PathoPharm Exam 3 (evolve)

The nurse is caring for a patient hospitalized with an acute episode (relapse) of MS. Which agent is the preferred treatment during relapse? A. Interferon beta-1a [Avonex] IM B. Methylprednisolone [Solu-Medrol] IV C. Glatiramer acetate [Copaxone] subQ D. Natalizumab [Tysabri] IV infusion

B During an acute relapse episode of MS, the treatment of choice is a high-dose IV glucocorticoid, such as methylprednisolone, to reduce the inflammation and diminish symptoms. The other agents are disease-modifying drugs that are used in the long-term management of MS.

A patient is hit in the temporal portion of his skull. Although initial loss of consciousness occurs, the patient soon awakens and is conversant. Three hours later vomiting, drowsiness, and confusion are noted. These symptoms are most likely related to which type of brain injury? A. Epidural B. Intracerebral C. Diffuse axonal D. Subdural

A The classic presentation of an epidural hematoma is a person hit in the temporal area with damage to the middle meningeal artery. The patient will lose consciousness at the time of injury, but there may be a period where consciousness is regained. The patient will then become more confused and drowsy. This scenario is not typical with the other types of brain injuries.

The most common cause of TBI for children and older adults is: A. falls. B. sports-related events. C. motor vehicle accidents. D. violence.

A The most common cause of TBI's for children and older aduts are falls. This is followed closely by unintentional blunt trauma and motor vehicle accidents.

The healthcare provider orders Namenda syrup 20 mg PO daily in two divided doses. The concentration available is Namenda 2 mg/mL. How many mL will the patient receive for each dose? A. 2 mL B. 5 mL C. 10 mL D. 20 mL

B Each dose will be 5 mL. The total of 20 mg is divided into two doses of 10 mg. The concentration is 2 mg/mL. Divide 10 mg by 2 mg to equal 5 mL.

The nurse receives a laboratory report indicating that the phenytoin [Dilantin] level for the patient seen in the clinic yesterday is 16 mcg/mL. Which intervention is most appropriate? A. Continue as planned, because the level is within normal limits. B. Tell the patient to hold today's dose and return to the clinic. C. Consult the prescriber to recommend an increased dose. D. Have the patient call 911 and meet him/her in the emergency department.

A The therapeutic range for phenytoin is 10 to 20 mcg/mL. Because this level is within normal limits, the nurse would continue with the routine plan of care.

The nurse is caring for a patient with a suspected overdose of pancuronium, which was used during surgery. Which drug does the nurse anticipate will be used as a reversal agent? A. Neostigmine [Prostigmin] B. Atropine C. Pralidoxime [DuoDote] D. Dobutamine [Dobutrex]

A Because neostigmine inhibits cholinesterase, it allows acetylcholine to accumulate at synapses. This action can help reverse neuromuscular blockade in postoperative patients, especially when a nondepolarizing neuromuscular blocker, such as pancuronium, has been used.

It is true that an acute cerebrovascular accident (CVA) is: A. the leading cause of disability in the United States. B. very likely to be followed by a second stroke within 1 year. C. experienced by 2 million individuals each year. D. the fifth most common cause of death in the United States.

A CVAs are the leading cause of disability and the third leading cause of death. There are 500,000 stroke victims a year, and only 5%-14% have a second stroke within 1 year.

A patient presents with a wide-based gait in which the feet are turned outward. Staggering is noted when walking and the pelvis is held stiff. These characteristics are representative of: A. cerebellar gait. B. apraxia. C. basal ganglion gait. D. decorticate posture.

A Cerebellar dysfunction results in a wide-based gait in which the feet are turned inward or outward. Basal ganglion gait is a wide-based gait in which the person walks with small steps and decreased arm swing. Decorticate posture occurs when the upper extremities are flexed at the elbows and held close to the body while the lower extremities are externally rotated and extended. Apraxia is the inability to perform purposeful or skilled motor acts in the absence of paralysis, sensory loss, abnormal posture, or tone.

A trauma patient diagnosed with a brain contusion experiences changes in attention, memory, affect, and emotion. In which region of the brain is the contusion most likely located? A. Frontal B. Cerebellum C. Cerebral D. Midbrain

A Contusions are most commonly found in the frontal lobes, particularly at the poles and along the inferior orbital surfaces. They result in changes in attention, memory, and executive attentional functioning.

A patient experiences demyelination of the peripheral nerves with sparing of the axons. This is characteristic of: A. Guillain-Barré. B. Alzheimer disease. C. amyotrophic lateral sclerosis (ALS). D. myasthenia gravis.

A Guillain-Barré is an idiopathic polyneuritis with acute inflammatory demyelinating characteristics. There is demyelination of the peripheral nerves with relative sparing of the axons. Alzheimer disease is a form of dementia caused by tangles. Myasthenia gravis is due to anti-acetylcholine-receptor antibodies. ALS is a degenerative disorder diffusely involving lower and upper motor neurons, resulting in progressive muscle weakness.

The term used to describe a patient who sustains a cerebrovascular accident and the limbs are paralyzed on an entire side is: A. hemiplegia. B. paraplegia. C. diplegia. D. quadriplegia.

A Hemiplegia means loss of motor function on one side of the body. Paraplegia refers to loss of motor function of the lower extremities. Diplegia is the paralysis of both upper and lower extremities as a result of cerebral hemisphere injuries. Quadriplegia refers to paralysis of all four extremities.

The nurse is teaching a patient about a new prescription for mitoxantrone [Novantrone]. Which statement made by the patient indicates a need for further teaching? A. "I volunteer at a local day care center once a week." B. "I drink grapefruit juice with breakfast each morning." C. "I enjoy walking and outdoor activities in the sun." D. "I understand this drug may cause my urine to turn blue."

A Mitoxantrone can cause myelosuppression. Patients taking this drug should be advised to avoid contact with people who have infections, such as children in day care centers. The other statements are appropriate for patients taking this drug.

An obese male presents to a sleep clinic complaining of difficulty sleeping. He reports that he wakes gasping for air. Which is the most likely diagnosis for this patient? A. Obstructive sleep apnea B. Parasomnia C. Primary hypersomnia D. Somnambulism

A Obstructive sleep apnea is due to upper airway obstruction and is accompanied by excessive snoring and episodic apnea. Primary hypersomnia is excessive daytime sleepiness. Parasomnia is unusual behavior during sleep. Somnambulism is sleepwalking.

What is the pathophysiology for a myasthenic crisis? A. Insufficient ACh at the NMJ B. Excessive ACh at the NMJ C. Overdose with a cholinesterase inhibitor D. None of the above

A Patients who are inadequately medicated may experience myasthenic crisis, a state characterized by extreme muscle weakness caused by insufficient ACh at the NMJ. A cholinesterase inhibitor (eg, neostigmine) is used to relieve the crisis.

The appropriate term for pain that is present in an area distant from its point of origin is: A. referred pain. B. chronic pain. C. acute pain. D. somatic pain.

A Referred pain is pain that is present in an area removed or distant from its point of origin. Chronic pain is usually prolonged, lasting at least 3 months. Somatic pain arises from connective tissue, muscle, bone, and skin. It is may be sharp and well organized or dull, aching, and poorly localized. Acute pain arises from cutaneous, deep somatic, or visceral structures and is a protective mechanism.

A patient has elected to use rasagiline as a monotherapy treatment for PD. Which teaching statement by the nurse is incorrect? A. "Rasagiline may cause insomnia, so monitor your sleeping habits." B. "It is important to avoid tyramine-containing foods." C. "You may be at increased risk for malignant melanoma, so have regular skin checks." D. "You may experience side effects, such as headache, arthralgia, dyspepsia, depression, and flu-like symptoms."

A Unlike selegiline, rasagiline does not cause insomnia. Rasagiline may pose a risk of hypertensive crisis and hence patients should be instructed to avoid tyramine-containing foods. Rasagiline may increase the risk of malignant melanoma, a potentially deadly cancer of the skin. Periodic monitoring of the skin is recommended. Side effects are headache, arthralgia, dyspepsia, depression, and flu-like symptoms.

A patient often experiences vomiting with a central nervous system (CNS) injury when the trauma: A. involves the vestibular nuclei. B. also involves the abdominal area. C. causes a decrease in intracranial pressure. D. impinges directly on the floor of the third ventricle.

A Vomiting associated with CNS injuries involves the vestibular nuclei. It can also be caused by impingement on the fourth ventricle or an increase in intracranial pressure. Vomiting with no associated nausea indicates direct involvement of the central neural mechanisms regardless of abdominal trauma.

A characteristic of Alzheimer disease includes: (Select all that apply.) A. anxiety and depression. B. short-term memory loss. C. increased irritability and agitation. D. rapid onset of symptomatology. E. remissions resulting in cognitive clarity.

A, B, C Alzheimer disease is characterized with short-term memory loss, increased irritability and agitation, as well as anxiety and depression. Its onset of symptoms is gradual, and there are no remissions that allow for cognitive clarity.

Which assessments are essential before a patient receives a second dose of mitoxantrone [Novantrone]? (Select all that apply.) A. Pregnancy test B. Echocardiogram C. Complete blood count D. T3, T4, and TSH levels E. Ophthalmic examination F. Magnetic resonance imaging (MRI)

A, B, C Mitoxantrone [Novantrone] can cause a variety of adverse effects. Myelosuppression, cardiotoxicity, and fetal injury are the greatest concerns. Consequently, a pregnancy test and a complete blood count should be done, as well as an echocardiogram to determine the left ventricular ejection fraction. Thyroid function studies and MRI are not necessary. Ophthalmic examinations are necessary when the patient is experiencing macular edema, an adverse effect of fingolimod.

A patient is diagnosed with a meningioma. The most likely site of the tumor is the: (Select all that apply.) A. sphenoidal wing. B. tuberculum sellae. C. olfactory groove. D. cerebellopontine angle. E. sella turcica.

A, B, C, D, E Meningiomas are located most commonly in the olfactory grooves, on the wings of the sphenoid bone (at the base of the skull), in the tuberculum sellae (a structure next to the sella turcica), on the superior surface of the cerebellum, and in the cerebellopontine angle and spinal cord.

Endogenous opioids include: (Select all that apply.) A. endomorphins. B. enkephalins. C. dynorphins. D. denkephalins. E. endorphins.

A, B, C, E The four types of endogenous opioids include enkephalins, endorphins, dynorphins, and endomorphins. Denkephalins are not endogenous opioids.

A patient is brought to the emergency room following a motor vehicle accident in which a diffuse brain injury is sustained. Which symptoms would be expected to accompany the injury? (Select all that apply.) A. Short attention span B. Swallowing disorders C. Fatigue D. Memory deficits E. Agitation

A, B, D, E Diffuse brain injury can produce memory deficits, dysphagia, agitation, and short attention span. Fatigue is not part of diffuse brain injury.

A basic neural system essential to cognitive function would include: (Select all that apply.) A. memory systems. B. language systems. C. sensory systems. D. attentional systems. E. affective or emotive systems.

A, B, D, E In this case, sensory systems are not related to cognitive function.

The classification of acute pain includes: (Select all that apply.) A. referred. B. cutaneous. C. pleuritic. D. acute somatic. E. acute visceral.

A, B, D, E Pleuritic pain is described in terms of pulmonary function, not in general classification of pain. Acute pain arises from cutaneous, deep somatic, or visceral structures; these include acute visceral, acute somatic, and referred.

Which medications can be used to manage fatigue associated with multiple sclerosis? (Select all that apply.) A. Modafinil [Provigil] B. Clonazepam [Klonopin] C. Amantadine [Symmetrel] D. Carbamazepine [Tegretol] E. Dalfampridine [Ampyra]

A, C Fatigue develops in about 90% of patients with multiple sclerosis, and the drugs most commonly used to manage this symptom include modafinil and amantadine. Clonazepam may be useful for alleviating tremor and ataxia associated with the disease. Carbamazepine, an antiepileptic drug, may be helpful for alleviating neuropathic pain. Dalfampridine may be given to improve walking.

Criteria for determining brain death include: (Select all that apply.) A. no spontaneous respiration. B. pupils are reactive but unequal. C. isoelectric EEG. D. unresponsive coma. E. ocular response to head turning.

A, C, D The following criteria determine brain death: (1) Completion of all appropriate diagnostic and therapeutic procedures with no possibility of brain function recovery, (2) Unresponsive coma (no motor or reflex movements), (3) No spontaneous respiration (apnea). (4) No brainstem functions (ocular responses to head turning or caloric stimulation; dilated, fixed pupils; no gag or corneal reflex [see Figures 15-3 and 15-4]). (5) Isoelectric (flat) EEG (electrocerebral silence) (6) Persistence of these signs for an appropriate observation period.

A means of classifying a seizure includes: (Select all that apply.) A. clinical manifestations. B. length of activity. C. response to therapy. D. site of origin. E. EEG correlates.

A, C, D, E The following are ways to classify seizures: (1) clinical manifestations, (2) site of origin, (3) EEG correlates, and (4) response to therapy. The length of the seizure activity is not a classifying characteristic.

A cause of a cerebral aneurysm includes: (Select all that apply.) A. arteriosclerosis. B. heroin abuse. C. trauma. D. congenital anomaly. E. cocaine abuse.

A, C, D, E Arteriosclerosis, congenital anomalies, and trauma are all considered causes of an aneurysm. Cocaine has been linked to aneurysm formation; heroin has not.

Which of the following statements about Pralidoxime are true? (Select all that apply.) A. It is an antidote to organophosphate poisoning. B. It is an antidote to reversible cholinesterase inhibitors. C. It cannot cross the blood-brain barrier. D. It reverses cholinesterase inhibition in the CNS. E. Doses should be infused slowly.

A, C, E Pralidoxime is a specific antidote to poisoning by the irreversible (organophosphate) cholinesterase inhibitors; the drug is not effective against poisoning by reversible cholinesterase inhibitors. Since pralidoxime is a quaternary ammonium compound, it cannot cross the blood-brain barrier and therefore cannot reverse cholinesterase inhibition in the CNS. Intravenous doses should be infused slowly (over 20 to 30 minutes) to avoid hypertension.

Which complaint by a patient taking fingolimod [Gilenya] requires prompt evaluation by the prescriber? A. Hair loss B. Backache C. Dizziness and fatigue D. Blue-green tint to the skin

C Fingolimod slows the heart rate and can cause bradycardia. Dizziness and fatigue may be consequences of bradycardia. Backache is an adverse effect that occurs in 12% of patients taking the medication, but it does not require prompt attention. Reversible hair loss and a blue-green tint to the skin are adverse effects of mitoxantrone [Novantrone].

Which statement about memantine [Namenda] is false? A. Memantine is indicated for moderate or severe AD. B. Memantine modulates the effects of glutamate. C. Memantine does not slow the decline in function. D. The most common side effects are dizziness, headache, confusion, and constipation.

C For many patients, the drug can slow the decline in function, and, in some cases, it may actually cause symptoms to improve. The other statements are true.

Which is TRUE regarding metastatic brain tumors? A. One third of metastatic tumors are located within the brain. B. Tumors of the pelvis tend to involve the frontal lobe. C. Two thirds of metastatic tumors are located in the extradural spaces. D. Carcinomas are disseminated to the brain from the circulation.

D Carcinomas disseminate to the brain from the circulation. Two thirds of metastatic tumors are located within the brain, and one third are located in the extradural spaces. Tumors of the pelvis tend to metastasize to the cerebellum and pons.

Which is correct regarding hemorrhagic strokes? They: A. account for 50% of all CVAs. B. are the most common cause of CVA. C. are often the result of a microinfarct. D. are commonly caused by hypertension.

D Chronic, untreated hypertension is generally the cause of hemorrhagic stroke. Hemorrhagic stroke is the third most common cause of CVA. It accounts for 10%-15% of strokes in whites and 30% in blacks and Asians. An infarct is a type of occlusive stroke.

It is correct to assume that Grade III and Grade IV astrocytomas are: A. bluish gray in color with a hard purplish center. B. generally seen more in women than in men. C. commonly found in the frontal lobe and cerebral hemisphere. D. usually necrotic as a result of an absence of vascularity.

C Grades III and Grade IV astrocytomas are commonly found in the frontal lobe and cerebral hemisphere and are found twice as often in men as in women. They are often large and well circumscribed with a variegated pattern. The rim is pinkish gray and solid with a soft, yellow, necrotic center. There is vascular proliferation.

It is correct to assume that Cheyne-Stokes respirations (CSR): A. result in hypocapnia and increased ventilatory stimulus. B. involve a pathologic pattern of crescendo-decrescendo. C. cause changes in PaO2 that produce irregular breathing. D. increase PaCO2 level when overbreathing occurs.

B

A patient goes to the emergency department after using organophosphate insecticides improperly. Which assessment finding would the nurse expect? A. Urinary retention B. Stool incontinence C. Mydriasis D. Flushed, dry skin

B A toxic condition has been produced, which results in stimulation of the cholinergic nervous system and cholinergic crisis. The symptoms of cholinergic crisis include profuse salivary and bronchial secretions, urinary and stool incontinence, laryngospasm, bronchoconstriction, paralysis, and death. Miosis (pupil constriction), not mydriasis, occurs, as well as diaphoresis.

The nurse is preparing to give ethosuximide [Zarontin]. The nurse understands that this drug is only indicated for which seizure type? A. Tonic-clonic B. Absence C. Simple partial D. Complex partial

B Absence seizures are the only indication for ethosuximide. The drug effectively eliminates absence seizures in approximately 60% of patients and effectively controls 80% to 90% of cases.

Which cholinesterase inhibitor has the highest incidence of adverse gastrointestinal (GI) effects? A. Donepezil [Aricept] B. Rivastigmine [Exelon] C. Galantamine [Reminyl] D. Memantine [NMDA]

B All these drugs have the potential to cause GI distress, including nausea, vomiting, anorexia, and weight loss. Rivastigmine is thought to have the highest probability of producing these effects. Memantine (NMDA) is not a cholinesterase inhibitor.

A patient who is experiencing a loss of comprehension or the production of language is described as having: A. expressive dysphasia. B. dysphasia. C. aphasia. D. transcortical dysphasia.

B Aphasia is complete inability to speak. Dysphasia is impairment in comprehension or production of language. Expressive dysphasia is characterized primarily by deficits in expression, but comprehension may be present. Transcortical dysphasia involves the ability to repeat and to recite.

A patient who exhibits positioning that includes both arms being held close to the body with flexion at the elbows while legs are extended and rotated externally is demonstrating: A. decerebrate posture. B. decorticate posture. C. basal ganglion posture. D. spastic posture.

B Decorticate posture (also referred to as antigravity posture or hemiplegic posture) is characterized by upper extremities flexed at the elbows and held close to the body and by lower extremities that are externally rotated and extended. A spastic gait or posture manifests by a shuffling gait with the leg extended and held stiff, causing a scraping over the floor surface. The leg swings improperly around the body rather than being appropriately lifted and placed. The foot may drag on the ground, and the person tends to fall to the affected side. Decerebrate posture refers to increased tone in extensor muscles and trunk muscles, with active tonic neck reflexes. When the head is in a neutral position, all four limbs are rigidly extended. Basal ganglion posture refers to a stooped, hyperflexed posture with a narrow-based, short-stepped gait.

A patient who was admitted to a postsurgical unit 2 days ago is now demonstrating progressive restlessness and is uncharacteristically irritable. This scenario is characteristic of: A. dementia. B. delirium. C. Alzheimer disease. D. coma.

B Delirium is an acute state of confusion. It is abrupt in its onset. The patient may have difficulty in concentration, restlessness, irritability, tremulousness, insomnia, and poor appetite. Delirium is associated with autonomic nervous system overactivity and typically develops over 2-3 days. It most commonly occurs in critical care units, following surgery, or during withdrawal from central nervous system depressants (i.e., alcohol or narcotic agents). Dementia is a more chronic problem in which there is progressive failure of many cerebral functions. Alzheimer disease is a type of dementia. A coma is a loss of consciousness.

It is TRUE that encephalitis is: A. an afebrile illness lasting 1 week. B. caused by bacteria transmission. C. a result of arthropod borne viruses. D. caused exclusively by herpes simplex II.

C It is caused by a virus, often arthropod borne (tick/mosquito borne). Herpes simplex I can also causes the illness; type I is more common than type II. Encephalitis is an acute febrile illness.

Which statement made by a female patient newly diagnosed with complex partial seizures and starting treatment with valproic acid indicates a need for further teaching by the nurse? A. "The medication should not make me feel sleepy." B. "I should take the medication on an empty stomach." C. "I'll need to discuss a reliable form of birth control with my gynecologist." D. "I'll call my physician immediately if I develop a yellow tint to my skin or my urine appears tea-colored."

B Gastrointestinal side effects, such as nausea, vomiting, and indigestion, can occur when valproic acid is taken on an empty stomach; this statement indicates that further teaching is needed. Valproic acid has minimal sedative effects, is teratogenic, and can lead to hepatotoxicity. Female patients of child-bearing age must use effective methods of birth control to prevent pregnancy and must be taught the signs of liver failure (abdominal pain, malaise, jaundice), which must be reported immediately.

The nurse prepares to administer the antidote to a patient in cholinergic crisis. Which medication does the nurse anticipate the healthcare provider to order? A. Neostigmine [Prostigmin] B. Atropine C. Pralidoxime [DuoDote] D. Dobutamine [Dobutrex]

B Intravenous atropine can alleviate the muscarinic effects of cholinesterase inhibition. Pralidoxime is a specific antidote to poisoning by the irreversible (organophosphate) cholinesterase inhibitors; the drug is not effective against poisoning by reversible cholinesterase inhibitors.

Which medication used for the management of multiple sclerosis cannot be self-administered? A. Fingolimod [Gilenya] B. Natalizumab [Tysabri] C. Glatiramer acetate [Copaxone] D. Interferon beta-1b [Betaseron]

B Natalizumab [Tysabri] is administered by intravenous infusion over 1 hour. The patient must be observed during the infusion and also must be monitored for 1 hour after the infusion is complete. Before this medication can be prescribed and administered, everyone involved with the drug—patients, physicians, pharmacists, infusion nurses, and infusion centers—must be registered with the TOUCH Prescribing Program. The other medications can be self-administered: fingolimod (oral), glatiramer acetate, and interferon beta-1b (subcutaneous injection).

The nurse is preparing to give neostigmine [Prostigmin]. Which best describes the action of this drug? A. It inhibits acetylcholine at all cholinergic synapses. B. It prevents inactivation of acetylcholine. C. It prevents activation of muscarinic receptors. D. It stimulates activation of adrenergic receptors.

B Neostigmine is a cholinesterase inhibitor. As such, it prevents the inactivation of acetylcholine, allowing it to linger at the synapses. It lacks selectivity and thus intensifies transmission at all cholinergic junctions.

It is TRUE that Alzheimer disease is: A. not believed to have a genetic relationship. B. a result of neuronal proteins becoming distorted and tangled. C. the cause of plaques increasing nerve impulse transmission. D. an uncommon neurologic disorder.

B Neurofibrillary tangles occur when the proteins in neurons become tangled and distorted. There is a genetic relationship in late-onset familial Alzheimer dementia. It is a common neurologic disorder; nearly 6 million Americans had the disease in 2000. With the formation of plaques, there is decreased nerve impulse transmission.

Pinhole-sized pupils can be a result of an overdose of: A. atropine. B. opiates. C. scopolamine. D. amphetamines.

B Opiates (heroin and morphine) cause pinhole or constricted pupils. The other choices cause large dilated pupils.

Which statement should the nurse include in the teaching plan for a patient being started on levodopa/carbidopa [Sinemet] for newly diagnosed Parkinson's disease? A. Take the medication on a full stomach. B. Change positions slowly. C. The drug may cause the urine to be very dilute. D. Carbidopa has many adverse effects.

B Postural hypotension is common early in treatment, so the patient should be instructed to change positions slowly. Administration with meals should be avoided, if possible, because food delays the absorption of the levodopa component. If the patient is experiencing side effects of nausea and vomiting, administration with food may need to be considered. The levodopa component in Sinemet may darken the color of the urine. Carbidopa has no adverse effects of its own.

The nurse is caring for a patient with MS who is having worsening recurrent episodes of neurologic dysfunction followed by periods of partial recovery. How would this subtype be classified? A. Relapsing-remitting B. Secondary progressive C. Primary progressive D. Progressive-relapsing

B Relapsing-remitting MS is marked by defined episodes of neurologic dysfunction separated by periods of partial or full recovery. In secondary progressive MS, the patient with the relapsing-remitting subtype experiences declining function with or without occasional recovery of function. Primary progressive MS presents with progressive decline of function from the onset. Progressive-relapsing MS is rare and is similar to primary progressive but has acute episodes in addition to the progressively worsening dysfunction.

The nurse is teaching a patient newly diagnosed with a seizure disorder about her disorder. Which statement made by the nurse best describes the goals of therapy with antiepilepsy medication? A. "With proper treatment, we can completely eliminate your seizures." B. "Our goal is to reduce your seizures to an extent that helps you live a normal life." C. "Seizure medication does not reduce seizures in most patients." D. "These drugs will help control your seizures until you have surgery."

B Seizure disorders are often treated successfully with medication in most patients. However, the dosages needed to completely eliminate seizures may cause intolerable side effects. Neurosurgery is indicated only for patients in whom medication therapy is unsuccessful.

After a fall at home, an elderly patient experiences a hematoma located on the top of the brain. The hematoma is most likely: A. epidural. B. subdural. C. intracerebral. D. extradural.

B Subdural hematomas (bleeding between the dura mater and the brain) arise in 10%-20% of persons with traumatic brain injury. Acute subdural hematomas develop rapidly, commonly within hours, and usually are located at the top of the skull (the cerebral convexities). Chronic subdural hematomas are commonly found in the elderly and persons who abuse alcohol. Epidural hematomas develop from bleeding between the dura mater and the skull in all age groups (most commonly in 20-40-year-olds). The temporal fossa is the most common site of extradural hematomas. Intracerebral hematomas are a result of bleeding within the brain.

The healthcare provider orders amantadine 100 mg PO daily. Available is amantadine 10 mg/mL syrup. How many mL will the nurse administer? A. 1 mL B. 10 mL C. 100 mL D. 0.1 mL

B The available concentration of amantadine is 10 mg/mL. The ordered dose of 100 mg would equal 10 mL of syrup. 100 mg/10 = 10 mL.

A patient with a history of numbness, weakness, and blurred vision recently was diagnosed with multiple sclerosis (MS). What does the nurse understand to be the underlying pathophysiology for these symptoms? A. An imbalance of dopamine and acetylcholine in the central nervous system B. Inflammation and myelin destruction in the central nervous system C. An inability of serotonin to bind to its receptors in the chemoreceptor trigger zone D. High-frequency discharge of neurons from a specific focus area of the brain

B The underlying pathophysiology of MS is related to myelin destruction and slowing of axonal conduction related to inflammation within the central nervous system. The demyelination leads to the characteristic neurologic symptoms associated with MS.

The nurse is caring for a patient whose seizures are characterized by a 10- to 30-second loss of consciousness and mild, symmetric eye blinking. Which seizure type does this most closely illustrate? A. Tonic-clonic B. Absence C. Atonic D. Myoclonic

B This scenario accurately describes absence seizures. Tonic-clonic seizures present with convulsions and muscle rigidity followed by muscle jerks. Patients may experience urinary incontinence and loss of consciousness. Atonic seizures cause sudden loss of muscle tone. Myoclonic seizures present with sudden muscle contractions that last but a second.

The healthcare provider orders donepezil [Aricept] 10 mg PO every day. The tablets available are donepezil 5 mg. How many tablets will the patient receive? A. 0.5 B. 2 C. 5 D. 10

B Two 5-mg tablets will equal the 10-mg dose ordered.

Which mechanism does not result in heat loss? A. Increased respiration B. Vasoconstriction C. Convection D. Conduction

B Vasoconstriction is a mechanism of heat conservation. Increased respiration, conduction, and convection are all mechanisms of heat loss.

A patient with Parkinson's disease is prescribed pramipexole [Mirapex] along with his levodopa/carbidopa [Sinemet]. Which symptom is most likely a manifestation of an adverse effect of these drugs when given together? A. Diarrhea B. Dyskinesia C. Wheezing D. Headache

B When pramipexole is combined with the levodopa component in Sinemet, patients are most likely to experience symptoms of dyskinesias, such as dyskinesia (head bobbing) and orthostatic hypotension. The other effects are not common responses to these drugs.

Risk factors for a CVA include: (Select all that apply.) A. obesity. B. arterial hypertension. C. atrial fibrillation. D. smoking. E. diabetes.

B, C, D, E Obesity may indirectly cause other risk factors but is not a direct risk factor for CVA. The other risk factors for CVAs include arterial hypertension, smoking, diabetes, insulin resistance, polycythemia, increased lipoprotein-a, impaired cardiac function, hyperhomocysteinemia, and atrial fibrillation.

Abnormal findings in which of the following evaluations would indicate possible neurologic dysfunction? SATA A. Decreased gastrointestinal motility B. Level of consciousness C. Pattern of breathing D. Motor responses E. Eye response

B, C, D, E The five categories that are critical for the evaluation process for neurologic function include: (1) level of consciousness (LOC), (2) pattern of breathing, (3) size and reactivity of pupils, (4) eye position and reflexive response, and (5) muscle motor responses. Gastrointestinal motility is not indicative of neurologic status.

The nurse is reviewing the care of patients with AD. Which factors are associated with the pathophysiology of this disease? (Select all that apply.) A. Dilation and inflammation of cranial blood vessels B. Beta-amyloid and neuritic plaques C. Neurofibrillary tangles and tau D. Autoimmune changes in the myelin sheath E. Firing of hyperexcitable neurons throughout the brain F. Neuronal degeneration and decreased acetylcholine

B, C, F AD is characterized by neuronal degeneration, reduced cholinergic transmission, beta-amyloid and neuritic plaques, and neurofibrillary tangles and tau. Dilation and inflammation of cranial blood vessels are associated with migraine. Multiple sclerosis is characterized by autoimmune changes in the myelin sheath, and epilepsy is associated with hyperexcitability of neurons and firing of those neurons throughout the brain.

The nurse is caring for a patient with MS who is receiving interferon beta-1a [Rebif] by subcutaneous injection. Which laboratory tests should be performed regularly in this patient to monitor for a potential adverse effect? (Select all that apply.) A. Blood urea nitrogen B. Complete blood count C. Hemoglobin A1c D. Alkaline phosphatase E. Immunoglobulin G levels

B, D When monitoring a patient receiving interferon, the nurse should watch for potential adverse reactions of hepatotoxicity (alkaline phosphatase) and myelosuppression (complete blood counts). The blood urea nitrogen value is an indicator of renal function, which is not affected by interferon beta-1a. The hemoglobin A1c test is a weighted average of the glucose level over the past several months. Glucose levels are not affected by interferon beta-1a. Immunoglobulin G levels might be assessed when making the diagnosis, but they are not used to monitor for adverse effects of interferon.

Overdose of cholinesterase inhibitors causes which of the following? (Select all that apply.) A. Xerostomia B. Excessive muscarinic stimulation C. Constipation D. Respiratory depression E. Cholinergic crisis

B, D, E Overdose with cholinesterase inhibitors causes excessive muscarinic stimulationand respiratory depression. The state produced by cholinesterase inhibitor poisoning is sometimes referred to as cholinergic crisis. Xerostomia and constipation are incorrect.

The healthcare provider orders entacapone 400 mg PO every 6 hours. The nurse notes that the total dose given in a 24-hour period would be what amount? A. 800 mg B. 1400 mg C. 1600 mg D. 3200 mg

C 24 hours divided by every-6-hour doses equals 4 doses of 400 mg. 400 mg times 4 doses equals 1600 mg.

A patient is experiencing pain that courses over the buttocks and into the calf and ankle. This is suggestive of a herniated disk at which vertebral level? A. Coccyx B. Cervical C. Lumbar D. Thoracic

C A herniated disk in the lumbosacral area is associated with pain that radiates along the sciatic nerve and courses over the buttock and into the calf and ankle. Both a cervical and thoracic injury would indicate pain that originated higher on the body. A herniated coccyx vertebrate would result in pain beginning a point lower than that described.

The nurse is caring for a group of patients diagnosed with Alzheimer's disease (AD). Which neurotransmitter level is decreased by as much as 90% in patients with severe AD? A. Norepinephrine B. Serotonin C. Acetylcholine D. Dopamine

C Acetylcholine (ACh) levels naturally decline by a small percentage with age. Patients with severe AD may have ACh levels that are as much as 90% below normal. This is likely part of the explanation for the pathophysiology of AD.

A patient newly diagnosed with MS asks the nurse how a person gets this disease. Which response by the nurse is most accurate and appropriate? A. "Multiple sclerosis is a congenital condition that typically manifests itself in late adulthood." B. "Multiple sclerosis is a disease believed to be caused by exposure to drugs during a mother's pregnancy." C. "This is an autoimmune disease that occurs in people with certain genetic traits when they are exposed to some environmental trigger factor." D. "This disease is most often caused by an increase of rapidly dividing cells in the central nervous system."

C Although the exact cause is unknown, MS is believed to have a genetic link. Susceptible individuals have an autoimmune response when exposed to environmental or microbial factors. It is more common among first-degree relatives of individuals who have the disease and is more prevalent among Caucasians. It also is more common in cooler climates, with increased incidence moving away from the equator. MS may also be associated with the Epstein-Barr virus, human herpesvirus 6, and Chlamydia pneumonia.

Which statement made by a patient indicates a need for further teaching by the nurse about reducing injection site reactions from interferon beta? A. "I need to rotate my injection sites, so I'll need to keep a record of them." B. "I will apply hydrocortisone ointment to the injection site if it is itchy." C. "Applying a warm compress before giving the injection will reduce the risk of pain at the site." D. "I can take over-the-counter Benadryl if the injection site itches and is red."

C Brief application of ice rather than warm compress application is indicated prior to injection. Warm compresses may be helpful following the injection. Injection sites should be rotated to decrease discomfort. Itching and erythema can be reduced by topical application of hydrocortisone or oral diphenhydramine.

Which type of hearing loss is a result of foreign body obstruction of the middle ear? A. Sensorineural B. Functional C. Conductive D. Presbycusis

C Conductive hearing loss occurs when a change in the outer or middle ear, such as a foreign body lodged in the ear canal, impairs conduction of the sound from the outer to inner ear. Sensorineural hearing loss is caused by impairment of the organ of Corti or its central connections. Presbycusis is a form of sensorineural hearing loss usually seen in elderly people. Functional hearing loss is believed to be caused by emotional or psychological factors.

A patient who reports that "everything tastes unpleasant" is exhibiting symptoms of: A. hypogeusia. B. hyposmia. C. dysgeusia. D. anosmia.

C Dysgeusia is a perversion of taste in which everything has an unpleasant flavor. Hyposmia is an impaired sense of smell. Anosmia is a complete loss of smell. Hypogeusia is a decrease in taste sensation.

A patient has a brain abscess with a decreased necrotic center and mature collagen. This is most consistent with which stage? A. Late capsule formation B. Early cerebritis C. Early capsule formation D. Late cerebritis

C Early capsule formation occurs on days 10-13. The necrotic center decreases in size and inflammatory infiltrate changes in character. Mature collagen evolves, forming a capsule. Early cerebritis occurs on days 1-3 and is a localized inflammatory process. There are marked cerebral edema and a central core of necrosis. Late cerebritis occurs on days 4-9, and there is a necrotic center surrounded by inflammatory infiltrate of macrophages and fibroblasts. There is rapid new blood vessel formation. Late capsule formation occurs on day 14 and later. There is a well-formed necrotic center surrounded by a dense collagenous capsule.

A benefit of fever to human blood includes: A. diminished phagocytosis. B. increased iron concentration. C. a switch to lipolysis and proteolysis. D. decreased lymphocytic transformation.

C Fever has benefits. The higher body temperature decreases serum levels of iron, zinc, and copper, all of which are need for bacterial replication. It switches from burning glucose to lipolysis and proteolysis, thus depriving bacteria of a food source. There is increased lymphocytic transformation, increasing the immune response. Increased phagocytosis also occurs.

What is the goal of pharmacologic therapy in the treatment of Parkinson's disease? A. To increase the amount of acetylcholine at the presynaptic neurons B. To reduce the amount of dopamine available in the substantia nigra C. To balance cholinergic and dopaminergic activity in the brain D. To block dopamine receptors in presynaptic and postsynaptic neurons

C Parkinson's disease results from a decrease in dopaminergic (inhibitory) activity, leaving an imbalance with too much cholinergic (excitatory) activity. With an increase in dopamine, the neurotransmitter activity becomes more balanced, and symptoms are controlled.

A patient with Parkinson's disease who has been positively responding to drug treatment with levodopa/carbidopa [Sinemet] suddenly develops a relapse of symptoms. Which explanation by the nurse is appropriate? A. "You have apparently developed resistance to your current medication and will have to change to another drug." B. "This is an atypical response. Unfortunately, there are no other options of drug therapy to treat your disease." C. "This is called the 'on-off' phenomenon. Your healthcare provider can change your medication regimen to help diminish this effect." D. "You should try to keep taking your medication at the current dose. These effects will go away with time."

C Patients who have been taking levodopa/carbidopa for a period of time may experience episodes of symptom return. Adding other medications to the drug regimen can help minimize this phenomenon.

The nurse is caring for a patient with myasthenia gravis who is beginning a new prescription of neostigmine [Prostigmin], 75 mg PO twice daily. What is the most important initial nursing action? A. Obtain a measurement of the plasma level of neostigmine. B. Teach the patient to wear a Medic Alert bracelet. C. Assess the patient's ability to swallow. D. Check the patient's deep tendon reflexes (DTRs).

C Patients with myasthenia gravis have decreased muscle strength and may have impaired swallowing. If swallowing is insufficient, the medication must be given by the parenteral route. Plasma levels are not as important when beginning medication. Neostigmine typically is dosed to symptoms. The patient should be taught to wear a Medic Alert bracelet and may need to have DTRs monitored, but assessing swallowing is a higher priority.

A patient who reports a loss of childhood memories is describing a characteristic of: A. executive attention deficits. B. selective attention deficit. C. retrograde amnesia. D. anterograde amnesia.

C Retrograde amnesia is the loss of past memories, whereas anterograde amnesia is the inability to form new memories. Selective attention deficit is the ability to select specific information to be processed from environmental and internal stimuli. Executive attention deficit is the inability to maintain sustained attention, inability to set goals and recognize when an object meets a goal, and a deficit in working memory.

A patient with a history of Parkinson's disease treated with selegiline [Eldepryl] has returned from the operating room after an open reduction of the femur. Which physician order should the nurse question? A. Decaffeinated tea, gelatin cubes, and ginger ale when alert B. Docusate 100 mg orally daily C. Meperidine 50 mg IM every 4 hours as needed for pain D. Acetaminophen 650 mg every 6 hours as needed for temperature

C Selegiline can have a dangerous interaction with meperidine, leading to stupor, rigidity, agitation, and hyperthermia; therefore, this order should be questioned. Foods that contain tyramine should be restricted, but there is no contraindication to the fluids that have been ordered. Docusate and acetaminophen are not contraindicated for use with selegiline.

Which activity has been documented to increase the levels of circulating endogenous endorphins? A. Cough B. Pain C. Stress D. Sleep

C Stress, sexual intercourse, acupuncture, and excessive physical exertion have all been linked to increased levels of circulating endorphins. Drinking behavior and cough are actually moderated by endorphins. Sleep and pain are not linked with excessive amounts of endorphins.

A patient diagnosed with Parkinson disease initially experiences: A. difficulty walking. B. rigidity of leg muscles. C. resting tremors. D. postural instability.

C The classic manifestations of Parkinson disease are resting tremors, rigidity, bradykinesia/akinesia, postural disturbance, dysarthria, and dysphagia. Tremor is often the first symptom to appear. The symptoms are often unilateral and then become bilateral, progressing to affect gait and include postural instability and the inability to walk.

A patient has sustained a traumatic brain injury but is able to follow simple commands and can manipulate objects. The term used to describe this state is: A. coma. B. vegetative. C. minimally conscious. D. locked-in syndrome.

C The term minimally conscious refers to severely altered consciousness in which the person demonstrates minimal but defined behavioral evidence of self or environmental awareness. The clinical features include following simple commands, manipulation of objects, gestural or verbal yes/no responses, intelligible verbalization, and stereotypical movements. Locked-in syndrome describes an individual who has both the content of thought and the level of arousal intact. The efferent pathways are disrupted, which means the individual cannot communicate through speech or body movement. Coma is a state of neurobehavioral unresponsiveness. Vegetative state is a wakeful unconscious state.

The person at highest risk for traumatic brain injury (TBI) is: A. male and disabled. B. an economically advantaged young adult. C. black and economically disadvantaged. D. female and 20 years of age.

C Those at highest risk for TBI are children 0-4 years of age, older adolescents aged 15-19 years, and adults aged 65 years and older. Males have the highest incidence in every age-group. TBI is highest among blacks and in lower- and median-income families.

Which is TRUE regarding meningitis? A. Fungal meningitis is the most common form worldwide. B. Aseptic meningitis is most commonly caused by a fungus. C. Tubercular meningitis has a 90% recovery rate, if diagnosed early. D. Bacterial meningitis is a primary infection of the gray matter.

C Tubercular meningitis has a 90% recovery rate with early diagnosis and treatment. Fungal meningitis is uncommon. Aseptic meningitis is most commonly caused by a virus. Bacterial meningitis is caused by primary infection of the pia mater and arachnoid.

The nurse is assessing a patient receiving valproic acid [Depakene] for potential adverse effects associated with this drug. What is the most common problem with this drug? A. Increased risk of infection B. Reddened, swollen gums C. Nausea, vomiting, and indigestion D. Central nervous system depression

C Valproic acid is generally well tolerated. Gastrointestinal effects, which include nausea, vomiting, and indigestion, are the most common problems but tend to subside with use and can be lessened by taking the medication with food. Valproic acid does not cause hematologic effects resulting in an increased risk of infection, nor does it cause gingival hyperplasia. It causes minimal sedation.

A patient experiences a vertebral fracture in which the C1 vertebra is fractured into several fragments. This type of fracture can be described as: A. compressed. B. simple. C. dislocation. D. comminuted.

D A comminuted fracture is also called a burst fracture, in which the vertebral body is shattered into several fragments. A simple fracture is a single break usually affecting the transverse or spinous process. A compressed fracture is also called a wedge. This occurs when there is a crush type of injury and the vertebrae lose height. A dislocation is when two bones at a joint are no longer in alignment.

A young child presents with redness of the eyes. The parents indicate that this condition seems to be "going around" the day care. Which is the most likely diagnosis? A. Keratitis B. Blepharitis C. Trachoma D. Conjunctivitis

D Acute bacterial conjunctivitis, or pinkeye, is a highly contagious bacterial infection. Blepharitis is inflammation of the eyelids. Keratitis is an infection of the cornea. Trachoma is a bacterial infection caused by poor hygiene and is the leading cause of preventable blindness.

A patient who is experiencing difficulty in recognizing a pattern's form and the nature of objects is exhibiting characteristics of: A. Alzheimer disease. B. dysphasia. C. aphasia. D. agnosia.

D Agnosia is a defect of pattern recognition. Aphasia is the complete absence of speech. Dysphasia is impairment of comprehension or production of language. Alzheimer disease is a disease of dementia.

A female patient who is originally from Thailand is seen in the clinic for seizure control. She receives a new prescription for carbamazepine [Tegretol]. Before the patient takes the drug, which is the most appropriate initial nursing intervention? A. Warn her not to withdraw this drug abruptly. B. Recommend that she take this medication at bedtime with meals. C. Teach her family to assist by maintaining a seizure frequency chart. D. Ensure that genetic testing for HLA-B1502 is performed.

D Although all these interventions are appropriate for this patient, the initial nursing intervention would be to ensure that genetic testing is performed. Carbamazepine is associated with several dermatologic effects, including Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN). Patients of Asian descent are at higher risk for serious dermatologic reactions with this drug because of a genetic variation known as HLA-B1502. The FDA now recommends that before taking carbamazepine, patients of Asian descent undergo genetic testing.

A family member asks the nurse about amantadine. Which statement by the nurse is the most helpful in explaining the use of amantadine? A. "Amantadine was developed as an antiviral agent but is now used for treatment of PD." B. "Amantadine works slowly over time but can lose its effectiveness in 3 to 6 months." C. "Amantadine works rapidly and does not lose its effectiveness." D. "Amantadine is not as effective as some other medications, so it is not a first-line treatment, but it may be used in addition to other medications."

D Amantadine was developed as an antiviral agent, but this response is not helpful to explain the use of the medication to the family member. Medication effects develop rapidly—often within 2 to 3 days—but are much less profound than with levodopa or the dopamine agonists. Furthermore, effects may begin to diminish within 3 to 6 months. Amantadine is not considered a first-line agent. However, the drug may be helpful for managing dyskinesias caused by levodopa.

Which of the following statements is TRUE regarding grading of the astrocytoma? A. Grade III is not well circumscribed. B. Grade I is not treated. C. Grade II is treated with radiation only. D. Grades III and IV are treated with surgery.

D Grade I is treated with surgery and then follow-up CT scans for recurrence. Grade II is treated surgically if accessible and then with radiation. Grades III and IV are treated with surgery. Grade III is well circumscribed.

A patient who was outside on a summer day and is now experiencing increased sweating and thirst, weakness, and dizziness is exhibiting signs of: A. hyperthermic stroke. B. heat cramps. C. malignant hyperthermia. D. heat exhaustion.

D Heat exhaustion is the result of prolonged high core temperatures. There is often dehydration, feelings of weakness, dizziness, nausea, and fainting. Heat cramps are severe, spasmodic cramps in the abdomen and the extremities that follow prolonged sweating and associated sodium loss. Heat stroke may be lethal and is caused by exposure to excessive heat and loss of the body's protective mechanisms for cooling. Malignant hyperthermia is a lethal complication of a rare inherited muscle disorder.

A patient is diagnosed with Huntington disease. Which of the following is a TRUE statement? Huntington's disease is: A. a commonly diagnosed neurologic disorder. B. a nonhereditary disease. C. asymptomatic until the sixth decade of life. D. also known as chorea.

D Huntington disease is also called chorea. It is relatively rare and is a hereditary degenerative disorder. It most commonly affects those between the ages of 25 and 45.

Which is accurate regarding subarachnoid hemorrhages? They are: A. seldom experienced in individuals with hypertension. B. rarely fatal and result in minor cognitive impairments. C. a result of vasospasms not caused by trauma to the head. D. a particular risk for individuals with an intracranial aneurysms.

D Individuals with intracranial aneurysms are at risk for subarachnoid hemorrhage. Hypertension and trauma are also risk factors. The mortality is over 50%.

The nurse is caring for a patient receiving glatiramer acetate [Copaxone] for MS. Which finding, if present in this patient, could be considered a potential adverse effect of this drug? A. Flu-like symptoms with fever B. Decreased neutrophil count C. Jaundice and elevated bilirubin D. Injection site pain and redness

D Injection site reactions, such as pain, erythema, pruritus, and induration, are the most common adverse effects of glatiramer. Unlike interferon, glatiramer does not cause flu-like symptoms, myelosuppression, or hepatotoxicity, which would be indicated in the other responses.

Which best describes the rationale for using neostigmine [Prostigmin] in the treatment of myasthenia gravis? A. It promotes neuromuscular blockade in the periphery. B. It promotes emptying of the bladder and sphincter relaxation. C. It reduces intraocular pressure and protects the optic nerve. D. It increases the force of skeletal muscle contraction.

D Neostigmine is a cholinesterase inhibitor; therefore, at therapeutic doses it increases the force of contraction of skeletal muscles. Myasthenia gravis is a neuromuscular disease characterized by muscle weakness.

Involuntary unilateral or bilateral rhythmic movement of the eyes is referred to as: A. strabismus. B. glaucoma. C. amblyopia. D. nystagmus.

D Nystagmus may be present when at rest or when the eyes move. Amblyopia is reduced vision in an eye secondary to uncorrected strabismus. Strabismus is when one eye deviates from the other when a person is looking at an object. Glaucoma is increased intraocular pressure.

The appropriate definition of perceptual dominance is: A. repeated exposure to a pain stimulus. B. the point at which pain is perceived. C. the duration of time or intensity of pain before overt pain responses are initiated. D. pain at one location that may cause an increase in threshold at another location.

D Perceptual dominance is pain at one location that may cause an increase in threshold at another location. For example, when a patient has severe pain in his leg, he may not feel neck pain. Pain tolerance is the duration of time or intensity of pain before overt pain responses are initiated. Repeated exposure to pain usually decreases pain tolerance. The pain threshold is the point at which pain is perceived.

Natalizumab [Tysabri] is a very effective agent for treating MS. Which problem is associated with the administration of this drug, making it a second-line agent? A. Increased risk of sudden cardiac death B. Documented reports of necrotizing colitis C. Increased risk of Stevens-Johnson syndrome D. Rare cases of dangerous brain infections

D Soon after natalizumab was released on the market, there were three reports of progressive, multifocal leukoencephalopathy. All patients who developed this problem were taking natalizumab in combination with another immunosuppressant. The drug is now available only through a specialized, carefully controlled prescribing program.

It is TRUE that spinal shock: A. results in no disruption of thermal control. B. is characterized by an incomplete loss of reflex function. C. causes increased muscle tone below the lesion. D. involves all skeletal muscles below the level of injury.

D Spinal shock does involve function of skeletal muscles resulting in paralysis and flaccidity. Such an injury is characterized by a complete loss of reflex function below the level of the lesion, and impairment of control of thermal regulation is observed.

A patient experiencing the tonic phase of a seizure exhibits: A. muscle contraction alternating with placidity. B. alternating contraction and relaxation of muscle. C. complete paralysis. D. muscle contraction with increased muscle tone.

D The phase of muscle contraction with increased muscle tone is the tonic phase. Alternating contraction and muscle relaxation represent the clonic phase. The postictal phase immediately follows the seizure. There is no phase that is characterized with muscle contraction alternating with placidity.

Which pair of structures regulates the complex emotional responses to pain? A. Frontal and cerebellar lobes B. Midbrain and nuclei of thalamus C. Thalamus and brainstem D. Limbic and reticular system

D The reticular and limbic systems regulate what we feel about pain. The remaining structures are not involved.