neuro

Which of the following clients' signs and symptoms would allow a clinician to be most justified in ruling out stroke as a cause? An adult A) has had a gradual onset of weakness, headache, and visual disturbances over the last 2 days. B) has experienced a sudden loss of balance and slurred speech. C) has vomited and complained of a severe headache. D) states that his left arm and leg are numb, and gait is consequently unsteady.

A Feedback: A cardinal trait of the manifestations of stroke is that the onset is sudden, and a gradual onset of symptoms over 2 days would suggest an alternative etiology. Ataxia, slurred speech, and unilateral numbness are associated with stroke, with sudden vomiting and headache being particularly indicative of a hemorrhagic CVA.

Otitis media (OM), which can occur in any age group, is the most common diagnosis made by health care providers who care for children. Which bacterial pathogen causes the largest proportion of cases that result in sensorineural hearing loss? A)Streptococcus pneumoniae B)Acoustic neuromas C)Haemophilus influenzae D)Parainfluenza

A Feedback: S. pneumoniae is the most common cause of bacterial meningitis that results in sensorineural hearing loss after the neonatal period. Acoustic neuromas are cancers that cause impaired hearing. Parainfluenza and influenza viruses are common viral pathogens in OM.

A 20-year-old college student has presented to his campus medical clinic because of his unshakable despondency in recent months. He has been diagnosed with depression based on his signs, symptoms, and history. The nurse knows that which of the following treatments will likely be prescribed for this student? A) Medication that inhibits the reuptake of serotonin in his presynaptic space B) Drugs that inhibit the accumulation of cyclic adenosine monophosphate (cAMP) C) Benzodiazepines such as clonazepam that modulate his GABA receptors. D) Cholinesterase inhibitors that potentiate the action of available acetylcholine E) Antipsychotics such as olanzapine

A Feedback: SSRIs are common pharmacologic treatment modalities for depression. Drugs that inhibit the accumulation of cyclic adenosine monophosphate (cAMP) (answer B) are usually used in the treatment of bipolar depression. Benzodiazepines address anxiety, while cholinesterase inhibitors are used in the treatment of dementia. Antipsychotics are more often used in cases of schizophrenia.

When reviewing the purpose/action of neurotransmitters as they interact with different receptors, the nursing instructor gives an example using acetylcholine. When acetylcholine is released at the sinoatrial node in the right atrium of the heart, it is A)positively charged. B)inhibitory. C)overstimulated. D)dormant.

B Feedback: The action of a transmitter is determined by the type of receptor to which it binds. Acetylcholine is excitatory when it is released at a myoneural junction, and it is inhibitory when it is released at the sinoatrial node in the heart.

Following a collision while mountain biking, the diagnostic workup of a 22-year-old male has indicated the presence of an acute subdural hematoma. Which of the following pathophysiological processes most likely underlies his diagnosis? A) Blood has accumulated between the man's dura and subarachnoid space. B) Vessels have burst between the client's skull and his dura. C) A traumatic lesion in the frontal or temporal lobe has resulted in increased ICP. D) Blood has displaced CSF in the ventricles as a consequence of his coup-contrecoup injury.

A Feedback: A subdural hematoma develops in the area between the dura and the arachnoid space, while epidural hematomas exist between the skull and dura. Intracerebral hematomas are located most often in the frontal or temporal lobe, and the ventricles are not directly involved in a subdural hematoma.

The unique clinical presentation of a 3-month-old infant in the emergency department leads the care team to suspect botulism. Which of the following assessment questions posed to the parents is likely to be most useful in the differential diagnosis? A) "Have you ever given your child any honey or honey-containing products?" B) "Is there any family history of neuromuscular diseases?" C) "Has your baby ever been directly exposed to any chemical cleaning products?" D) "Is there any mold in your home that you know of?"

A Feedback: Botulism in infants is frequently attributable to honey. Family history is not a relevant consideration given the bacterial etiology, and mold and chemical cleaning products are not known to predispose to botulism toxicity.

A client with a diagnosis of insomnia is surprised when his physician explains to him that his brain is still highly active during normal sleep. Which of the following statements best captures the character of brain activity during sleep? A) "Fewer neurons in your brain are firing when you're asleep, but they're more synchronized than when you're awake." B) "While you're obviously less aware of stimuli when you're asleep, your brain is actually more active when you're asleep than when you're awake." C) "There are four types of brain activity, and actually all of them occur at different stages of sleep." D) "Your brain alternates between periods of activity and periods of inactivity when you're asleep, and these correspond to your eye movement."

A Feedback: Brain activity during sleep is lessened but is more synchronous than during waking. The brain is not more active during sleep, and alpha and beta rhythms are not associated with sleep. The brain is never truly inactive during sleep.

Which of the following hospital patients is most likely to be diagnosed with complex regional pain syndrome II (CRPS II)? A) A man who has been admitted for treatment of continuing hyperalgesia after sustaining a nerve injury in a motor vehicle accident B) A woman who requires analgesia more than 3 months after an episode of shingles C) A male client with diabetes mellitus who requires analgesia prior to each dressing change on his chronic foot wound D) A female who has seemingly unprovoked attacks of pain that are accompanied by facial tics and spasms

A Feedback: CRPS is marked by the presence of continuing pain, allodynia, or hyperalgesia after a nerve injury, not necessarily limited to the distribution of the injured nerve with evidence at some time of edema, changes in skin blood flow, or abnormal sensorimotor activity in the region of pain. Pain related to shingles is an example of postherpetic neuralgia, while a need for analgesia prior to dressing changes would not indicate CRPS. Sudden attacks of pain accompanied by facial tics and spasms may be indicative of trigeminal neuralgia.

Which of the following questions is most likely to be clinically useful in the differential diagnosis of sensorineural versus conductive hearing loss? A) "What medications do you currently take?" B) "What effect is this hearing loss having on your quality of life?" C) "Has your hearing loss developed quickly or more slowly?" D) "Do you ever hear a persistent ringing in your ears?"

A Feedback: Conductive hearing loss occurs when auditory stimuli are not adequately transmitted through the auditory canal, tympanic membrane, middle ear, or ossicle chain to the inner ear. It can be a temporary loss from impacted cerumen. Sensorineural hearing loss occurs with disorders that affect the inner ear, auditory nerve, or auditory pathways to the brain. Numerous drugs have ototoxic potential, a consequence of which is sensorineural hearing loss. The onset and course of hearing loss and the presence or absence of tinnitus do not necessarily help to differentiate between conductive and sensorineural hearing loss. The subjective effect of the client's hearing loss, while a valid concern, does not help with the differential diagnosis.

A badly burned firefighter has been in an induced coma for 3 weeks. When he awakens, he thanks his son for singing Happy Birthday to him a week earlier. Which part of the brain is responsible for allowing him to hear and comprehend while comatose? A)Thalamus B)Hypothalamus C)Corpus callosum D)Basal ganglia

A Feedback: Coordination and integration of peripheral sensory stimuli occur in the thalamus, along with some crude interpretation of highly emotion-laden auditory experiences that not only occur but also can be remembered. For example, a person can recover from a deep coma in which cerebral cortex activity is minimal and remember some of what was said at the bedside. Inferior to the thalamus, and representing the ventral horn portion of the diencephalon, is the hypothalamus; it is the area of master-level integration of homeostatic control of the body's internal environment. The corpus callosum is a massive commissure, or bridge, of myelinated axons that connects the cerebral cortex of the two sides of the brain. The basal ganglia lie on either side of the internal capsule, just lateral to the thalamus; they supply axial and proximal unlearned and learned postures and movements, which enhance and add gracefulness to UMN-controlled manipulative movements.

Following focal seizures that have damaged the dominant hemisphere of a patient's auditory association cortex, the nurse may observe the patient displaying A)receptive aphasia. B)facial drooping. C)auditory hallucinations. D)delusions of grandeur.

A Feedback: Damage to the auditory association cortex, especially if bilateral, results in deficiencies of sound recognition and memory (auditory agnosia). If the damage is in the dominant hemisphere, speech recognition can be affected (sensory or receptive aphasia). The others are not caused by focal seizures.

A 50-year-old woman has experienced devastating consequences in her family and work life as a result of her long-standing alcohol addiction. The levels and pathways of which of the following neurotransmitters in her body are likely to differ from an individual without addiction? A)Dopamine B)Acetylcholine C)Serotonin D)Norepinephrine

A Feedback: Dopamine levels are thought to be altered in addiction and possibly contribute to addiction. Acetylcholine, serotonin, and norepinephrine are not noted to play a central role in the neurophysiology of addiction.

During a clinical assessment of a 68-year-old client who has suffered a head injury, a neurologist suspects that a client has a sustained damage to her vagus (CN X) nerve. Which of the following assessment findings is most likely to lead the physician to this conclusion? A) The client has difficulty swallowing and has had recent constipation and hypoactive bowel sounds. B) The client is unable to turn her head from side to side, and her tongue is flaccid. C) The client has a unilateral facial droop, dry eyes, and decreased salivary production. D) The client is unable to perform any fine motor movements of her tongue.

A Feedback: Dysphagia and impaired GI motility are associated with damage to the vagus nerve. Lateral movement of the head is mediated by CN XI. Facial droop and dry eyes are associated with CN VII, the facial nerve, while abnormal tongue movement is a result of damage to CN XII, the hypoglossal nerve.

A student notices that at certain times during his studying for final exams, he is more awake and his ability to think at a higher level is happening easier. The nurse knows that this experience may be attributed to which of the following neurological functions? A) Release of excitatory neurotransmitters such as glutamate B) Release of GABA, an inhibitory neurotransmitter C) Release of corticotrophin-releasing hormone D) Heightened precortex processes

A Feedback: Excitatory neurotransmitters such as glutamate increase the probability that the target cell will fire an action potential by mediating the depolarization of the target cell. Excitatory transmitters serve as the body's stimulants promoting wakefulness, energy, and activity through regulating many of the body's most basic functions, including thought processes, higher thinking, and sympathetic activity. Distracters B, C, and D do not play a role in this process.

A psychiatrist is providing care for a 68-year-old female whose anxiety disorder is significantly decreasing her quality of life. The nurse knows that the client will likely benefit from which of the following pharmacologic therapies listed below? A) A drug that influences gamma-aminobutyric acid (GABA) levels B) An MAO inhibitor to increase the concentration of serotonin and norepinephrine C) An antipsychotic medication that blocks dopamine receptors D) A calcium channel-blocking agent

A Feedback: GABA is often implicated in anxiety disorders, and benzodiazepines address this neurotransmitter. An MAO inhibitor increases the concentration of serotonin and norepinephrine. MAO inhibitors are occasionally prescribed for depression not responding to SSRIs and would not be indicated for an anxiety disorder. Calcium channel blockers are good for lowering BP and minimizing arterial spasms but are usually not prescribed for anxiety.

During a flu shot clinic, one of the questions the student nurse asks relates to whether the patient has had Guillain-Barré syndrome in his medical history. The patient asks, "What is that?" How should the nursing student reply? A) "A type of paralysis that affects movement on both sides of the body that may even involve the respiratory muscles" B) "Swelling of your arm where you got your flu shot, and maybe your eyes and lips had some swelling as well" C) "A degenerative disease where you have trouble walking without the help of a cane or walker" D) "Influenza-like illness where you had fever and chills for 2 to 3 days after your last flu shot"

A Feedback: Guillain-Barré syndrome is an acute immune-mediated polyneuropathy. The majority of people report having had an acute, influenza-like illness before the onset of symptoms. It progresses along the ascending muscle weakness of the limbs, producing a symmetric flaccid paralysis. The rate of disease progression varies, and there may be disproportionate involvement of the upper or lower extremities. Option B is anaphylaxis following the flu shot. It is not a degenerative disease.

The nurse is educating the new mother about the sleep patterns of a newborn. Which of the following statements should she include in her education? A) "Newborns usually sleep approximately 16 to 20 hours/day." B) "Newborns generally sleep 6 to 8 hours/day and then are awake for 2 to 4 hours." C) "Don't worry about them sleeping too long; they will wake up when they are hungry." D) "Most newborns will have their days and nights mixed up."

A Feedback: Newborns usually sleep approximately 16 to 20 hours/day. Equally distributed over night and daytime, sleep periods generally last for 1 to 4 hours interspersed with 1- to 2-hour periods of wakefulness. Initially, sleep-wake patterns are based on hunger.

A 29-year-old woman has been diagnosed with otosclerosis after several years of progressive hearing loss. What pathophysiological process has characterized her diagnosis? A) New spongy bone has been formed around her stapes and oval window. B) Her incus, malleus, and stapes have become disconnected from her normal neural pathways. C) Her temporal bone is experiencing unusually rapid resorption. D) Her tympanic cavity is becoming filled with bone due to inappropriate osteogenesis.

A Feedback: Otosclerosis begins with resorption of bone in one or more foci. During active bone resorption, the bone structure appears spongy and softer than normal (i.e., osteospongiosis). The resorbed bone is replaced by an overgrowth of new, hard, sclerotic bone. Distortion of neural pathways, resorption of the temporal bone, and filling of the tympanic cavity do not occur with otosclerosis.

During an acute phase of schizophrenia when the patient is experiencing hallucinations and delusions, the nurse should anticipate that the physician will prescribe which of the following medication categories listed below? A)An antipsychotic like risperidone B)A benzodiazepine like lorazepam C)A cholinesterase inhibitor like donepezil D)An opioid receptor antagonist like naltrexone

A Feedback: Pharmacological treatment with antipsychotics is often helpful particularly with the positive s/s of schizophrenia (delusion, hallucinations, agitation, etc.). The negative s/s of schizophrenia respond more favorably to the atypical antipsychotic drugs. Often antipsychotics are combined with benzodiazepines or antiparkinson agents during the acute phase of treatment to reduce the risk of extrapyramidal effects from large doses of antipsychotic agents. Distracters B and C are prescribed for Alzheimer disease and D is used for alcohol addiction.

When educating a patient about to undergo a pacemaker insertion, the nurse explains the normal phases of cardiac muscle tissue. During the repolarization phase, the nurse will stress that membranes must be repolarized before they can be reexcited. Within the cell, the nurse understands that A) potassium channels open while sodium channels close, causing repolarization to the resting state. B) the influx of calcium is the primary stimulus for the repolarization of cardiac tissue. C) only the electrical activity within the heart will determine when repolarization occurs. D) the cell membranes need to stay calm resulting in muscle tissue becoming refractive.

A Feedback: Repolarization is the phase during which the polarity of the resting membrane potential is reestablished. This occurs with the closure of the sodium channels and opening of the potassium channels.

A male newborn infant has been diagnosed with spina bifida occulta. Which of the following pathophysiological processes has most likely contributed to the infant's health problem? A) The neural groove failed to fuse and completely close across the top of the neural plate. B) The infant's spinal cord and meninges protrude through his skin. C) The child's central and peripheral nervous systems have insufficiently differentiated during embryonic development. D) The infant's soma and viscera are underdeveloped.

A Feedback: Spina bifida occulta is characterized by incomplete closure of the axial groove around the ectodermal tube (neural tube). Protrusion of the spinal cord and meninges through the skin is associated with meningomyelocele. Insufficient development of the CNS, PNS, soma, or viscera is not considered a central characteristic of spina bifida occulta.

During a physical exam, the nurse practitioner notes that the patient's optic disk is very pale with a larger size/depth of the optic cup. At this point, they are thinking the patient may have A)glaucoma. B)diabetes retinopathy. C)macular degeneration. D)retinal tear.

A Feedback: The normal optic disk has a central depression called the optic cup. With progressive atrophy of axons caused by increased intraocular pressure, pallor of the optic disk develops, and the size and depth of the optic cup increase. Diabetes retinopathy, macular degeneration, nor retinal tear has these clinical manifestations.

A 45-year-old diabetic male is experiencing erectile dysfunction. If his erectile dysfunction is caused by the nervous system, then the nurse can educate the patient that the venous blood supply to the penis is controlled by A)sacral parasympathetic fibers. B)the hypothalamus. C)the vagus nerve. D)postganglionic sympathetic neurons.

A Feedback: The pelvic nerves leave the sacral plexus on each side of the cord and distribute their peripheral fibers to the bladder, uterus, urethra, prostate, distal portion of the transverse colon, descending colon, and rectum. Sacral parasympathetic fibers also supply the venous outflow from the external genitalia to facilitate erectile function. The hypothalamus, vagus nerve, and postganglionic sympathetic neurons do not control erectile function.

A 20-year-old has been diagnosed with an astrocytic brain tumor located in the brain stem. Which of the following statements by the oncologist treating the client is most accurate? A) "Your prognosis will depend on whether we can surgically resect your tumor." B) "Our treatment plan will depend on whether your tumor is malignant or benign." C) "This is likely a result of a combination of heredity and lifestyle." D) "The major risk that you face is metastases to your lungs, liver, or bones."

A Feedback: The prognosis of people with pilocytic astrocytomas is influenced primarily by their location. The prognosis is usually better for people with surgically resectable tumors, such as those located in the cerebellar cortex, than for people with less accessible tumors, such as those involving the hypothalamus or brain stem. Because of infiltration of brain tissue that prevents total resection, surgery rarely cures brain tumors. The binary of malignant and benign is not used to characterize brain tumors, and the etiology and substantive risk factors are largely unknown. Brain tumors rarely metastasize outside the CNS.

A student is feeling inside her backpack to find her mobile phone. There are a number of other items in the bag other than the phone. The nurse knows that which of the following terms best describes one's ability to sense of shape and size of an object in the absence of visualization? A)Stereognosis B)Astereognosis C)Modalities D)Somesthesia

A Feedback: The sense of shape and size of an object in the absence of visualization is known as stereognosis. Astereognosis is a deficit whereby a person can correctly describe the object but does not recognize it. "Modalities" is a term used for qualitative, subjective distinctions between sensations such as touch, heat, and pain. Somesthesia describes most of the perceptive aspects of body sensation and requires the function of the parietal association cortex.

The parents of a 15-year-old boy are frustrated at his persistent inability to fall asleep at a reasonable hour at night, as well as the extreme difficulty that they have rousing him in the morning. While sleepy after waking, the son claims not to feel drowsy after lunch or in the evening. What is the most likely classification of the boy's sleep disorder? A)Delayed sleep phase syndrome (DSPS) B)Non-24-hour sleep-wake syndrome C)Advanced sleep phase syndrome (ASPS) D)Chronic insomnia

A Feedback: The teen's sleep patterns are characteristic of DSPS. Non-24-hour sleep-wake syndrome is characterized by a sleep cycle that greatly exceeds 24 hours, and ASPS is the opposite of DSPS. Chronic insomnia would likely include afternoon and evening drowsiness.

A 31-year-old female has been recently diagnosed with type 2 diabetes mellitus and is attending a diabetes education class. Which of the following statements by the woman demonstrates an accurate understanding of her health problem? A) "I'll have to control my blood sugars, my blood pressure, and my cholesterol in order to make sure I don't develop sight problems." B) "I'm grieving the fact that I won't be able to get pregnant without causing permanent damage to my vision." C) "It's surprising that sugar in my blood can accumulate on the lens of my eye and cause a loss of sight." D) "I want to avoid going through the treatments for sight restoration that I would need if my diabetes causes damage to my vision."

A Feedback: The threat to vision that is posed by poorly controlled blood sugar levels is compounded by high blood pressure and/or cholesterol levels. Pregnant women with diabetes need additional care to monitor their sight, but they will not necessarily lose it. The damage caused by diabetes does not occur on the lens, and restoration of lost visual acuity is not normally possible.

A 5-year-old boy has starting sitting up in bed displaying signs of extreme anxiety. In the morning, when the parents ask the boy about this, he has no recollection. What should the nurse convey to the parents if this happens again? A) Assist the boy in settling down without awakening him after an episode. B) Watch him closely to see if he has any twitching or thrashing about. C) Bring him back to the clinic if this keeps happening, so we can prescribe some sleep medicine. D) Shake him to wake him up, and then comfort him and put him back in bed.

A Feedback: Treatment for sleep terrors in children consists primarily of educating and reassuring the family. The child should be assisted in settling down without awakening. The child must be protected if he gets up and walks during these episodes.

A client in an acute medicine unit of a hospital with a diagnosis of small bowel obstruction is complaining of intense, diffuse pain in her abdomen. Which of the following physiological phenomena is most likely contributing to her complaint? A) Nociceptive afferents are conducting the sensation of pain along the cranial and spinal nerve pathways of the ANS. B) First-order neurons are inappropriately signaling pain to the dorsal root ganglion. C) The client is experiencing neuropathic pain. D) The client's C fibers are conducting pain in the absence of damaged Aδ fibers.

A Feedback: Visceral pain, as characterized by the client's description of her pain, is conducted by way of nociceptive afferents that use the cranial and spinal nerve pathways of the ANS. The problem is not likely rooted in the inappropriate firing of first-order neurons or the substitution of conduction by C fibers. Pain that is attributable to a pathological process apart from the neural pain network is not normally considered to be neuropathic.

A public health nurse is teaching a health promotion class to a group of older adults at a seniors' center. A woman attending states that, "My husband has got dry macular degeneration, and I don't know what we're going to do when he goes blind from it." How can the nurse best respond to the woman's statement? A) "Vitamins C and E as well as zinc and beta carotene may have some value in slowing the progression of his disease." B) "You should talk to your doctor about the surgical options that might help preserve his sight." C) "If your husband can lower his blood pressure and bad cholesterol, it can possibly slow the progression of his disease." D) "Cataract surgery is showing promise as a way of replacing the part of the eye associated with macular degeneration."

A Feedback: Vitamin E, vitamin C (ascorbic acid), zinc, and beta carotene have shown promise at slowing the progression of the age-related macular degeneration in persons with the disease. Surgical options are not normally available for the dry variety of macular degeneration. Blood pressure control, cholesterol control, and cataract surgery are unlikely to be directly useful.

Which of the following is the most likely course of Wernicke syndrome? A) If the symptoms are correctly diagnosed, most of the effects of the disease can be reversed through better nutrition and supplemental thiamine. B) Wernicke syndrome is uniformly fatal, with death most often occurring within a few months of onset. C) Wernicke syndrome has no treatment, but drugs may be used to treat its associated dyskinesias and behavioral disturbances. D) The course of the disease is relentless, and most affected persons will die of infection within 2 to 10 years.

A Feedback: Wernicke syndrome is caused by a deficiency of thiamine (vitamin B1), and many of the symptoms are reversed when nutrition is improved with supplemental thiamine.

Which of the following diagnostic findings is likely to result in the most serious brain insult? A) Mean arterial pressure (MAP) that equals intracranial pressure (ICP) B) Moderate decrease in brain tissue volume secondary to a brain tumor removal C) Increased ICP accompanied by hyperventilation D) High intracellular concentration of glutamate

A Feedback: When the pressure in the cranial cavity approaches or exceeds the MAP, tissue perfusion becomes inadequate; cellular hypoxia results; and neuronal death may occur. Displacement of CSF and blood can partially compensate for decreased brain tissue volume. Hyperventilation partially mitigates, rather than exacerbates, increase in ICP. Glutamate is normally in far higher concentrations intracellularly than extracellularly.

A geriatrician is assessing an 84-year-old male recently admitted to a subacute medical unit of a hospital for rehabilitation following a recent fall resulting in a hip contusion. Which of the following aspects of the client's sleep history would the physician want to follow up with education? Select all that apply. A) "I make sure that I take a long nap each afternoon to compensate for my frequent waking at night." B) "I've got a bottle of diazepam at home, but I only take them once or twice a month." C) "I try my best to get out for a walk after breakfast or after supper." D) "I make it a rule not to drink any alcohol in the evening." E) "Once my head hits the pillow, I am fast asleep."

A, B Feedback: Daytime sleeping can interfere with the normal sleep-wake cycle. Diazepam is a long-acting benzodiazepine, and occasional use is acceptable. However, excessive use could lead to falls. Moderate exercise not performed before bedtime can help with insomnia. Alcohol can inhibit sleep in the elderly.

A 70-year-old woman has been brought to the emergency department by her daughter who noticed the woman is weak, confused, and forgetful in recent months, along with uncoordinated movements and visual disturbances at times. Which of the following questions by the physician are most likely to address her probable diagnosis? Select all that apply. A)"What medications is your mother currently taking?" B)"Does your mother drink alcohol?" C)"Does your mother have a history of stroke?" D)"Is your mother facing significant stressors right now?" E)"Is your mother lonely?"

A, B Feedback: The client's symptoms are characteristic of Wernicke-Korsakoff syndrome, which is associated with alcohol abuse. Medications can cause numerous cognitive and motor disturbances in elderly clients. Prior CVA and stress are less likely to contribute to her symptomatology.

Which of the following clinical manifestations would the nurse assess in the patient with bipolar disorder who is experiencing mania? Select all that apply. A)Labile mood B)Highly distractible C)Inflated self-esteem D)Despondent when asked questions E)Excessive sleepiness

A, B, C Feedback: Clinical manifestations of mania include decreased need for food and sleep, labile mood, irritability, racing thoughts, high distractibility, rapid and pressured speech, inflated self-esteem, and excessive involvement with pleasurable activities. Despondency is a symptom of the depressive phase.

Nurses regularly rotate between day shift hours and overnight work hours. Following an overnight shift, nurses frequently exhibit which of the following manifestations? Select all that apply. A) Unable to sleep for a long period of time during the day B) Falling asleep while sitting in front of a computer charting during the night C) Finding it difficult to sleep when they have a night off D) Heightened alertness and reflexes on their drive home after work E) Increased hunger and thirst in the middle of the night

A, B, C Feedback: Manifestations of sleep disorders of night shift workers include shortened and interrupted daytime sleep after the night shift, somnolence and napping at work, sleepiness while commuting home, and insomnia on the nights off from work.

When explaining an upcoming test, a polysomnography, the nurse should include which of the following education related to equipment placements the patient will have placed on his or her person during the sleep study? Select all that apply. A) An ECG with lots of chest leads will monitor heart rate and rhythm. B) A pulse oximeter placed on a finger is used to determine arterial oxygen saturation. C) An EOG will be placed on the skin near the eye to record eye movements. D) An EMG patch will be placed under the chin to record muscle movement. E) An actigraph device will be placed on the wrists and ankles to measure body motion.

A, B, C, D Feedback: The ECG, which measures heart rate, is used to detect cardiac rhythm disorders, and the pulse oximeter is used to determine arterial oxygen saturation, which indicates adequacy of ventilation. The EOG, which records eye movements, and the EMG, which records muscle movement, will also be attached. During REM sleep, the eyes move rapidly, but the muscles are paralyzed. Periods during which the EOG recorded lots of movement, and the EMG recorded very little, would indicate REM sleep. An actigraph device will be placed on the wrists and ankles to measure body motion for obtaining objective measurements of sleep duration.

While a travel during a vacation via car, the mother notes that her 14-year-old child is getting sick. The mother suspects motion sickness. Which of the following clinical manifestations would confirm this diagnosis? Select all that apply. A)Rapid breathing B)Feeling faint C)Red, flushed face D)Rapid pulse rate E)Severe balance problems

A, B, D Feedback: Autonomic signs (of motion sickness) including lowered BP, tachycardia, and excessive sweating may occur. Hyperventilation produces changes in blood volume and pooling of blood in the lower extremities, leading to postural hypotension and sometimes syncope. Red, flushed face is usually associated with elevated temperature. Severe balance problems are usually associated with irritation or damage of the vestibular end organs.

A 41-year-old woman was diagnosed with multiple sclerosis (MS) 7 years ago and is sharing her story with members of an MS support group, many of whom have been diagnosed recently. Which of the following aspects of her health problem should the woman warn others to expect at some point in the progression of the disease? Select all that apply. A)Debilitating fatigue B)Progressive loss of visual acuity C)Gradual development of a resting tremor D)Loss of mental acuity E)Shuffling gait

A, B, D Feedback: Fatigue, visual deficits, and cognitive disturbances are all noted manifestations of MS, while respiratory function and GI function are not normally affected. Shuffling gait is usually associated with Parkinson disease.

Which of the following individuals would be considered at high risk for developing cataracts? Select all that apply. A) An 88-year-old female with osteoporosis and congestive heart failure B) A 51-year-old female whose rheumatoid arthritis is controlled with oral corticosteroids C) A 50-year-old male who takes nebulized bronchodilators four times daily for the management of his emphysema D) A 39-year-old woman with a history of open-angle glaucoma and poorly controlled diabetes E) A 29-year-old artist who spends long hours in sunlight painting landscapes

A, B, D, E Feedback: Advanced age, steroid use, and sunlight exposure are all significant risk factors for the development of cataracts. Metabolically induced cataracts are caused by disorders of carbohydrate metabolism (diabetes). Use of bronchodilators is not noted to be strongly associated with cataracts.

When assessing a patient diagnosed with brain stem ischemia complaining of vertigo, the nurse will likely observe which of the following clinical manifestations? Select all that apply. A)Inability to coordinate voluntary muscular movements B)Difficulty in articulating words C)Feelings of ear fullness D)Deafness E)Facial weakness

A, B, E Feedback: Inability to coordinate voluntary muscular movements (ataxia), difficulty in articulating words (dysarthria), and facial weakness are usually associated with brain stem ischemia. Fullness in the ear is often a sign of Ménière disease. Deafness is usually not associated with brain stem ischemia.

A brain tumor causing clinical manifestations of headache, nausea, projectile vomiting, and mental changes is likely located in which parts of the brain? Select all that apply. A)Intra-axially B)Extra-axially C)Brain stem D)Temporal lobe E)Frontal lobe

A, B, E Feedback: Tumors within the intracranial (intra-axially) cavity are fixed and cause s/s of increased ICP like headache, nausea, vomiting, mental changes, papilledema, visual disturbances, and alterations in sensory and motor function. Outside the brain tissue (extra-axially), but within the cranium, tumors may reach large sizes without producing s/s. After they reach a sufficient size, s/s of increased ICP appear. Temporal lobe tumors often produce seizures as their first symptom. Brain stem tumors commonly produce upper/lower motor neuron s/s such as weakness of facial muscles and ocular palsies. Frontal lobe tumors also grow to a large size and cause s/s of increased ICP.

The nurse knows that the patient admitted for opioid addiction may benefit from which of the following treatment modalities? Select all that apply. A) Prescription for dolophine (Methadone) B) Administration of a long-term pain reliever like duragesic (Fentanyl) C) Involvement in a self-help group like Opioid Anonymous (an offshoot of Alcoholics Anonymous) D) Intense exercise therapy under supervision of a body builder E) Administering beta-blocking medications to minimize agoraphobia symptoms

A, C Feedback: Methadone, used in opiate addictions, has the narcotic properties of addiction and sedation, but lacks the euphoric effects of heroin. Naltrexone is used in treatment of alcohol and opiate addictions and works by blocking the opioid receptors and euphoric effects. Fentanyl is a pain medication, and Benadryl is an antihistamine.

A 20-year-old has been admitted to a rehabilitation center after hospital treatment for an ischemic stroke. Which of the following aspects of the client's history would be considered to have contributed to his stroke? Select all that apply. The client A) is an African American male. B) takes iron supplements for the treatment of chronic anemia. C) blood pressure has historically been in the range of 150s/90s. D) was diagnosed with type 2 diabetes 8 years ago. E) takes corticosteroids for the treatment of rheumatoid arthritis.

A, C, D Feedback: African American race, male gender, hypertension, and diabetes are all well-documented risk factors for stroke. Anemia, autoimmune disorders like rheumatoid arthritis, and the use of corticosteroids are not noted to predispose to stroke.

If the nurse suspects a spinal cord injury, the patient has developed autonomic dysreflexia. Which of the following assessments would confirm this complication? Select all that apply. A)BP 180/98 B)Skin covered with macular rash C)Pulse rate 49 D)Complains of a pounding headache E)Cold, cyanotic lower legs

A, C, D Feedback: Autonomic dysreflexia represents an acute episode of exaggerated sympathetic reflex responses that occur in people with injuries at T6 and above, in which CNS control of spinal reflexes is lost. It is characterized by hypertension (BP 180/98), skin pallor, vagal slowing of the heart rate (pulse 49), and headache ranging from dull to severe and pounding.

Which of the following patients would be considered high risk for developing papilledema? Select all that apply. A) A 2-year-old patient who has a shunt placed following delivery where he was diagnosed with hydrocephalus B) A 55-year-old male with substernal chest pain radiating down both arms and experiencing nausea C) A 43-year-old male with diabetes, renal insufficiency, and BP 200/107 D) A 25-year-old motorcyclist who was in an accident and has a potential subdural hematoma E) An 18-year-old female complaining of severe cramps with her menstrual bleeding

A, C, D Feedback: The most common conditions causing increased intracranial pressure include cerebral tumors, subdural hematoma, hydrocephalus, and malignant hypertension. Possible MI is not one of the causes of increased intracranial pressure.

A 4-year-old boy has had otitis media with effusion (OME) for several weeks, and his condition has recently progressed to acute otitis media (AOM). Which of the following factors could have contributed to his AOM? Select all that apply. A) Reflux of fluid from the boy's nose into his middle ear B) A deficiency in immunoglobulin M C) Accumulation of cerumen in the external acoustic meatus D) Sensorineural deficits in the auditory control apparatus E) Exposure to respiratory virus

A, E Feedback: Reflux via the eustachian tubes, IgG deficiency, and exposure to RSV have all been implicated in the development of AOM. Cerumen accumulation in the outer ear, deficient IgM, and sensorineural deficits are unlikely to contribute to AOM.

Match the pain theory to the correct physiologic basis for the pain. 1. Light touch applied to the skin would produce the sensation of touch through low-frequency firing of the receptor. 2. Repeated sweeping of a soft-bristled brush on the skin over or near a painful area may result in pain reduction for several minutes. 3. Proposes that the brain contains a widely distributed neural network that contains somatosensory, limbic, and thalamocortical components. 4. Describes how an acute injury is predicted to be but does not take into account the person's feelings of how the pain feels to him or her. A. Specificity theory B. Pattern theory C. Gate control theory D. Neuromatrix theory

A-4, B-1, C-2, D-3 Feedback: Specificity theory—describes how an acute injury is predicted to be but does not take into account the person's feelings of how the pain feels to him or her; pattern theory—light touch applied to the skin would produce the sensation of touch through low-frequency firing of the receptor; gate control theory—repeated sweeping of a soft-bristled brush on the skin over or near a painful area may result in pain reduction for several minutes; neuromatrix theory—proposes that the brain contains a widely distributed neural network that contains somatosensory, limbic, and thalamocortical components.

A woman has a long-running compulsion to repeatedly check if the doors of her home are locked and has received a diagnosis of obsessive-compulsive disorder (OCD). Her husband is at a loss to understand her irrational behavior and has sought help from a therapist himself to deal with the effect that his wife's OCD is having on their daily lives. Which of the husband's following statements would require correction? A) "It's a relief to know that this can be changed if she continues with therapy and the medications she's been prescribed." B) "It's odd that someone like her and someone who's depressed might both respond positively to the same drugs." C) "I thought that this was something exceedingly rare, but I'm actually a bit relieved to learn that others have this disorder as well." D) "I'm glad that this is something that's a result of life stressors and is not associated with any dysfunction in her brain."

Ans: D Feedback: OCD is thought to have a neurophysiological component and is not a consequence of stress. Medications combined with behavioral therapy provide a good prognosis, and SSRI antidepressants are often used. OCD has a prevalence of 2%.

Following a motor vehicle accident 3 months prior, a 20-year-old female who has been in a coma since her accident has now had her condition declared a persistent vegetative state. How can her care providers most accurately explain an aspect of her situation to her parents? A) "Your daughter has lost all her cognitive functions as well as all her basic reflexes." B) "Though she still goes through a cycle of sleeping and waking, her condition is unlikely to change." C) "If you or the care team notices any spontaneous eye opening, then we will change our treatment plan." D) "Your daughter's condition is an unfortunate combination with total loss of consciousness but continuation of all other normal brain functions."

B Feedback: A continuation of the sleep-wake cycle can exist in a persistent vegetative state. Reflexes often remain, as does spontaneous eye opening. Aspects of brain function beyond those governing consciousness are affected.

A 26-year-old female is resting after a one-minute episode during which she lost consciousness while her muscles contracted and extremities extended. This was followed by rhythmic contraction and relaxation of her extremities. On regaining consciousness, she found herself to have been incontinent of urine. What has the woman most likely experienced? A)A myoclonic seizure B)A tonic-clonic seizure C)An absence seizure D)A complex partial seizure

B Feedback: A tonic-clonic seizure often begins with tonic contraction of the muscles with extension of the extremities and immediate loss of consciousness. Incontinence of the bladder and bowel is common. Cyanosis may occur from contraction of airway and respiratory muscles. The tonic phase is followed by the clonic phase, which involves rhythmic bilateral contraction and relaxation of the extremities. A myoclonic seizure involves bilateral jerking of muscles, generalized or confined to the face, trunk, or one or more extremities. Absence seizures are nonconvulsive, and complex partial seizures are accompanied by automatisms.

A 37-year-old male has survived a logging accident in which the severing of his femoral artery and consequent blood loss resulted in cardiogenic shock. On recovery, one of the deficits that he finds most frustrating is a significant loss of visual acuity. Which is the most likely rationale for his vision damage? A) Decreased cerebral perfusion results in progressive damage to the optic nerve. B) Circulatory collapse causes rapid death of retinal neurons. C) Lack of oxygen results in a distortion of the fovea. D) The visual cortex is susceptible to hypoxic necrosis.

B Feedback: Acute decreased circulation can result in sight damage from edema and death of retinal neurons. Damage to the optic nerve, the fovea, and the visual center are not likely to be contributing factors.

Following a knee injury, a football player is taking ibuprofen, a nonsteroidal anti-inflammatory drug, for the control of pain. Which of the following drug actions is most likely to result in diminished sensation of pain for the player? A) The drug inhibits communication by third-order neurons between the thalamus and cerebral cortex. B) The drug inhibits the enzyme needed for prostaglandin synthesis. C) The drug changes the postexcitatory potential in C fibers, leading to pain sensitization. D) The drug slows the conduction velocity of myelinated Aδ fibers in the pain pathway.

B Feedback: Analgesia can be achieved by inhibition of prostaglandin synthesis, as in the case of many NSAIDs. These drugs do not affect the function of third-order neurons, the action potential of C fibers, or the conduction velocity of Aδ fibers.

Which of the following would be an example of a child born with congenital insensitivity to pain? A child who A) develops pins-and-needles sensation after jumping out of a tree. B) fell off a skate board and fractured ankle but did not feel any pain and just noted swelling in foot. C) skinned knee from a bike accident but only told parents when it started burning. D) cries every time the wind blows because it hurts his face and ears.

B Feedback: Analgesia is the absence of pain on noxious stimulation or the relief of pain without loss of consciousness. Congenital insensitivity is when the peripheral nerve defect apparently exists such that the transmission of painful nerve impulses does not result in perception of pain. Pens-and-needles sensation is called paresthesia. Burning sensations are usually associated with temperature (hyperthermia). Pain associated with wind (or any nonnoxious stimuli) is called allodynia.

As you are walking in the park, a huge black Labrador (dog) runs up to you and places his paws on your shoulders. Immediately your heart starts racing, you feel palpations and anxiety, and your hands become a little shaky. The nurse knows that this response is primarily caused by A) fear of dogs that make you feel like your chest is being tightened and that you have lost control of the situation. B) increased levels of glucocorticoids by the adrenal glands that result in an increase in epinephrine level. C) response of the cholinergic muscarinic receptors on innervational targets of postganglionic fibers. D) stimulation of the release of β2-adrenergic receptors, which will open the airway and increase oxygenation.

B Feedback: Any situation sufficiently stressful to evoke increased levels of glucocorticoids also increases epinephrine levels. Increased epinephrine levels results in tachycardia, palpitations, anxiety, and tremors. Cholinergic muscarinic receptors and β blockers do not help in times of immediate stress.

While working at the triage desk in the local emergency department, which of the following patients is likely having a medical emergency and needs to be seen first? A) A 17-year-old high school student who has a red, itchy eye B) A 55-year-old truck driver complaining of sudden onset of ocular pain and blurred vision C) A 45-year-old school teacher complaining of a red eye that is draining yellow secretions D) An infant with red eyes who is irritable and refusing to eat

B Feedback: Attacks of increased intraocular pressure are manifested by ocular pain and blurred vision caused by corneal edema. Acute angle-closure glaucoma is an ophthalmic emergency. Treatment is directed at reducing the intraocular pressure, usually with pharmacologic agents.

Which of the following individuals is most likely to be diagnosed with a central vestibular disorder? A) A man who got up quickly from his bed and sustained an injury after he "blacked out" B) A woman who has ongoing difficulty in balancing herself when walking C) A woman who suffered a loss of consciousness after being struck on the head during a soccer game D) A man who states that he feels car sick whenever he rides in the back seat of a vehicle

B Feedback: Central vestibular disorders are marked by a sensation of motion that interferes with balance but that is mild and constant and chronic in duration. It should be differentiated from postural hypotension, loss of balance from a head injury, or motion sickness.

A 7-year-old child had an emergency appendectomy during the night. When trying to assess his pain, the nurse should A) ask him to rate his pain on a scale of 0 to 10, with 0 = no pain and 10 = worse pain ever. B) show him a scale with faces of actual children and have him point to the picture that best describes how he is feeling. C) consider his pulse and BP readings to be the most specific indicators of the amount of pain he is experiencing. D) try to distract him by blowing bubbles to minimize the use of opioids so that he does not become addicted to the narcotic.

B Feedback: Children do feel pain and have been shown to reliably and accurately report pain. With children 3 to 8 years of age, scales with faces of actual children or cartoon faces can be used to obtain a report of pain. Physiologic measures, such as heart rate, are convenient to measure, but they are nonspecific. They may be a sign of anxiety and not pain. Distraction methods are good, but medications should be used on an individual basis to match the analgesic agent with the level of pain.

The father of a third grade girl has brought his daughter to a walk-in clinic because he believes the girl has pink eye, which has been going around the students in her class. The nurse at the clinic concurs with the father's suspicion of conjunctivitis. Which follow-up explanation by the nurse is most accurate? A) "The insides of her eyelids have become infected. This often produces severe discomfort." B) "The surfaces of her eyes have bacteria or a virus established, and it's important to maintain good hand hygiene until it goes away." C) "An antibiotic ointment will likely resolve her infection, but pain control will be necessary in the mean time." D) "It's important to aggressively treat this in children, since damage to her sight can result if it's not treated."

B Feedback: Conjunctivitis often spontaneously resolves. The pain associated with conjunctivitis usually produces only mild discomfort compared with severe discomfort associated with corneal lesions or deep and severe pain associated with acute glaucoma. Conjunctivitis may spread to other family members. The corneal surface is not primarily involved, and pain that is severe suggests corneal involvement rather than conjunctivitis. Sight damage is not likely to result.

Following a serious bout of bacterial meningitis, the parents of a 14-month-old has noted the child is not responding to verbal commands. The nurse will explain the pathophysiologic principle behind this by educating the patients by which of the following statements? A) "This could be caused by the same organism that caused the meningitis, infecting the child's tympanic membrane." B) "This may be due to a loss of hair cells and damage to the auditory nerve." C) "The ear and the lining of the brain that was infected are all connected together." D) "It is common for meningitis to use up all the natural killer cells and therefore increase the risk of having brain tumors develop."

B Feedback: Deafness or some degree of hearing impairment is the most common serious complication of bacterial meningitis in infants and children. The mechanism causing hearing impairment seems to be suppurative labyrinthitis or neuritis resulting in the loss of hair cells and damage to the auditory nerve. There is no direct connection between the meninges of the brain and the tympanic membrane. Bacterial meningitis is not associated with an increased risk of developing a brain tumor.

A 30-year-old woman has sought care because of her recurrent photophobia, tearing, and eye irritation. During assessment, her care provider asks about any history of cold sores or genital herpes. What is the rationale for the care provider's line of questioning? A) Herpes simplex virus (HSV) conjunctivitis indicated a need for antiviral rather than antibacterial treatment. B) HSV infection of the cornea is a common cause of corneal ulceration and blindness. C) Chronic viral infection of the eyes can result in HSV autoinoculation of the mouth and labia. D) A history of HSV with eye irritation is suggestive of glaucoma.

B Feedback: Herpes simplex virus (HSV) keratitis (not conjunctivitis) with stromal scarring is the most common cause of corneal ulceration and blindness in the Western world. Autoinoculation from the eyes to other sites is not common, and glaucoma is not noted to be a consequence or symptom of HSV infection.

A mother is placing her child into the bathtub. The child immediately jumps out of the tub and begins to cry, stating his feet are "burning." The nurse in the emergency department knows that the child's response is based on which of the following pathophysiological principles listed below? A) Children react much quicker to contact with hot water than adults. B) The tactile sensation occurs well in advance of the burning sensation. The local withdrawal reflex reacts first. C) It takes a long time for thermal signals to be processed before the brain can send a signal through the spinal cord and tell the foot to withdraw. D) The thermal processing center is located on the rapid conducting anterolateral system on the same side of the brain as the injury.

B Feedback: If a person places a foot in a tub of hot water, the tactile sensation occurs well in advance of the burning sensation. The foot has been removed from the hot water by the local withdrawal reflex well before the excessive heat is perceived by the forebrain. All other responses are incorrect.

If the anterior-posterior dimension of the eyeball is too long, the focus point for an infinitely distant target is anterior to the retina. This patient would be diagnosed as having A)hyperopia. B)myopia. C)cycloplegia. D)presbyopia.

B Feedback: If the anterior-posterior dimension of the eyeball is too long, the focus point for an infinitely distant target is anterior to the retina. This condition is called myopia or nearsightedness. People with myopia can see close objects without problems. Hyperopia is farsightedness. Cycloplegia is paralysis of the ciliary muscle, with loss of accommodation. Presbyopia refers to a decrease in accommodation that occurs because of aging.

Which of the following statements best conveys an aspect of the role of cerebrospinal fluid (CSF)? A) It provides physical protection for the brain and ensures that leukocytes and erythrocytes are evenly distributed in the CNS. B) CSF cushions the brain and provides a near-water medium for diffusion of nutrients. C) CSF distributes plasma proteins throughout the superficial gray matter of the CNS. D) It ensures that the high metabolic and oxygenation needs of the brain are met, as well as absorbing physical shocks.

B Feedback: In addition to providing a cushion for the CNS, CSF provides a medium that is 99% water in which nutrients, electrolytes, and wastes can be diffused. It is not centrally involved in the distribution of oxygen, plasma proteins, or blood cells.

A 44-year-old female has been diagnosed with major depression. Which of the following neuroimaging findings is most congruent with the woman's diagnosis? A) Decreased brain activity in the pons and brain stem B) Reduced activity and gray matter volume in the prefrontal cortex C) Atrophy and decreased blood flow in the amygdala D) Enlargement of the lateral and third ventricles and reduction in frontal and temporal volumes

B Feedback: In some cases of familial major depressive disorder and bipolar disorder, PET and MRI studies have demonstrated a reduction in the volume of gray matter in the prefrontal cortex, with an associated decrease in activity in the region. Brain stem involvement is not common, and the amygdala tends to have increased blood flow and oxygen consumption during depression. Enlargement of the lateral and third ventricles and reduction in frontal and temporal volumes are associated with schizophrenia.

A patient with diabetes mellitus has just undergone a right, below-the-knee amputation following gangrene infection. A few days post-op, the patient confides in the nurse that he still feels his right foot. Knowing the pathophysiologic principles behind this, the nurse can A) administer a psychotropic medication to help the patient cope with the loss of his leg. B) explain that many amputees have this sensation and that one theory surmises that the end of a regenerating nerve becomes trapped in the scar tissue of the amputation site. C) call the physician and ask him for an order for a psychological consult. D) educate the patient that this area has an usually abnormal increase in sensitivity to sensation but that it will go away with time.

B Feedback: Multiple theories exist related to the causes of phantom limb pain. One rationale is that the end of the regenerating nerve becomes trapped in the scar tissue that forms a barrier to regenerating outgrowth of the axon. The usual treatment includes the use of sympathetic blocks; TENS of the large myelinated afferents innervating the area; hypnosis; and relaxation training.

A 70-year-old woman with a diagnosis of benign paroxysmal positional vertigo (BPPV) is receiving teaching from her physician about her diagnosis. The client is eager to avoid future episodes of vertigo and has asked the physician what she can do to prevent future episodes. How can the physician best respond? A) "Unfortunately there aren't any proven treatments for your condition." B) "There are some exercises that I'll teach you to help reorient your inner ear and prevent vertigo." C) "Although they involve some risks, there are some options for ear surgery that can prevent future vertigo." D) "We usually don't actively treat BPPV unless it starts to affect your hearing."

B Feedback: Nondrug therapies for BPPV using habituation exercises and canalith repositioning are successful in many people. Canalith repositioning involves a series of maneuvers in which the head is moved to different positions in an effort to reposition the free-floating debris in the endolymph of the semicircular canals. Surgery is not a noted treatment option, and even in the absence of hearing loss, treatment is warranted.

Staff at the care facility note that a woman has started complaining of back pain in recent weeks and occasionally groans in pain. She has many comorbids that require several prescription medications. The nurse knows that which of the following factors is likely to complicate the clinician's assessment and treatment of the client's pain? A) Neural pain pathways in the elderly differ from those in younger adults and are less responsive to treatment. B) Assessment and treatment are possibly complicated by the large number of drugs that the client receives. C) Accurate pain assessment is not possible in clients with significant cognitive deficits. D) Frequent complaints of pain in older adults with dementia normally indicate hyperalgesia rather than an underlying physical problem.

B Feedback: Polypharmacy complicates both assessment and treatment of pain in the older adult. While minor changes in pain pathways do occur as an age-related change, these do not mean that treatment is unsuccessful. Pain assessment is more difficult in clients with cognitive deficits, but it is not impossible. Reports of pain in the elderly, as with any client, may signal an underlying health problem.

Which of the following observations of a female client in a sleep lab would indicate the clinicians that she is in REM sleep? A) Rolling eye movements are observed, and she has moderate muscle activity. B) Her motor movements are suppressed, and muscle tone is flaccid. C) Delta waves are evident on her EEG, and the heart and respiration rates are slowed. D) She has a low level of cerebral activity, and her EEG indicates low voltage and mixed frequencies.

B Feedback: REM sleep is accompanied by low levels of muscle movement and loss of muscle tone. Rolling eye movements, delta waves, and low levels of cerebral activity are associated with stages 1 through 4 of sleep.

While working for a neurologist who is assessing a patient experiencing restless legs syndrome (RLS), the nurse should be prepared to answer the question about why the patient needs to have his iron level drawn? The nurse response should include, A) "Many of the drugs we give for RLS can cause drastic decreases in your iron level." B) "Many patients with RLS also have an iron deficiency anemia as well." C) "You just look a little pale, and so we want to make sure you have normal blood levels." D) "People with low iron levels do not have enough oxygen circulating to their legs."

B Feedback: RLS may be a symptom of iron deficiency, so the patient should undergo testing for serum ferritin and iron saturation levels. Iron deficiency is frequently present in the absence of anemia. Answer choice A is incorrect since one of the ways RLS is treated is by administering medication to correct the iron deficiency. Answer choice C is a common sign of anemia. Answer choice D is incorrect since the number of RBCs will decrease the oxygen carrying capacity to the body, not iron levels. Low iron levels can be caused by infection, cancer, chronic blood loss, or dietary deficiencies to name a few.

As the eyes rotate upward, the upper eyelid reflexively retracts. Which cranial nerve is primarily responsible for this response? A)Cranial nerve I B)Cranial nerve III C)Cranial nerve VI D)Cranial nerve IV

B Feedback: The CN III (oculomotor) nucleus, which extends through a considerable part of the midbrain, contains clusters of lower motor neurons for each of the five eye muscles it innervates. Because of its plane of attachment, the inferior oblique rotates the eye in the frontal plane pulling the top of the eye laterally. In other words, as the eyes rotate upward, the upper eyelid is reflexively retracted, and in the downward gaze, it is lowered, restricting exposure of the conjunctiva to air and reducing the effects of drying. CN I is involved in olfactory function; CN VI (abducens nerve) innervates the lateral rectus, which abducts the eye. CN IV (trochlear nerve) innervates the superior oblique muscle, which depresses, rotates laterally, and intorts the eyeball.

The nurse knows which of the following phenomena listed below is an accurate statement about axonal transport? A) Anterograde and retrograde axonal transport allow for the communication of nerve impulses between the neuron and the central nervous system (CNS). B) Materials can be transported to the nerve terminal by either a fast or slow component. C) The unidirectional nature of the axonal transport system protects the CNS against potential pathogens. D) Axonal transport facilitates the movement of electrical impulses but precludes the transport of molecular materials.

B Feedback: The bidirectional axonal transport system allows for the transport of molecular materials (as opposed to electrical impulses); anterograde transport has both slow and fast components.

A 21-year-old male is brought to the ED following a night of partying in his fraternity. His friends found him "asleep" and could not get him to respond. They cannot recall how many alcoholic beverages he drank the night before. While educating a student nurse and the roommates in the fraternity, the nurse begins by explaining that alcohol is A) water-soluble compound that is easily absorbed by the gastric lining of the stomach. B) very lipid soluble and rapidly crosses the blood-brain barrier. C) able to reverse the transport of some substances to remove them from the brain. D) very likely to cause sedation, and therefore the patient just needs to sleep it off.

B Feedback: The blood-brain barrier prevents many drugs from entering the brain. Most highly water-soluble compounds are excluded from the brain. Many lipid-soluble molecules cross the lipid layers of the blood-brain barrier with ease. Alcohol, nicotine, and heroin are very lipid soluble and rapidly enter the brain. Alcohol toxicity can kill patients, especially if they are not used to consuming beverages. These patients should never be left alone to "sleep it off."

While assessing a critically ill patient in the emergency department, the nurse notes on the cardiac monitor an R-on-T premature ventricular beat that develops into ventricular tachycardia (VT). Immediately, the patient became unresponsive. The nurse knows that based on pathophysiologic principles, the most likely cause of the unresponsiveness is A) metabolic acidosis that occurs spontaneously following any dysrhythmias. B) interruption of the blood/oxygen supply to the brain. C) massive cerebrovascular accident (CVA) resulting from increased perfusion. D) a blood clot coming from the heart and occluding the carotid arteries.

B Feedback: The brain receives 15% to 20% of the total resting cardiac output and consumes 20% of its oxygen. The brain cannot store oxygen or engage in anaerobic metabolism. An interruption of blood or oxygen supply to the brain rapidly leads to clinically observable signs and symptoms. Unconsciousness occurs almost simultaneously with cardiac arrest. Metabolic acidosis will occur later in the cardiac arrest but not immediately and is not responsible for the patient's unresponsiveness. CVAs can be caused by thrombosis formation or plaque occlusions, but it is not the primary reason for unconsciousness in VT.

A nurse on a neurology unit is assessing a female brain-injured client. The client is unresponsive to speech, and her pupils are dilated and do not react to light. She is breathing regularly, but her respiratory rate is 45 breaths/minute. In response to a noxious stimulus, her arms and legs extend rigidly. What is her level of impairment? A)Delirium B)Coma C)Brain death D)Vegetative state

B Feedback: The continuum of loss of consciousness is marked by the degree of client's responsiveness to stimuli, in addition to the preservation of brain stem reflexes. Since this client still exhibits a pain response (the extended arms and legs indicate decerebrate posturing), even though her pupils are not responsive to light, she has sustained sufficient brain function that she fails to qualify as being brain dead or in a vegetative state.

A 22-year-old female college student is shocked to receive a diagnosis of myasthenia gravis. What are the etiology and most likely treatment for her health problem? A) Autoimmune destruction of skeletal muscle cells; treatment with intensive physical therapy and anabolic steroids B) A decline in functioning acetylcholine receptors; treatment with corticosteroids and intravenous immunoglobulins C) Cerebellar lesions; surgical and immunosuppressive treatment D) Excess acetylcholinesterase production; treatment with thymectomy

B Feedback: The etiology of myasthenia gravis involves a deficiency of acetylcholine receptors at neuromuscular junctions. Treatment can include corticosteroid therapy and intravenous immunoglobulins. Destruction of skeletal muscle cells, cerebellar lesions, and excess acetylcholinesterase are not noted to underlie the disease.

Which of the following statements on the final diagnostic report regarding a computerized tomography (CT) of the head with contrast would lead health care providers to diagnose a patient with Alzheimer disease? A) Large area of ischemia noted in the temporal lobe B) Too numerous to count beta-amyloid (βA) deposits noted C) Ninety percent obstruction in the posterior cerebral artery D) Mural thrombus of vertebrobasilar arteries

B Feedback: The major microscopic features of Alzheimer disease are the presence of neuritic (senile) plaques, neurofibrillary tangles, and amyloid angiopathy. Distracters A, C, and D are causes for a stroke.

A 9-year-old boy has been brought to the emergency department by his father who is concerned by his son's recent fever, stiff neck, pain, and nausea. Examination reveals a petechial rash. Which of the following assessment questions by the emergency room physician is most appropriate? A) "Is your son currently taking any medications?" B) "Has your son had any sinus or ear infections in the last little while?" C) "Does your son have a history of cancer?" D) "Was your son born with any problems that affect his bone marrow or blood?"

B Feedback: The most common symptoms of acute bacterial meningitis are fever and chills; headache; stiff neck; back, abdominal, and extremity pains; and nausea and vomiting. Risk factors associated with contracting meningitis include otitis media and sinusitis or mastoiditis. Particular medications, a history of neoplasm, and hematopoietic problems would be unlikely to relate directly to his symptoms of meningitis.

An adult, who was sexually abused as a child, has been displaying some stress. She seems to complain of increasing medical problems when she is under more stress. The nurse would classify this as an example of A)vitamin deficiency. B)the stress-diathesis theory. C)mendelian research. D)parental disassociation.

B Feedback: The stress-diathesis model of psychiatric disorders evolved from a recognition that genetics (diathesis) and environment (stress) both contribute to the development of psychiatric disorders. Adults who report significant traumatic experiences such as an emotional, physical, or sexual abuse as children show a graded positive response; that is, the more trauma experienced, the more both medical and mental illness occur later in life. Vitamin deficiency has not been implicated as a cause of increasing medical complaints when experiencing stress. Mendelian research studies genetics and describes the way in which genes modulate behavior and psychological traits. Parental nurturing mediates this epigenetic response, but in the absence of nurturing (dissociation), children have difficulties with attention and following directions. As teenagers, they are more likely to engage in high-risk behaviors and, as adults, show increased aggression, impulsive behavior, weakened cognition, and an inability to discriminate between real and imagined threats.

A care aide at a long-term care facility has informed a resident physician that an 80-year-old woman's eyes appear to be inflamed and that her eyelids are caked with sticky secretions. The woman has been subsequently diagnosed with posterior blepharitis. Which of the following treatments is the physician likely to initiate? A) Surgical repair of the woman's blocked meibomian glands B) Warm compresses to be applied regularly to her eyes in addition to oral antibiotics C) Regularly scheduled cleansing of the woman's eyes with normal saline D) Intravenous steroids coupled with topical antibiotic ointment

B Feedback: Treatment of posterior blepharitis is determined by associated conjunctival and corneal changes. Initial therapies can include warm compressing of the lids and use of flaxseed or fish oil tablets to provide omega-3 fatty acid benefits to meibomian oil secretions. Long-term, low-dose systemic antibiotic therapy guided by results of bacterial cultures along with short-term topical steroids may also be needed.

A clinician is conducting an assessment of a male client suspected of having a disorder of motor function. Which of the following assessment findings would suggest a possible upper motor neuron (UMN) lesion? A) The client has decreased deep tendon reflexes. B) The client displays increased muscle tone. C) The client's muscles appear atrophied. D) The client displays weakness in the distal portions of his limbs.

B Feedback: UMNs typically produce increased muscle tone, while hyporeflexia, muscle atrophy, and weakness in the distal portion of limbs are more commonly indicative of LMN lesions.

If the patient's dorsal columns are not functioning, the nurse will observe which of the following responses during neurotesting, where the nurse asks the patient to close his eyes and then proceeds to touch corresponding parts of the body on each side simultaneously with two sharp points? A) Grimacing when body touched with sharp points B) No response to two-point discrimination C) Heightened proprioceptive response D) Inability to identify which way his finger was moved during the test

B Feedback: When comparing the discriminative dorsal column-medial lemniscus pathway with anterolateral tactile pathways with testing (with eyes closed), gently brush the skin with cotton, touch an area with one or two sharp points, touch corresponding parts of the body on each side simultaneously or in random sequence, and passively bend the person's finger one way and then another. If dorsal columns are not functioning, the tactile threshold two-point discrimination and proprioception are missing, and the person has difficulty discriminating which side of the body received stimulation.

Following an injury where a child hit his head from a fall, the CT scan reveals a contusion that the doctor classifies as a moderate brain injury. Which of the following manifestations will the nurse more than likely assess on this child that support this diagnosis? Select all that apply. A)Coma with total paralysis B)Periods of unconsciousness C)Aphasia at times D)Nuchal rigidity E)Weakness or slight paralysis affecting one side of the body

B, C, E Feedback: Moderate brain injury is characterized by a period of unconsciousness and may be associated with focal manifestations such as hemiparesis (weakness or slight paralysis affecting one side of the body), aphasia, and cranial nerve palsy. Coma with total paralysis is seen in severe brain injury. Nuchal rigidity is a classic sign of meningitis.

Which of the following characteristics describe stage 2 non-REM sleep? Select all that apply. A) It occurs at the onset of sleep and lasts approximately 7 minutes. B) During this stage, theta waves are primarily seen on EEG. C) This stage is known as deep sleep where heart rate and BP are decreased. D) This stage has interruptions of spindle activity that helps with integration of new memories. E) Muscles of the body are relaxed.

B, D Feedback: Stage 2 non-REM sleep lasts approximately 10 to 25 minutes, where on EEG activity includes predominantly theta waves that are interrupted by sleep spindles consisting of bursts of high-frequency (12 to 14 Hz) waves. Answer choice A relates to stage 1 sleep that occurs at the onset of sleep and lasts approximately 7 minutes. Answer choices C and E relate to stages 3 and 4 of non-REM sleep, known as deep sleep where heart rate and BP are decreased and the muscles of the body are relaxed.

Stepping out of a mall and into the sunshine has caused a man's pupils to constrict. Place the following anatomical components of the man's pupillary reflex in the ascending chronological order that they responded to the light. Use all the options. A) Oculomotor nuclei B) Retinal ganglionic cells C) Preganglionic neurons D) Pretectal nuclei

B, D, C, A Feedback: Pretectal areas on each side of the brain are connected, explaining the binocular aspect of the light reflex. The afferent stimuli for pupillary constriction arise in the ganglionic cells of the retina and are transmitted to the pretectal nuclei at the junction of the thalamus and the midbrain and from there to preganglionic neurons in the oculomotor (CN III) nuclei via the pretectooculomotor tract.

A baseball player was hit in the head with a bat during practice. In the emergency department, the physician tells the family that he has a "coup" injury. How will the nurse explain this to the family so they can understand? A) "It's like squeezing an orange so tight that the juice runs out of the top." B) "Your son has a huge laceration inside his brain where the bat hit his skull." C) "Your son has a contusion of the brain at the site where the bat hit his head." D) "When the bat hit his head, his neck jerked backward causing injury to the spine."

C Feedback: A direct contusion of the brain at the site of external force is referred to as a coup injury. Contrecoup injury (answer choice D) is the rebound injury on the opposite side of the brain. Answer choice B relates to lacerations that are usually not caused by a direct blow to the head. However, depending on how hard the head was hit with a bat, a hematoma could form as the brain strikes the rough surface of the cranial vault.

The neurotransmitter GABA mainly functions to trigger inhibitory postsynaptic potentials (IPSPs). Therefore, when explaining this to a group of nursing students, the nurse will state that A) it takes at least three chemical substances (amino acids, neuropeptides, and monoamines) to stimulate any activity between the cells. B) there is a symbiotic relationship; therefore, the end result will be depolarization of the postsynaptic membrane. C) the combination of GABA with a receptor site is inhibitory since it causes the local nerve membrane to become hyperpolarized and less excitable. D) the neurotransmitters will interact with cholinergic receptors to bind to acetylcholine in order to produce hypopolarization within the cell.

C Feedback: A neurotransmitter can cause an excitatory or an inhibitory graded potential. The combination of a transmitter with a receptor site is inhibitory in the sense that it causes the local nerve membrane to become hyperpolarized and less excitable. This is called inhibitory postsynaptic potential (IPSP).

A nurse working in a busy orthopedic clinic is asked to perform the Tinel sign on a patient having problems in his hand/wrist. In order to test Tinel sign, the nurse should give the patient which of the following directions? A) "Stand tall, arms at your side, shut your eyes; place the tip of your index finger to your nose." B) "Hold your wrist in complete flexion; keep it in this position for 60 seconds; how does your hand feel after placing it in a neutral position?" C) "I'm going to tap (percuss) over the median nerve in your wrist; tell me what sensation you feel while I am doing this. Does the sensation stay in the wrist or go anywhere else?" D) "I'm going to tap this tuning fork and place it on the side of your thumb; then tell me what you are feeling in your hand and wrist."

C Feedback: A positive Tinel sign will help diagnose carpal tunnel syndrome. The patient will have a tingling sensation radiating into the palm of the hand when lightly percussed over the median nerve at the wrist. Answer choice B relates to Phalen sign, which is also a test to help diagnose carpel tunnel syndrome. Answer choice D is not the medical test for carpal tunnel syndrome.

Which of the following statements about over-the-counter (OTC) melatonin is accurate? A) It has received the FDA approval for effectiveness as a sleep aid. B) Long-term studies of melatonin conclude that it is nonaddicting. C) It produces phase-shifting changes in the circadian rhythm. D) Under strict clinical testing, potency and purity of melatonin have been shown to be consistent.

C Feedback: Administration of melatonin produces phase-shifting changes in the circadian rhythm similar to those caused by light. Synthetic forms of melatonin are available without prescription in health food stores and pharmacies. However, synthetic forms of melatonin are not regulated by the FDA; therefore, their potency, purity, safety, and effectiveness cannot be ensured. There is a lack of clinical trial evidence about dosage, adverse effects, and drug interactions with over-the-counter forms of melatonin.

Which of the following preoperative teaching points related to corneal transplantation is most justified? A) "You should know that there is a significant risk that your body will reject the transplant." B) "The cornea is highly vascular, and therefore you will be at risk for hemorrhage." C) "Your new cornea would come from someone who has recently died." D) "You run a risk of developing a major inflammatory response post-op and will need frequent follow-up appointments."

C Feedback: Advances in ophthalmologic surgery permit corneal transplantation using a cadaver cornea. The low rejection rate is due to several factors: the cornea is avascular, which limits perfusion by immune elements; major histocompatibility complexes are virtually absent in the cornea; antigen-presenting cells are not present in great numbers; the cornea secretes immunosuppressive factors; and corneal cells secrete substances that protect against apoptosis, thereby minimizing inflammation.

6. When educating the parents of a child who has just had tympanostomy tube insertion, the nurse should provide further teaching if the parents say which of the following statements? A) "I will call the physician if I see that the tube has come out." B) "I will be looking for any drainage coming from the ears." C) "I'm so glad that we can take the child swimming next week when we go on vacation." D) "I'm so glad we had the child tested for allergies prior to having these tubes placed."

C Feedback: After tube insertion, the ears of children with tubes must be kept out of water. All of the other distracters are normal post-op teaching for this procedure. Anytime a device comes out after surgery, the physician should be notified. Routine post-op education includes looking for infection, which in this case could be fever, increase in drainage from the ear, or restlessness. Prior to surgery, most children with recurrent otitis media have allergy testing performed.

A 60-year-old man has presented to his family physician following an earache that has become progressively more painful in recent days. Following a history and examination with an otoscope, the man has been diagnosed with otitis externa. Which of the physician's following statements to the man is most accurate? A) "You'll need to avoid getting any water in your ear until you finish your course of antibiotic pills." B) "I'm going to instill some warm water into your ear to flush out debris and bacteria." C) "I'll prescribe some ear drops for you, and in the mean time, it's important not to use ear swabs." D) "This likely happened because your ears aren't draining like they should, but antibiotics that you'll put in your ears will resolve this."

C Feedback: Antimicrobial ear drops are the standard treatment for otitis externa, and the ears must be protected from trauma during infection. Oral antibiotics are not commonly used, and flushing the ears is not indicated for the condition. A lack of normal ear drainage is not part of the etiology of otitis externa.

The geriatrician providing care for a 74-year-old man with diagnosis of Parkinson disease has recently changed the client's medication regimen. What is the most likely focus of the pharmacologic treatment of the man's health problem? A) Maximizing acetylcholine release from synaptic vesicles at neuromuscular junctions B) Preventing demyelination of the efferent cerebellar pathways C) Increasing the functional ability of the underactive dopaminergic system D) Preventing axonal degradation of motor neurons

C Feedback: Antiparkinson drugs act by increasing the functional ability of the underactive dopaminergic system. The cerebellar pathways, acetylcholine levels, and axonal degradation are not components of the etiology of Parkinson disease.

During a procedure to remove impacted cerumen, the nurse should be assessing the patient for which of the following most critical complications? A) Excessive bleeding from the ear B) Pain related to instillation of warm fluids to soften the cerumen C) Symptomatic bradycardia from vagal nerve innervation D) Respiratory distress related to fluid entering bronchiole tubes

C Feedback: Because the external auditory canal is innervated by the auricular branch of the vagus nerve, coughing or even cardiac deceleration can result from stimulation of the canal by cerumen impactions or removal attempts. Since this just involves irrigation using a bulb syringe and warm tap water, bleeding should not occur. Pain may occur but is not a critical complication. Since the fluid is going into the ear canal, there should be no fluid entering the respiratory system.

A geriatrician and social worker are facilitating a family meeting for the children and wife of a 79-year-old man who has been diagnosed with Alzheimer disease. What goal of treatment will the clinicians most likely prioritize in their interactions with the family? A) Modest reversal of brain plaque formation and improved symptomatology through cholinesterase inhibitors B) Surgical treatment of the underlying ischemic changes that underlie the manifestations of the man's disease C) The use of medications such as donepezil and rivastigmine to slow the progression of the disease D) Cognitive and behavioral therapy to counteract the agitation, depression, and suspiciousness associated with Alzheimer disease

C Feedback: Cholinesterase inhibitors like donepezil and rivastigmine may slow the progression of Alzheimer's but do not reverse the organic brain changes that characterize the etiology. Ischemic changes are associated with vascular dementia, and cognitive therapy is of limited use in treatment.

A nurse on a postsurgical unit is providing care for a 76-year-old female client who is 2 days posthemiarthroplasty (hip replacement) and who states that her pain has been out of control for the last several hours, though she is not exhibiting signs of pain. Which of the following guidelines should the nurse use for short-term and long-term treatment of the client's pain? A) Reconciling the client's need for opioid analgesics with the risk of addiction to these drugs B) Recognizing the client's pain is not likely self-limiting C) Knowing that the client's self-report of pain is the most reliable indicator of pain D) Realizing that chronic pain is likely to require innovative and complex treatment

C Feedback: Clinically, the patient's self-report of pain is the most reliable indicator of pain. The risk of addiction to opioids is extremely low, and since the client's pain is acute rather than chronic, it is likely self-limiting.

Which of the following individuals is likely to have the best prognosis for recovery from his or her insult to the peripheral nervous system? An adult A) who developed rhabdomyolysis and ischemic injury after a tourniquet application. B) who suffered a bone-depth laceration to the shoulder during a knife attack. C) who had his forearm partially crushed by gears during an industrial accident. D) who had nerves transected during surgery to remove a tumor from the mandible.

C Feedback: Crushing-type injuries carry a higher possibility of nerve function recovery than do lacerations and insults resulting from ischemia.

As part of the diagnostic workup for a client's long-standing vertigo, a clinician wants to gauge the eye movements that occur in the client. Which of the following tests is the clinician most likely to utilize? A)Romberg test B)Rotational tests C)Electronystagmography (ENG) D)Caloric stimulation

C Feedback: ENG is an examination that records eye movements in response to vestibular, visual, cervical (vertigo triggered by somatosensory input from head and neck movements), rotational, and positional stimulation. With ENG, the velocity, frequency, and amplitude of spontaneous or induced nystagmus and the changes in these measurements brought by a loss of fixation, with the eyes open or closed, can be quantified. The Romberg test, rotational tests, and caloric stimulation do not allow for these data.

A teenager, exposed to West Nile virus a few weeks ago while camping with friends, is admitted with headache, fever, and nuchal rigidity. The teenager is also displaying some lethargy and disorientation. The nurse knows which of the following medical diagnoses listed below may be associated with these clinical manifestations? A)Rocky Mountain spotted fever B)Lyme disease C)Encephalitis D)Spinal infection

C Feedback: Encephalitis represents a generalized infection of the parenchyma of the brain or spinal cord. A virus, such as West Nile virus, usually causes encephalitis although it may be caused by bacteria, fungi, and other organisms. Encephalitis is characterized by fever, headache, and nuchal rigidity. However, more often, people also experience neurologic disturbances, such as lethargy, disorientation, seizures, focal paralysis, delirium, and coma. Rocky Mountain spotted fever (answer choice A) is a tick-borne disease caused by the bacterium Rickettsia rickettsii and usually begins with a sudden onset of fever and headache. A rash may occur 2 to 5 days after fever onset. Lyme disease (answer choice B) is also a tick-borne disease. Typical symptoms include fever, headache, fatigue, and a characteristic skin rash called erythema migrans. As the disease progresses, the patient develops bouts of severe joint pain and swelling of the joint. Neurological problems may occur for weeks, months, or even years after the infection and may include inflammation of the membranes surrounding the brain (meningitis). Spinal infections (answer choice D) can be thought of as a spectrum of diseases comprising spondylitis, discitis, spondylodiscitis, pyogenic facet arthropathy, and meningitis.

Which of the following individuals would be expected to have the highest risk of developing sleep apnea? A) A woman with restless legs syndrome and chronic obstructive pulmonary disease B) A male client with a diagnosis of unstable angina and peripheral arterial disease C) A man with poorly controlled diabetes and hypertension D) A female with chronic insomnia and atrial fibrillation that is treated with warfarin

C Feedback: Male gender, diabetes, and hypertension are all associated with sleep apnea. COPD, angina, PAD, and atrial fibrillation are not noted to be strongly associated with sleep apnea.

A patient has sought medical attention because of a loss of different half-fields in the two eyes. Knowing the potential causes of this complaint, the nurse anticipates that the physician will order tests looking for A)metal fragments in the eyes. B)hemorrhages in the capillaries of both eyes. C)an enlarging pituitary tumor. D)subarachnoid hemorrhage.

C Feedback: Enlarging pituitary tumors can produce longitudinal damage through the optic chiasm with loss of medial fibers of the optic nerve representing both nasal retinas and both temporal visual half-fields. The loss of different half-fields in the two eyes is called a heteronymous loss. Metal fragments can get in the eye from welding. Hemorrhages in both eyes have numerous causes like uncontrolled hypertension and diabetes. Subarachnoid hemorrhages are usually trauma related.

Following a spinal cord injury suffered in a motor vehicle accident, a 22-year-old male has lost fine motor function of his fingers and thumb but is still able to perform gross motor movements of his hand and arm. Which of the following components of his white matter has most likely been damaged? A)The inner layer (archilayer) B)The middle layer (paleolayer) C)The outer layer (neolayer) D)The reticular formation

C Feedback: Fine manipulation skills are the domain of the outer layer, or neolayer, of the tract systems. The inner and middle layers and the reticular formation are not noted to be responsible for these functions.

Which of the following individuals would most likely experience global ischemia to his or her brain? A) A male client who has just had an ischemic stroke confirmed by CT of his head B) A woman who has been admitted to the emergency department with a suspected intracranial bleed C) A man who has entered cardiogenic shock following a severe myocardial infarction D) A woman who is being brought to hospital by ambulance following suspected carbon monoxide poisoning related to a faulty portable heater

C Feedback: Global ischemia is associated with a cessation of blood flow to the entire brain, as often occurs during cardiac arrest or myocardial infarction. Ischemic stroke and intracranial bleeding are likely to cause focal ischemia; carbon monoxide toxicity is associated with hypoxia.

A toddler brought up in a chaotic, nonnurturing environment may suffer neurological consequences if the parent does not achieve attachment with the child. The nurse knows that which of the following nervous systems listed below is the first to respond to the safety needs of the child? A)Parasympathetic nervous system B)Autonomic nervous system C)Sympathetic nervous system D)Limbic system

C Feedback: If the ventral vagus is utilized and fails to provide safety, the SNS is recruited first. The other distracters are not the first to respond.

A college student has been experiencing frequent headaches that he describes as throbbing and complaining of difficulty concentrating while studying. Upon cerebral angiography, he is found to have an arteriovenous malformation. Which of the following pathophysiological concepts is likely responsible for his symptoms? A) Increased tissue perfusion at the site of the malformation B) Hydrocephalus and protein in the cerebral spinal fluid C) High pressure and local hemorrhage of the venous system D) Localized ischemia with areas of necrosis noted on CT angiography

C Feedback: In arteriovenous malformations, a tangle of arteries and veins acts as a bypass between the cerebral arterial and venous circulation, in place of the normal capillary bed. However, the capillaries are necessary to attenuate the high arterial blood pressure before this volume drains to the venous system. As a result, the venous channels experience high pressure, making them to hemorrhage and rupture more likely; the lack of perfusion of surrounding tissue causes neurologic deficits such as learning disorders. Headaches are severe, and people with the disorder may describe them as throbbing (synchronous with their heartbeat). Increased tissue perfusion means that more oxygenated blood is brought to the area, which is not the case. The elevated arterial and venous pressures divert blood away from the surrounding tissue, impairing tissue perfusion. Answer choice B is incorrect since arteriovenous malformation is associated with blood vessels and not the fluid within the ventricles of the brain. Answer choice D is incorrect in that there is blood flow to the area. Ischemia is associated with decreased arterial flow resulting in death to brain tissue.

An adult male has a new diagnosis of Guillain-Barré syndrome. The nurse knows which of the following pathophysiological processes underlie the deficits that accompany the degeneration of myelin in his peripheral nervous system (PNS)? A) The destruction of myelin causes fewer Schwann cells to be produced in the client's PNS. B) The axonal transport system is compromised by the lack of myelin surrounding nerve cells. C) Unless remyelination occurs, the axon will eventually die. D) A deficit of myelin predisposes the client to infection by potential pathogens.

C Feedback: In some pathologic conditions, the myelin may degenerate or be destroyed. This leaves a section of the axonal process without myelin while leaving the nearby oligodendroglial or Schwann cells intact. Unless remyelination takes place, the axon eventually dies. A lack of myelin is associated with reduced insulation and impulse conduction. Schwann cells produce myelin, not vice versa, and the myelin is responsible for neither the axonal transport system nor protection against pathogens.

A patient is asked to stand with feet together, eyes open, and hands by the sides. Then the patient is asked to close his eyes while the nurse observes for a full minute. What assessment is the nurse performing? A)Segmental reflex B)Posture C)Proprioception D)Crossed-extensor reflex

C Feedback: Information from the sensory afferents is relayed to the cerebellum and cerebral cortex and is experienced as proprioception or the sense of body movement and position independent of vision. The knee-jerk reflex is a form of stretch reflex. The crossed-extensor reflex serves to integrate motor movements, so they function in a coordinated manner.

The nurse should anticipate she will need to teach the newly diagnosed multiple sclerosis patient how to give injections if he is prescribed which medication to modify the course of the disease by reducing exacerbations? A)Corticosteroids B)Plasmapheresis C)Interferon beta D)Mitoxantrone

C Feedback: Interferon beta helps modify the course of treatment of MS. It may also reduce exacerbations in persons with relapsing-remitting MS. It is a cytokine that acts as an immune enhancer. It is administered by injection. The other medications are prescribed for MS but not given by injection.

A woman with severe visual and auditory deficits is able to identify individuals by running her fingers lightly over their face. Which of the following sources is most likely to provide the input that allows for the woman's unique ability? A)Pacinian corpuscles B)Ruffini end organs C)Meissner corpuscles D)Free nerve endings

C Feedback: Meissner corpuscles, which are present on the hair-free areas like palms and fingers, are responsible for fine tactile sensation. Pacinian corpuscles provide input on vibration, while Ruffini end organs exist in deeper structures that signal continuous states of deformation. Free nerve endings also detect touch and pressure, but not to the highly differentiated degree of Meissner corpuscles.

Which of the following statements best captures the current understanding of the etiology of mental illness? A) The role of "nurture," experiences, and relationships has been largely disproven. B) Mental illness can be attributed to organic brain changes and pathophysiological processes. C) Mental illness exists from the interplay of biologic factors and psychosocial influences. D) Current understanding of mental illness has shown that both biologic psychiatry and psychosocial psychiatry are incorrect.

C Feedback: Mental illness is currently thought to be the outcome of anatomical and/or physiological influences and psychosocial factors. Neither factor can attribute for 100% of the diagnoses and manifestations of mental illness. Both biologic psychiatry and psychosocial psychiatry have their merits and demerits; neither is wholly incorrect.

The parents of a 3-year-old boy have brought him to a pediatrician for assessment of the boy's late ambulation and frequent falls. Subsequent muscle biopsy has confirmed a diagnosis of Duchenne muscular dystrophy. Which of the following teaching points should the physician include when explaining the child's diagnosis to his parents? A) "Your son's muscular dystrophy is a result of faulty connections between muscles and the nerves that normally control them." B) "He'll require intensive physical therapy as he grows up, and there's a good chance that he will outgrow this problem as he develops." C) "Your son will be prone to heart problems and decreased lung function because of this." D) "His muscles will weaken and will visibly decrease in size relative to his body size throughout his childhood."

C Feedback: Muscular dystrophy is associated with cardiac and respiratory complications. It does not involve the nervous system, and the problem will not dissipate with time. While muscles become weakened, pseudohypertrophy means that their size does not decrease.

Which of the following motor disorders of sleep can be life threatening? A)Narcolepsy B)Periodic limb movement disorder C)Obstructive apnea D)Restless legs syndrome

C Feedback: Obstructive apnea causes poor ventilation, poor-quality sleep, and daytime sleepiness, at best. At worst, it can contribute to depression, auto- and work-related accidents, cardiac dysrhythmias, and hypertension. Severe apnea can lead to pulmonary hypertension, polycythemia, or cor pulmonale. Periodic limb movement disorder and restless legs syndrome, although distressing and possibly indicative of a disease, are not of themselves life threatening. Narcolepsy is not a motor disorder of sleep.

As part of a health promotion initiative, a public health nurse is meeting with a group of older adult residents of an assisted living facility. Which of the following teaching points about hearing loss in the elderly should the nurse include in the teaching session? A) "It is actually a myth that seniors have worse and worse hearing as they age." B) "Most hearing loss in older adults is the result of easily fixed problems, such as impacted ear wax." C) "Experts don't quite know what causes seniors to lose their hearing with age, but drugs like aspirin can contribute to the problem." D) "With older adults, the goal is to adjust lifestyle to accommodate diminished hearing rather than trying to treat the hearing loss itself."

C Feedback: Presbycusis is an identified phenomenon that is thought to be multifactorial, and ototoxic drugs are known to contribute significantly to hearing loss in the elderly. Sensorimotor etiologies are most common, and while lifestyle modifications are often necessary, this does not rule out treatment of the hearing loss.

A toddler is displaying signs and symptoms of weakness and muscle atrophy. The pediatric neurologist suspects it may be a lower motor neuron disease called spinal muscular atrophy (SMA). The patient's family asks how he got this. The nurse will respond A) "This could result from playing in soil and then ingesting bacteria that are now attacking his motor neurons." B) "No one really knows how this disease is formed. We just know that in time, he may grow out of it." C) "This is a degenerative disorder that tends to be inherited as an autosomal recessive trait." D) "This is a segmental demyelination disorder that affects all nerve roots and eventually all muscle groups as well."

C Feedback: SMA is a distinctive group of degenerative disorders involving LMNs that begins in childhood. Answer choice A relates to botulism. It is known which gene is involved in SMA. Answer choice D does not describe SMA.

Which of the following clients may be experiencing a sensory focal seizure that has sent an abnormal cortical discharge to the autonomic nervous system (ANS)? A) A 44-year old patient complaining of constant movement and pain in the legs that gets worse when he tries to sleep B) An 85-year-old patient experiencing drooping of the right side of the face and numbness in the right arm and leg C) A 56-year-old complaining of tingling sensations and has both an elevated pulse and BP D) A 22-year-old complaining of a stiff neck and achiness, along with some nausea and vomiting

C Feedback: Sensory symptoms correlate with the location of seizure activity on the contralateral side of the brain and may involve somatic sensory disturbance (tingling). With abnormal cortical discharge stimulating ANS, tachycardia, diaphoresis, hypo- or hypertension, or papillary changes may be evident. Distracter A is associated with restless legs syndrome (RLS). Distracter B is associated with stroke (CVA). Distracter D is associated with meningitis.

A child is experiencing difficulty with chewing and swallowing. The nurse knows that which of the following cells may be innervating specialized gut-related receptors that provide taste and smell? A)Special somatic afferent fibers B)General somatic afferents C)Special visceral afferent cells D)General visceral afferent neurons

C Feedback: Special visceral afferent cells innervate specialized gut-related receptors. Their central processes communicate with special VIA column neurons that project to reflex circuits producing salivation, chewing, swallowing, and other responses. Special somatic afferent fibers are concerned with joint and tendon sensation. General somatic afferents respond to stimuli that produce pressure or pain. General visceral afferent neurons innervate visceral structures such as the GI tract, urinary bladder, and the heart and great vessels.

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 A) are an accumulation of small deficits that may eventually equal the effects of a full CVA. B) are a relatively benign sign that necessitates monitoring but not treatment. C) resolve rapidly but may place the client at an increased risk for stroke. D) are caused by small bleeds that can be a warning sign of an impending stroke.

C Feedback: TIAs can be considered a warning sign for future strokes. They are not hemorrhagic in nature, and their effects are not normally cumulative. They may require treatment medically or surgically.

A 25-year-old woman who works as an air-traffic controller presents with facial pain and severe headache. She reports that she sometimes feels the pain in her neck or ear and that it is particularly bad during very busy times at the airport. What is the most likely diagnosis? A)Migraine headache B)Cluster headache C)Temporomandibular joint syndrome D)Sinus headache

C Feedback: Temporomandibular joint syndrome causes pain that originates in the temporomandibular joint and is usually referred to the face, neck, or ear. Headache is also common. It is aggravated by jaw function and can be particularly severe in people under stress, especially if they grind their teeth.

After being thrown off the back of a bull, the bull rider can move his arms but has loss of motor function in the lumbar and sacral segments of the spinal cord. This is usually referred to as A)tetraplegia. B)quadriplegia. C)paraplegia. D)anterior cord syndrome.

C Feedback: Tetraplegia and quadriplegia are loss of motor or sensory function after damage to neural structures in the cervical segments of the spinal cord. Paraplegia refers to loss of motor or sensory function in thoracic, lumbar, or sacral segments. The arms function as normal. Anterior cord syndrome includes loss of motor function provided by the corticospinal tracts and loss of pain and temperature sensation from damage to the lateral spinothalamic tracts.

A 9-year-old girl has a diffuse collection of symptoms that are indicative of deficits in endocrine and autonomic nervous system control. She also suffers from persistent fluid and electrolyte imbalances. The nurse knows which of the following aspects of the nervous system listed below would her health care providers focus their diagnostic efforts on? A) Her afferent and efferent cranial nerve function B) Possible damage to her pons and medulla C) Impaired function of her hypothalamus D) Potential damage to the girl's cerebellum

C Feedback: The hypothalamus plays a central role in the maintenance of fluid and electrolyte balance and in the maintenance of endocrine control. Various cranial nerves, the hindbrain, and the cerebellum would be less likely to be implicated.

A 47-year-old woman was diagnosed with amyotrophic lateral sclerosis 3 years ago and has experienced a progressive onset and severity of complications. She has been admitted to a palliative care unit due to her poor prognosis? What assessments and interventions should the nursing staff of the unit prioritize in their care? A) Assessment and documentation of cognitive changes, including confusion and restlessness B) Regular pain assessment and administration of opioid analgesics as needed C) Assessment of swallowing ability and respiratory status D) Cardiac monitoring and administration of inotropic medications

C Feedback: The late stages of ALS normally involve deterioration in swallowing and speech and in the respiratory musculature. Cognitive changes are not common complications, and pain and cardiac complications are not noted to be paramount in the course of ALS.

A college junior calls his mother, a nurse, complaining of "not being able to see." When questioned further, he describes, "A gray curtain just went down my right visual field. I don't know what to do." The nurse should recognize this symptom as which of the following conditions and have her teenager go to the emergency department immediately. A)Glaucoma B)Strabismus C)Retinal detachment D)Macular degeneration

C Feedback: The primary symptom of retinal detachment consists of painless changes in vision. Commonly, flashing lights or sparks, followed by small floaters or spots in the field of vision, occur as the vitreous pulls away from the posterior pole of the eye. As detachment progresses, the person perceives a shadow or dark curtain progressing across the visual field.

Parents of a 16-year-old male who has been behaving in increasingly bizarre ways in recent months are distraught that he has been diagnosed with schizophrenia. Which of the mother's following statements about her son's diagnosis demonstrates an accurate understanding of the disease? A) "It's disturbing to know that what I did when I was pregnant and the way we raised him contributed to this." B) "We are somewhat relieved that psychotherapy and a supportive environment will resolve most of the positive and negative symptoms." C) "This makes us even more worried about his younger brother and whether he might develop schizophrenia." D) "We're committed to lovingly but firmly convincing him that his delusions aren't based in reality."

C Feedback: The risk of developing schizophrenia is much higher in individuals with a first-degree relative who has the disease. Prenatal behavior and child-rearing techniques are not strongly linked with the development of schizophrenia, and therapy and support alone are not likely to eliminate symptoms. Delusions are not normally amenable to reason.

Which of the following statements most accurately characterizes an aspect of the neurobiology of sleep? A) The hypothalamus stimulates the anterior and posterior pituitary to modulate sleeping-waking cycles. B) The pituitary releases melatonin at predictable points in the circadian rhythm in order to facilitate sleep. C) The reticular formation, thalamus, and cerebral cortex interact to integrate the sleep-wake cycle. D) Input from the retinas is interpreted by the cerebellum and contributes to maintenance of the circadian rhythm.

C Feedback: The sleep-wake cycle is rooted anatomically in the reticular formation and the interaction between the thalamus and cerebral cortex. Melatonin is produced by the pineal gland, and the hypothalamus and cerebellum are not central contributors to the sleep-wake cycle.

A 57-year-old female has presented to a clinic exasperated by the effect that restless legs syndrome is having on her sleep. The clinician has performed client teaching prior to choosing a treatment plan. Which of the following responses by the client demonstrates a sound understanding of her condition? A) "Increasing my calcium intake is something simple that might help." B) "Transcutaneous electrical nerve stimulation might be a treatment that can help me avoid needing drugs for this." C) "This could be something that I'm simply prone to genetically." D) "I'll try to get more exercise, since there aren't really any effective medications for restless legs syndrome."

C Feedback: There is a strong suggestion of a genetic component to RLS. Calcium intake is not noted to influence RLS, and TENS is not a noted treatment modality. Pharmacologic treatments exist for the problem.

A nurse practitioner is assessing a 7-year-old boy who has been brought to the clinic by his mother, who is concerned about her son's increasingly frequent, severe headaches. Which of the nurse's following questions is least likely to yield data that will allow for a confirmation or ruling out of migraines as the cause of his problem? A) "Does your son have a family history of migraines?" B) "When your son has a headache, does he ever have nausea and vomiting as well?" C) "Does your son have any food allergies that have been identified?" D) "Is your son generally pain free during the intervals between headaches?"

C Feedback: While food may trigger migraines in some individuals, food allergies are not an identified contributor to migraines, and their presence or absence would be unlikely to provide a differential diagnosis of migraine. Migraines have a strong genetic component and, in children, nausea and vomiting during a headache are suggestive of migraine. Individuals who are prone to migraines are pain free in the times between episodes.

A 30-year-old female has suffered a third-degree burn to her hand after spilling hot oil on it in a kitchen accident. Which of the following teaching points by a member of her care team is most appropriate? A) "Tell us as soon as you sense the beginnings of a round of pain, and we will start with analgesics." B) "Opioids like morphine often cause constipation, but if this happens to you, we will discontinue opioids and change to another family of medications." C) "Opioids aren't without side effects, but we will take action to manage these side effects, so you can continue getting these drugs." D) "It's imperative that we prevent you from developing a tolerance for opioids while you're getting treatment for your burn."

C Feedback: While opioids carry side effects such as constipation, these can be managed in order to continue treatment; constipation would not preclude the continued use of opioids, but would require management. Pain medications should precede the onset of pain, and tolerance is not grounds for discontinuing treatment.

A 3-year-old girl has been diagnosed with amblyopia. Which of the following pathophysiological processes is most likely to underlie her health problem? A) The child may have a congenital deficit of rods and/or cones. B) The girl may have chronic bacterial conjunctivitis. C) She may have been born with infantile cataracts. D) The child may have a neural pathway disorder.

C feedback: there are multiple potential causes of amblyopia, including cataracts. a deficit of rods or cones, a neural pathway disorder, and chronic conjunctivitis are not noted to be common precursors.

While batting, a baseball player is struck in the ribs by a pitch. Place the following components of the player's pain pathway in the chronological order as they contribute to the player's sensation of pain. Use all the options. A) Thalamus B) Dorsal root ganglion body C) Dorsal root ganglion periphery D) Axon E) Cerebral cortex

C, B, D, A, E Feedback: All somatosensory information from the limbs and trunk shares a common class of sensory neurons called dorsal root ganglion neurons. Somatosensory information from the face and cranial structures is transmitted by the trigeminal sensory neurons, which function in the same manner as the dorsal root ganglion neurons. The cell body of the dorsal root ganglion neuron, its peripheral branch (which innervates a small area of periphery), and its central axon (which projects to the CNS) communicate with the thalamus, which in turn communicates with the cerebral cortex using third-order neurons.

12. A 17-year-old female is suspected of having narcolepsy. Which of the following aspects of her medical history and sleep analysis would contribute to a confirmation of the diagnosis? Select all that apply. A) She repeatedly moves her large toe, ankle, and knee during sleep. B) She complains of a powerful urge to move her legs when in bed at night. C) She has frequently awakened unable to move or speak. D) She believes that she experiences auditory hallucinations when she awakens. E) Her sleep latency is normally around 1 hour.

C, D Feedback: Sleep paralysis and hypnopompic hallucinations are symptoms of narcolepsy. Repeated toe, ankle, and leg movements are associated with periodic limb movement disorder, while an urge to move her legs would suggest restless legs syndrome. Narcolepsy is not normally associated with long sleep latency periods.

Following a car accident of a male teenager who did not have his seatbelt on, he arrived in the emergency department with a traumatic brain injury. He has severe cerebral edema following emergent craniotomy. Throughout the night, the nurse has been monitoring and reporting changes in his assessment. Which of the following assessments correspond to a supratentorial herniation that has progressed to include midbrain involvement? Select all that apply. A)Clouding of consciousness B)Decorticate posturing with painful stimulation C)Pupils fixed at approximately 5 mm in diameter D)Respiration rate of 40 breaths/minute E)Decerebrate posturing following painful stimulation of the sternum

C, D, E Feedback: With midbrain involvement, pupils are fixed and midsized (5 mm in diameter), and reflex adduction of the eyes is impaired; pain elicits decerebrate posturing; and respirations change from Cheyne-Stokes respiration to neurogenic hyperventilation. Cloudiness of consciousness occurs in early diencephalic stages. Decorticate posturing with pain occurs in the diencephalic stage.

A 60-year-old male client with a long history of back pain has had little success with a variety of analgesic regimens that his family physician has prescribed. He has recently been diagnosed with a chronic pain disorder. Which of the following teaching points about chronic pain would his physician most likely emphasize to the client? A) "If your pain comes and goes, then we won't characterize it as chronic, and it will require different treatment." B) "You need to remind yourself that this is a purely physical phenomenon that requires physical treatment." C) "Our challenge is to bring you relief but still treat the underlying back problem that your body is telling you about." D) "These pain signals your body is sending likely serve no real, useful, or protective function."

D Feedback: A hallmark of chronic pain is that it usually does not serve any useful function, and that it is often remote from, or even irrelevant to, the originating cause. Like all pains, chronic pain is a complex and multifaceted phenomenon that supersedes purely physical considerations. Chronic pain need not be continuous and unchanging to be characterized as chronic.

Not realizing that its surface was hot, a woman has quickly withdrawn her hand from the surface of a bowl that she was removing from a microwave. Which of the following phenomena has facilitated the rapid movement of her hand in response to the painful stimulus? A) Her midbrain has rapidly responded to the nociceptive stimuli and induced arm flexion. B) The withdrawal reflex of her peripheral nervous system has quickly mediated between afferent and effector neurons. C) The forebrain has mediated a protective spinal cord reflex. D) Her CNS has enacted a protective response received by neurons that innervate her arm muscles.

D Feedback: A reflex is a CNS-mediated response to a painful stimulus that involves an afferent neuron and an effector neuron. The midbrain and forebrain do not necessarily participate in the sensory or motor components of the response.

A business traveler has just arrived in Japan from the United States. During a meeting with his customer, he begins to experience yawning and stretching with an inability to stay focused on the meeting. He also has some eye irritation and has developed a headache. Based on these clinical manifestations, what diagnosis would most likely be causing these symptoms? A)Advanced sleep phase syndrome B)Delayed sleep phase syndrome C)Free-running sleep disorder D)Time zone change syndrome

D Feedback: All of the symptoms are manifestations of jet lag syndrome. Answer choice A relates to early sleep onset and early arising, where people have trouble staying awake in the evening. Answer choice B relates to difficulty in falling asleep at a conventional hour of night and awakening on time in the morning. Answer choice C relates to a lack of synchronization between the internal sleep-wake rhythm and the external 24-hour day, seen commonly in blind people.

A 70-year-old male has been diagnosed with a stroke that resulted in an infarct to his cerebellum. Which of the following clinical findings would be most closely associated with cerebellar insult? A) Flaccid loss of muscle tone B) Difficulty in starting movement, stopping movement, and maintaining rhythmic movements. C) Tremor, rigidity, and bradykinesia D) Unsteady gait and difficulty in speaking and swallowing

D Feedback: An unsteady gait characterizes cerebellar ataxia, and both swallowing and speaking are partly the domain of the cerebellum. Flaccid loss of muscle tone is not noted to accompany cerebellar insult, and difficulties with starting movement, stopping movement, and maintaining rhythmic movements are indicative of basal ganglia disorders. Tremor, rigidity, and bradykinesia are associated with Parkinson disease.

An adult client is experiencing chronic insomnia related to a recent divorce and child custody proceedings. The client is requesting a renewable prescription for "sleeping pills." The nurse knows that which of the following interventions listed below will provide the most beneficial treatment for this client? A) Sedatives and hypnotic drugs will not provide safe relief of the client's health problem. B) The client is suffering from primary insomnia. C) Melatonin supplements will be the safest and most effective long-term pharmacological treatment. D) Behavioral therapies and education regarding sleep hygiene will provide assistance for the client.

D Feedback: Behavioral therapies may be beneficial in the treatment of insomnia. Sleep hygiene establishing a regular wake-up time to help set the circadian clock and regularity of sleep onset are encouraged. Drugs may be of use in the short term and should be used judiciously rather than completely avoiding them. The efficacy of melatonin is unproven, and his insomnia would likely be categorized as secondary insomnia, given the obvious contribution of stressors.

A middle-aged woman is brought to the emergency room after a minor auto accident. Her gait is staggering and unsteady; her speech is slurred; and she displays slight nystagmus. The police officer who brought her in says she has not been drinking. Her blood pressure is very high. Which of the following health problems most likely underlies her present state? A)Multiple sclerosis B)Guillain-Barré syndrome C)Myasthenia crisis D)Cerebellar damage caused by a cerebrovascular accident

D Feedback: Cerebellar damage can resemble the effects of alcohol, because alcohol affects the cerebellum. This woman has not been drinking, but her high blood pressure puts her at risk for cerebrovascular accident.

Distraught at the persistent ringing in his ears and his inability to alleviate it, a 50-year-old man has visited his health care provider. After diagnostic testing, no objective cause (like impacted cerumen or vascular abnormality) was found. Given these testing results, which of the following teaching points by the care provider is most appropriate? A) "This is most often the result of a psychological disturbance, and therapy is often useful in relieving tinnitus." B) "There are many drugs such as blood pressure pills, relaxants, heart medications, and antihistamines that can cause tinnitus." C) "A specialist can listen with a sensitive microphone to determine whether you are actually hearing these sounds." D) "There are some treatments like tinnitus retraining therapy, which includes the extended use of low-noise generators, which has shown good success."

D Feedback: Current treatment modalities for tinnitus address the symptoms of the problem rather than curing the underlying etiology. While therapy can be of some use, it is inaccurate to characterize tinnitus as a psychological disturbance. Medications, including antihistamines, anticonvulsant drugs, calcium channel blockers, benzodiazepines, and antidepressants, have been used for tinnitus alleviation; they are not implicated as a cause. While listening to differentiate between objective and subjective tinnitus is possible, the absence of objective sounds does not mean that tinnitus does not exist, rather that it is subjective. The use of tinnitus retraining therapy, which includes directive counseling and extended use of low-noise generators to facilitate auditory adaptation to the tinnitus, has met with considerable success.

Several months ago, a 20-year-old male suffered a spinal cord injury brought about by a snowboard trick gone wrong. The lasting effects of his injury include a flaccid bowel and bladder and the inability to obtain an erection. While sensation has been completely preserved in his legs and feet, his motor function is significantly impaired. What type of incomplete spinal cord injury has the man most likely experienced? A)Anterior cord syndrome B)Brown-Séquard syndrome C)Central cord syndrome D)Conus medullaris syndrome

D Feedback: Functional deficits resulting from conus medullaris syndrome usually result in flaccid bowel and bladder and altered sexual function. Sacral segments occasionally show preserved reflexes if only the conus is affected. Motor function in the legs and feet may be impaired without significant sensory impairment. Anterior cord syndrome and Brown-Séquard syndrome include a loss of pain and temperature sensation, while central cord syndrome manifests in spastic paralysis and is more common among older adults.

A female client with bone metastases secondary to lung cancer is admitted for palliative radiation treatment and pain control. The client is presently experiencing pain that she rates at 9 out of 10. Which of the following nonpharmacological treatments is most likely to be a useful and appropriate supplement to pharmacological analgesia at this point? A)Teaching the client guided imagery and meditation B)Initiating neurostimulation C)Heat therapy D)Relaxation and distraction

D Feedback: Given the client's high pain rating, initiating teaching around imagery and meditation is unlikely to be effective or appropriate. Neurostimulation requires implantation and/or placement of internal components, while heat is more likely to address superficial pain or pain caused by muscle tension. Relaxation and distraction would be plausible treatment options for this client.

A 58-year-old woman comes to the clinic for evaluation of a sharp, intermittent, severe, stabbing facial pain that she describes as, "like an electric shock." The pain occurs only on one side of her face; it seems to be triggered when she chews, brushes her teeth, or sometimes when she merely touches her face. There is no numbness associated with the pain. What is most likely causing her pain? A)Postherpetic neuralgia B)Migraine headache C)Complex regional pain syndrome D)Trigeminal neuralgia

D Feedback: Her symptoms are characteristic of trigeminal neuralgia, caused by damage to the fifth cranial nerve, which carries impulses of touch, pain, pressure, and temperature to the brain from the face and jaw.

A client with a diagnosis of depression has been prescribed a medication that ultimately increases the levels of the neurotransmitter serotonin between neurons. Which of the following processes will accompany the actions of the neurotransmitter in a chemical synapse? A) Two-way communication between neurons is permitted in contrast to the one-way communication in electrical synapses. B) Communication between a neuron and the single neuron it is connected with will be facilitated. C) The neurotransmitter will cross gap junctions more readily. D) More neurotransmitters will cross the synaptic cleft and bond with postsynaptic receptors.

D Feedback: In chemical synapses, neurotransmitters cross the synaptic cleft and bond with postsynaptic receptors to facilitate communication between neurons. This communication is one way, not two way, and each neuron has synaptic connections with thousands of other neurons. Gap junctions are associated with electrical synapses, not chemical synapses.

1A 30-year-old woman has presented to her family doctor complaining of three distressing episodes over the last several months during which she got extremely dizzy, had loud ringing in her ears, and felt like her ears were full of fluid. She states that her hearing diminishes, and she feels nauseous during these episodes. What diagnosis is the physician most likely to first suspect? A)Acute otitis media B)Acute vestibular neuronitis C)Benign paroxysmal positional vertigo (BPPV) D)Ménière disease

D Feedback: Ménière disease is characterized by fluctuating episodes of tinnitus, feelings of ear fullness, and violent rotary vertigo that often renders the person unable to sit or walk. There is a need to lie quietly with the head fixed in a comfortable position, avoiding all head movements that aggravate the vertigo. Symptoms referable to the autonomic nervous system, including pallor, sweating, nausea, and vomiting, usually are present. The more severe the attack, the more prominent are the autonomic manifestations. A fluctuating hearing loss occurs with a return to normal after the episode subsides. Her symptomatology is not characteristic of AOM, acute vestibular neuronitis, or BPPV.

A 77-year-old woman is concerned because she has occasionally found her husband sleepwalking in the last several weeks. What is her care provider's most appropriate response to her concerns? A) "This is not an uncommon event that often accompanies older age." B) "I'll likely prescribe a benzodiazepine for this when I next see your husband." C) "This is understandably upsetting for you, but as long as the environment is safe, it's likely not significant." D) "There may be something else going on with your husband such as delirium or a problem with his medications."

D Feedback: New-onset sleepwalking in the elderly is usually a manifestation of another problem such as delirium, drug toxicity, or a seizure disorder. It is not a normal age-related change, and a benzodiazepine is not a prudent initial treatment.

Which of the following would be considered an abnormal finding when the nurse practitioner uses an otoscope to look at a toddler's ear? The tympanic membrane is described as A)"transparent." B)"a shallow, oval cone pointing inward toward apex." C)"small, whitish cord seen traversing the middle ear from back to front." D)"yellow, amber discoloration noted."

D Feedback: Otoscopic signs of middle ear effusion will be seen in the tympanic membrane as a yellow, amber discoloration. All of the other distracters are normal findings.

As part of a diagnostic workup of a 22-year-old male with recently diagnosed schizophrenia, a neurologist wants to examine the levels of metabolic activity in particular areas of the client's brain. Which of the following diagnostic procedures is the physician most likely to order? A)Computed tomography (CT) B)Electroencephalography (EEG) C)Magnetic resonance imaging (MRI) D)Positron emission tomography (PET)

D Feedback: PET is rooted in the selective brain uptake of radiolabeled isotopes. As such, it can measure brain metabolic activity. CT and MRI offer visualization of structural components, while EEG measures electrical activity.

A nursing student having trouble moving his head from side to side is likely experiencing a problem with which type of neurons? A)General visceral efferent neurons B)Preganglionic neurons C)Parasympathetic postganglionic neurons D)Pharyngeal efferent neurons

D Feedback: Pharyngeal efferent neurons innervate brachial arch skeletal muscles, muscles of mastication and facial expression, and muscles of the pharynx and larynx. They also innervate muscles responsible for moving the head. General visceral efferent neurons and preganglionic neurons (same) innervate smooth and cardiac muscle and glandular cells of the body, most of which are in the viscera. Parasympathetic postganglionic neurons have no effect in moving the head.

A 4-month-old infant and his mother are at an appointment with a pediatrician to follow up his nonaccommodative strabismus and to determine a treatment plan. Which of the following treatments is most likely to prevent future loss of vision? A) Prescribing glasses once the infant is 6 months of age B) Use of beta-adrenergic blockers and latanoprost eye drops C) Regularly scheduled eye exams and monitoring of self-correction of his eyes D) Surgical correction of the musculature

D Feedback: Strabismus is ideally treated by surgery rather than with glasses in the case of infants. The condition will not resolve independently, and medications are unlikely to help the condition.

The nurse knows that which of the following treatment plans listed below is most likely to be prescribed after a computed tomography (CT) scan of the head reveals a new-onset aneurysmal subarachnoid hemorrhage? A) Stat administration of tissue plasminogen activator (tPA) B) Administration of a diuretic such as mannitol to reduce cerebral edema and ICP C) Monitoring in the ICU for signs and symptoms of cerebral insult D) Craniotomy and clipping of the affected vessel

D Feedback: Surgery for treatment of aneurysmal subarachnoid hemorrhage involves craniotomy and inserting a specially designed silver clip that is tightened around the neck of the aneurysm. Administration of tPA would exacerbate bleeding, and a diuretic would not address the issue of bleeding. Monitoring alone would be an insufficient response given the severity of the problem.

A 46-year-old male has presented to the emergency department because of the eye pain, severe headache, and blurred vision that have followed an eye exam at an optometrist's office earlier in the day. The client tells the triage nurse that he received eye drops during the exam "to keep my pupils wide open." What differential diagnosis will the care team first suspect? A)Infectious conjunctivitis B)Keratitis C)Corneal trauma D)Angle-closure glaucoma

D Feedback: Symptoms of acute angle-closure glaucoma are related to sudden, intermittent increases in intraocular pressure. These occur after prolonged periods in the dark, emotional upset, and other conditions that cause extensive and prolonged dilation of the pupil. Administration of pharmacologic agents such as atropine that cause pupillary dilation (mydriasis) also can precipitate an acute episode of increased intraocular pressure in persons with the potential for angle-closure glaucoma. Attacks of increased intraocular pressure are manifested by ocular pain and blurred or iridescent vision. The man's symptomatology is not characteristic of conjunctivitis, corneal trauma, or keratitis.

During descent, an airplane passenger is complaining that his "ears are plugged." What aspect of the structure and function of the ear best accounts for the passenger's complaint? A) The inner ear adjusts its volume in response to atmospheric pressure, increasing during low pressure and decreasing in high pressure. B) The eustachian tubes must remain patent to equalize pressure between the middle ear and inner ear. C) The tympanic membrane is selectively permeable in order to accommodate pressure changes, and this capacity is often impaired during upper respiratory infections. D) Air must be able to flow between the middle ear and nasopharynx in order to accommodate pressure changes.

D Feedback: The eustachian tubes between the middle ear and nasopharynx must be patent to allow for changes in atmospheric pressure. Pressure is not accommodated by changing the volume of the middle ear, and the tympanic membrane is not selectively permeable to air.

A 60-year-old male office worker presents to a clinic complaining of new onset of lower back pain that has been worsening over the last 6 weeks. The nurse knows which of the following components of his physical assessment and history is most indicative of a serious pathological process (like aortic aneurysm or cancer)? A) His pain is relieved by extended bed rest. B) When supine, passive rising of his leg to 90 degrees results in hamstring pain. C) He has needed regular nonsteroidal anti-inflammatory drugs to control the pain in recent weeks. D) His onset of pain has been gradual, and he has no prior history of lower back problems.

D Feedback: The gradual onset of back pain unrelated to injury and initial presentation after age 50 are considered red flags for more serious pathologies such as aortic aneurysm, malignancy, or compression fracture. Pain that is aggravated by lying down is a red flag for malignancy or infection. The onset of hamstring pain at 90 degrees of hip flexion is a normal finding. The need for and use of NSAIDs for lower back pain relief are not indicative of a serious pathology in and of itself.

1A Tae Kwon Do (TKD) master is applying downward pressure just above the elbow joint on an attacker who immediately collapses to the ground. The TKD master knows the elbow joint can bend inward toward the body but not in the opposite direction. Which of the following reflexes is applicable to this example? A)Knife-clasp B)Withdrawal C)Myotatic D)Inverse myotatic

D Feedback: The inverse myotatic reflex is demonstrated in this example; when too much pressure is applied to the arm and tension reaches a certain level, the Golgi tendon "relaxes." Since the arm bar is being held, the only way the body can "reflex" is by going down toward the ground, making the attacker fall downward. In persons with spastic paralysis, the inverse myotatic reflex becomes hyperactive and produces what is called the clasp-knife reaction. The withdrawal reflex is stimulated by a damaging (nociceptive) stimulus and quickly moves the body part away from the offending stimulus, usually by flexing a limb part. The myotatic or stretch reflex controls muscle tone and helps maintain posture.

Which of the following is a negative symptom of schizophrenia? A)Hallucinations B)Incoherence C)Word salad D)Affective flattening

D Feedback: The negative symptoms of schizophrenia reflect the absence of normal social and interpersonal behaviors and include alogia (tendency to speak very little), avolition (lack of motivation for goal-oriented activity), apathy, affective flattening (lack of emotional expression), and anhedonia (an inability to experience pleasure in things that ordinarily are pleasurable). Positive symptoms are those that reflect the presence of abnormal behaviors and include disorganized, incomprehensible speech; delusions (e.g., that one is being controlled by an outside force); hallucinations (hearing voices is the most common); and grossly disorganized or catatonic behavior.

After surviving an ischemic stroke, a 79-year-old male has demonstrated significant changes in his emotional behavior, with his family noting that he now experiences wide mood swings with exaggerated responses of empathy, anger, and sadness to situations. His care team would most likely attribute these responses to ischemic changes in which of the following brain structures? A)The man's occipital lobe B)The client's temporal lobe in general and Wernicke area in particular C)The man's parietal lobe D)The components of the client's limbic system

D Feedback: The neural structures that constitute the limbic system are primarily responsible for the regulation of emotion. Clinical studies have suggested that this area of the brain is important for mood states and has extensive connections with the limbic system. The occipital lobe interprets visual information, while language is the domain of the Wernicke area. The parietal lobe processes sensory input.

A patient in the intensive care unit who has a brain tumor has experienced a sharp decline. The care team suspects that water and protein have crossed the blood-brain barrier and been transferred from the vascular space into the client's interstitial space. Which of the following diagnoses best captures this pathophysiology? A)Focal hypoxia B)Cytotoxic edema C)Hydrocephalus D)Vasogenic edema

D Feedback: Vasogenic edema occurs with conditions that impair the function of the blood-brain barrier and allow transfer of water and protein from the vascular into the interstitial space. It occurs in conditions such as tumors, prolonged ischemia, hemorrhage, brain injury, and infectious processes. Focal hypoxia is associated with localized delivery of blood with inadequate oxygen, and cytotoxic edema is an absolute increase in intracellular fluid. Hydrocephalus is an abnormal increase in CSF volume in any part or all of the ventricular system.

A 32-year-old man is complaining of burning, itching, photophobia, and severe pain in his right eye after swimming in the ocean. To determine that the eye condition was a corneal rather than a conjunctival disease, which of the following would be the distinguishing symptom? A)Burning B)Itching C)Photophobia D)Severe pain

D Feedback: While burning, itching, and photophobia are all important symptoms of conjunctivitis, severe pain suggests corneal rather than conjunctival disease.

During a late night study session, a pathophysiology student reaches out to turn the page of her textbook. Which of the following components of her nervous system contains the highest level of control of her arm and hand action? A)Cerebellum B)Thalamus C)Basal ganglia D)Frontal lobe

D Feedback: While intentional movement involves input from various components of the nervous system including the cerebellum, thalamus, and basal ganglia, primary control and coordination are controlled by the motor cortex in the frontal lobe.

A stroke affecting which of the following areas of the brain would be most likely to leave an individual's vestibular system intact and posture and balance maintained? A)The brain stem B)The thalamus C)The temporal and parietal cortex D)The limbic system of the cerebrum

D Feedback: While the brain stem, thalamus, and temporal and parietal cortex are components of the vestibular apparatus, the limbic system is not a central component of the maintenance of posture and balance.

The nurse knows that which of the following observations of a client during a sleep study would be most likely considered a pathological finding? A) The client experiences periods of apnea of 5 to 15 seconds in duration. B) The client's intrinsic clock involves a sleep-wake cycle that is consistently 2 hours longer than the actual length of a day. C) The client's PCO2 level is increased, and his PO2 level decreased during deep sleep. D) The client spends the majority of his sleeping hours in deep REM sleep.

D Feedback: While vital, REM sleep does not normally occupy the majority of sleeping hours. The brain is highly active during REM sleep, and it accounts for 20% to 25% of normal sleep. Brief apneic spells are not uncommon, and the circadian rhythm often does not match the 24-hour length of day. It is normal for PCO2 to increase and PO2 to decrease during deep sleep.