speak and he cannot move his right leg. Which of the following is the most likely cause associated with this patient? ~Cerebral vascular accident caused by an athernorma in the abdominal portion of the aorta ~Cerebral vascular accident cause by a hemorrhage ~Cerebral vascular accident caused by an embolus ~Cerebral vascular accident caused by an thrombus ~Cerebral vascular accident caused by vagal-vagal response

Cerebral vascular accident caused by a hemorrhage

A 41 year old former professional football player was diagnosed with amyotrophic lateral sclerosis. Although unable to play football physically, the patient desires to remain in football as a coach or as a mentor to young football players. What is the most appropriate statement about this disease that you can share with the patient? ~Cognitive function remains normal ~Cause of death is usually a cardiac arrhythmia ~ALS affect primarily young women and occurrence in males is extremely rare ~Sensory neurons are damaged initially but do recover

Cognitive function remains normal

The dementia of Alzheimer disease is associated with structural changes in the brain, including ~Deposition of amyloid plaques in the brain ~Degeneration of basal ganglia ~Hypertrophy of frontal lobe neurons ~Significant aluminum deposits in the brain

Deposition of amyloid plaques in the brain

What is the pathophysiology to multiple sclerosis? ~Destruction of myelin sheath with resulting plaque formation at the site ~Destruction of acetylcholine receptors at the myoneural junction ~Destruction of neurotransmitters in the synaptic cleft ~Inhibition of synaptic vesicle binding ~Inhibition of neurotransmitters reuptake

Destruction of myelin sheath with resulting plaque formation at the site

Which of the following neurotransmitters play a key role in the etiology of Parkinson's disease? ~Dopamine ~Acetylcholine ~Norepinephrine ~Serotonin ~GABA

Dopamine

A 60 year old patient with a long term history of hypertension presents to the ER for changes in mental status. What does the nurse suspect cause this type of stroke? ~Infarction ~Thrombotic ~Embolic ~Hemorrhagic

Hemorrhagic

A 40 year old male complains of uncontrolled excessive movement and progressive dysfunction of intellectual and thought processes. He is experiencing movement problems that begin in the face and arms and eventually affect the entire body. The most likely diagnosis is: ~Tardive dyskinesia ~Huntington disease ~Hypokinesia ~Alzheimer disease

Huntington disease

A patient has excessive movement. What disorder will the nurse see documented on the chart? ~Hypokinesia ~Ainesia ~Hyperkinesia ~Dysdiadochokinesia

Hyperkinesia

Which of the following systemic diseases is strongly associated with the hemorrhagic cerebral vascular accident? ~Diabetes mellitus ~Atherosclerosis ~Hypertension ~Cushing's disease ~All of the above

Hypertension

A major contributing process in CVA's is the development of atheromatous plaques in cerebral circulation. Where do these plaques most commonly form? ~In the larger veins ~Near capillary sphincters ~In the cerebral arteries ~In the venous sinuses

In the cerebral arteries

A 20 year old present to the eye clinic complaining of intermittent diplopia (double vision). Initial eye exam was unremarkable and an MRI was ordered. Multiple plaques of demyelination were visible on MRI scan. What is the most likely condition? ~Amyotrophic lateral sclerosis ~Multiple sclerosis ~Huntington disease ~Niemann-Pick disease ~Creutzfeldt-Jakob disease

Multiple sclerosis

Patients diagnosed with multiple sclerosis often have pathologic changes involving the ~Astrocytes ~Satellite cells ~Oligodendrocytes ~Ependymal

Oligodendrocytes

Before making a diagnosis of Alzheimer disease ~A brain biopsy demonstrating organic changes is necessary ~Biochemical tests for aluminum toxicity must be positive ~Other potential causes of dementia must be ruled out ~Increased protein is found in a lumbar puncture

Other potential causes of dementia must be ruled out

A 66 year old man is finding that he has more difficulty getting up and moving about for the past year. He is annoyed by a tremor in his hands, but the tremor goes away when he performs routine tasks using his hands. His friends remark that he seems sullener and doesn't smile at them, but only stares with a fixed expression on his face. He has not suffered any loss of mental ability. Which of the following conditions is he most likely to have? ~Niemann-Pick disease ~Parkinson disease ~Amyotrophic lateral sclerosis ~Myasthenia gravis ~Huntington disease

Parkinson disease

Which of the following diseases is caused by the lack of dopamine? ~Muscular dystrophy ~Myasthenia gravis ~Multiple sclerosis ~Alzheimer's disease ~Parkinson's disease

Parkinson's disease

A 50 year old African American man has had headaches for the past month. On physical examination, his blood pressure is 190/110 mm Hg (N = 120/80 mm Hg). He cannot afford to take any medications. He is admitted to the hospital after suddenly losing consciousness. When he is aroused, he cannot speak and he cannot move his right leg. For the above patient, what is the most likely cause for his condition on admission? ~Poorly controlled ADH secretion ~Poorly controlled dietary habits ~Poorly controlled heart disease ~Poorly controlled hypertension ~Poorly controlled diabetes mellitus

Poorly controlled hypertension

A nurse at a long-term care facility provides care for an 85 year old man who has had recent transient ischemic attacks (TIAs). Which of the following statements best identifies future complications associated with TIAs? TIAs ~Are caused by small bleeds that can be a warning sign of impending stroke ~Are accumulations of small deficits that may eventually equal the effects of a full CVA ~Are a relatively benign sign that necessitates monitoring but not treatment ~Resolve rapidly but may place the patient at an increased risk for stroke.

Resolve rapidly but may place the patient at an increased risk for stroke.

The classic manifestations of Parkinson disease include ~Intention tremor and akinesia ~Rest tremor and skeletal muscle rigidity ~Ataxia and intention tremor ~Skeletal muscle rigidity and intention tremor

Rest tremor and skeletal muscle rigidity

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

The age of onset ranges from 20 to 50 years

Which of the following is a TRUE statement about transient ischemic attacks (TIAs)? ~The usually cause necrosis and permanent brain damage ~They may be caused by rupture of an aneurysm or a damaged artery ~They usually indicate systemic hypertension ~They can warn of potential cerebrovascular accidents

They can warn of potential cerebrovascular accidents

A 72 year old patient demonstrates a left sided weakness of upper and lower extremities. The symptoms lasted less than an hour and resolved with no evidence of infarction. The patient most likely experienced a(n): ~Cerebral vascular accident ~Arteriovenous malformation ~Transient ischemic attack ~Cerebral hemorrhage

Transient ischemic attack