Pathophysiology 4B
A client asks the nurse what the difference is between Parkinson disease and secondary parkinsonism. Which response by the nurse is best? "Parkinson disease is not curable, but secondary parkinsonism is usually reversible." "Parkinson disease is a genetically inherited disorder affecting chromosome 4." "Secondary parkinsonism is caused by neuritic plaques and neurofibrillary tangles." "Secondary parkinsonism occurs as a side effect of drugs used to treat Parkinson disease."
1
A client has difficulty writing and using tools or utensils. Which term will the nurse use to describe this finding? Apraxia Dystonia Akathisia Hypomimesis
1
A client is diagnosed with Parkinson disease. The daughter asks the nurse to explain what causes this disorder. Which information is the best? There is a lack of dopamine, which leads to rigidity. There is too much dopamine, which leads to limpness. There is a lack of acetylcholine, which leads to rigidity. There is too much acetylcholine, which leads to limpness.
1
A nurse is teaching about vasogenic edema, cytotoxic edema, and interstitial edema. What type of edema is the nurse describing? Cerebral Oculomotor Supratentorial Autoregulation
1
A nurse observes pinpoint-sized pupils in a client upon assessment. Which type of drug does the nurse suspect the client has taken? Opiates Atropine Sedatives Scopolamine
1
Which client would most likely be diagnosed with a noncommunicating hydrocephalus? 6 year old 19 year old 48 year old 82 year old
1
Which term should the nurse use to describe a client that fails to recognize the form and nature of objects? Agnosia Aphasia Diplegia Dysphasia
1
Which type of movement will the nurse expect to observe in a client diagnosed with hepatic encephalopathy? Asterixis Athetosis Bradykinesia Essential tremor
1
While making rounds the nurse observes the client in the position illustrated in the image. How should the nurse chart this finding? Decorticate posturing Decerebrate posturing Basal ganglion posturing Dysfunctional postural fixation
1
A nurse is caring for a client with Alzheimer disease. Which of these pathophysiologic changes are consistent with Alzheimer disease? . Neuritic plaques Acetylcholine loss Epileptogenic focus Excitation of neurons Neurofibrillary tangles Focal cerebral edema
1, 2, 5
Which assessment findings will the nurse expect to observe in a client with Parkinson disease? Rigidity Chorea Resting tremors Difficulty walking Postural abnormalities
1, 3, 4, 5
A nurse is teaching a class about Alzheimer disease. Which information should the nurse include in the teaching session? It is the leading cause of dementia. It is an uncommon neurologic disorder. Its pathogenesis does not have a genetic component. It causes plaques that increase nerve impulse transmissions. It is a result of neuronal proteins becoming distorted and tangled.
1,5
A client presents with a wide-based gait, in which the feet are turned outward. Upon assessment, the client staggers when walking and holds the pelvis stiff. Which condition do these assessment findings support? Apraxia Cerebellar gait Basal ganglion gait Decorticate posture
2
A client who experienced a head injury to the frontal lobe develops gegenhalten (paratonia). Which clinical manifestation will the nurse expect to observe? Limp, atrophied muscles Resistance to passive movements Decerebrate rigidity of lower extremeties Writhing, twisted movements of both arms
2
A nurse charts that a client has Cheyne-Stokes respirations. What did the nurse observe upon assessment to support this finding? A sustained, deep, rapid, regular pattern A pathologically alternating pattern of tachypnea slowing to apnea A cluster of breaths with a disordered sequence and with irregular pauses A pattern of deep "all-or-none" breaths accompanied by a slow respiratory rate
2
Upon assessment of a client, the nurse finds permanent progressive loss of memory, orientation, judgment, and problem-solving ability. The nurse is caring for which client? A client with delirium A client with dementia A client with anterograde amnesia A client with selective attention deficit
2
Which assessment finding would support the medical diagnosis of Parkinson disease? Chorea Akinesia Hypertension Waddling gait
2
Which information should the nurse include when educating a client about bradykinesia? "Most clients can expect to have problems with memory." "Walking will become slow and will take more time to start." "You will have involuntary movements of your face and arms." "Eventually seizures will develop, and paralysis usually occurs."
2
Which mechanism causes rigidity in a client with Parkinson disease? Lewy body formation Excess cholinergic activity Lower motor neuron destruction Gamma-aminobutyric acid depletion
2
Which term will the nurse use to describe a client who sustains a cerebrovascular accident with paralysis on the left side? Left paraplegia Left hemiplegia Right hemiplegia Right paraplegia
2
Which type of dementia should the nurse expect to occur in a client who is diagnosed with Parkinson disease? Vascular dementia Lewy body dementia Frontotemporal dementia Creutzfeldt-Jakob dementia
2
Upon assessment, the nurse determines the client with head trauma is experiencing increased intracranial pressure (ICP). Which assessment findings support the nurse's conclusion? Pupils equal and reactive to light Widening pulse pressure Full and bounding pulse Awake and alert Eupnea
2, 3
Which information should the nurse include when discussing attention deficit hyperactivity disorder (ADHD)? Working memory is not affected. It is a common childhood disorder. Impulsivity is often a characteristic. Inability to maintain sustained attention is common. The disorder generally goes into remission by adulthood.
2, 3, 4
A nurse is assessing a client with suspected normal-pressure hydrocephalus. Which findings would be consistent with this diagnosis? Delirium Incontinence Declining memory Abrupt occurrence Unsteady gait with falling
2, 3, 5
Which clients have basal ganglia motor syndromes? A client diagnosed with poliomyelitis A client diagnosed with Parkinson disease A client diagnosed with a spinal cord injury A client diagnosed with Tourette syndrome A client diagnosed with Huntington disease
2, 5
Which criteria will be used to determine brain death in a client? Gag reflex present Unresponsive coma No spontaneous respiration Reactive but unequal pupils Isoelectric electroencephalogram (EEG)
2,3,5
A client diagnosed with a cerebellar motor syndrome is likely to demonstrate which clinical finding upon assessment? Oral temperature of 96° F Respirations of 8 per minute Difficulty standing on one foot Pathologic laughter or crying
3
A client has basal ganglion damage. Which muscle tone alteration will the nurse observe upon assessment? Dystonia Flaccidity Cogwheel Alpha rigidity
3
A client has difficulty understanding the nurse's speech after a cerebrovascular accident. How will the nurse report this finding to the oncoming shift? The client has apraxia. The client has agnosia. The client has receptive aphasia. The client has expressive aphasia.
3
A client is diagnosed with vasogenic cerebral edema after a traumatic brain injury. Which information should the nurse include when teaching the client about the pathophysiology of vasogenic cerebral edema? Bleeding of cranial vessels results in a severe decrease in intracranial pressure. Brain swelling causes cerebrospinal fluid to flow more readily through the ventricles. When the blood-brain barrier is disrupted, plasma proteins leak into extracellular spaces. Toxins that are released cause brain cells to transport potassium in exchange for sodium.
3
A client was found at home in the fetal position reporting a severe, sudden onset headache. Assessments in the emergency department reveal confusion, disorientation, and one dilated pupil. While waiting, the family notices cyclic breathing with increasing then decreasing rates and depths and then short periods of not breathing. Which type of breathing pattern is occurring? Cluster breathing Ataxic respirations Cheyne-Stokes respirations Central neurogenic hyperventilation
3
A nurse is caring for a client with upper motor neuron paresis. Which information indicates the nurse has an accurate understanding of upper motor neuron paresis? This involves fasciculations. This causes hypotonia and flaccidity. This can also be called spastic paresis. This is from an extrapyramidal motor syndrome.
3
An individual arrives in the emergency department in a coma with a possible drug overdose. Which drug classification would cause the pupils to be moderately dilated, unequal, and fixed? Opiates Atropine Sedatives Scopolamine
3
The nurse receives a report from a licensed practical nurse about care provided to clients on a neurologic unit. It is most important for the nurse to follow up on which statement first? "The 84-year-old client with Alzheimer disease is depressed and anxious." "The 45-year-old client with Huntington disease has writhing movements of both hands." "The 72-year-old client with Parkinson disease reports dizziness when standing up." "The 15-year-old client with Tourette syndrome is repeating words over and over again."
3
When a nurse passively moves a client's muscles and there is little to no resistance, which term should the nurse use to report this finding to the oncoming shift? Dystonia Cogwheel Hypotonia Hypertonia
3
Which statement, made by the nurse, defines the difference between paresis and paralysis? "Spinal shock causes paresis, but not paralysis." "Paralysis is permanent, and paresis is only a temporary condition." "Paresis is muscle weakness, and paralysis is loss of motor function." "Paresis affects lower motor neurons, and paralysis affects upper motor neurons."
3
Which term should the nurse use to describe limp, atrophied muscles that can be moved without resistance? Rigidity Dystonia Flaccidity Hypertonia
3
Which classic clinical manifestations will the nurse observe in a client diagnosed with Parkinson disease? Paralysis Flaccidity Dysarthria Dysphagia Bradykinesia Urinary incontinence
3, 4, 5
Which clients are exhibiting manifestations of a pyramidal motor syndrome? A client with a resting tremor A client with an unsteady gait A client with hyperactive reflexes A client with a positive Babinski sign A client with clasp-knife phenomenon
3, 4, 5
A client has Alzheimer disease. The nurse will focus interventions on which deficient neurotransmitter? Potassium Dopamine Glutamate Acetylcholine
4
A client has an expanding lesion in one hemisphere causing enough of a lateral shift that the cingulate gyrus is being forced under the falx cerebri. Which term will the nurse use to describe this type of herniation? Uncal herniation Central herniation Infratentorial herniation Cingulate gyrus herniation
4
A client has sustained a traumatic brain injury but is able to follow simple commands and can manipulate objects and blink. Which term will the nurse use in report to describe this state? Coma Vegetative state Locked-in syndrome Minimally conscious
4
A client has upper motor neuron paralysis. Which term will the nurse use to document this condition? Diplegia Hemiplegia Quadriparesis Spastic paralysis
4
A nurse is asked to define spinal shock. How should the nurse respond? Slow destruction of efferent pathways Presence of hyperactive deep tendon reflexes Increased spinal reflexes resulting in a hypertensive crisis Complete cessation of spinal cord function below the lesion Confident Not Sure
4
A nurse is caring for a client with Parkinson disease. Which pathophysiologic process must the nurse consider when planning care for this client? Abnormal, involuntary movements that occur as spasms Autosomal dominant trait with mutation on chromosome 4 Lower motor neuron syndrome originating in the anterior horn Degeneration of the basal ganglia with loss of dopamine-producing neurons
4
A nurse is caring for clients with various types of dementia. Which assessment finding is consistent for all clients with dementias? Seizures Abrupt onset Receptive dysphasia Progressive deterioration
4
An individual having difficulty concentrating is restless, irritable, and tremulous. These changes have developed over 2 to 3 days. Which term will the nurse use to describe this condition? Coma Dementia Hemiparesis Acute confusional state
4
The nurse should prepare the client for which test to determine the type of seizure and its focus? Urinalysis Chest x-ray exam Blood urea nitrogen Electroencephalography
4
Which client has the lowest level of consciousness (LOC)? A 49-year-old client who is not oriented to person or place A 36-year-old client who falls asleep unless touched by the nurse A 52-year-old client who answers questions with a yes or no response A 28-year-old client who responds by withdrawing from a painful stimulus
4
Which client is at highest risk for developing dementia and mental status changes? A 42-year-old client who has a history of spinal shock A 58-year-old client who has upper motor neuron syndrome A 65-year-old client who has a history of Guillain-Barré syndrome A 74-year-old client who takes several medications to treat Parkinson disease
4
Which finding will indicate to the nurse that a client is in the clonic phase of a seizure? Loss of consciousness Spasticity with placidity Muscle contraction with increased muscle tone Alternating contraction and relaxation of muscle
4
Which structure is essential for the client to have a state of awakeness? Renal system Cardiac system Memory system Reticular activating system
4
Which term will the nurse use to describe muscle rippling or quivering visible under the client's skin? Areflexia Fibrillations Dyskinesias Fasciculations
4
A client has a central nervous system injury that is causing vomiting. Which information should the nurse remember when planning care about what can cause vomiting? Decompression of the brainstem Decrease in intracranial pressure Impingement on the third ventricle Compression of the medulla oblongata Impingement directly on the floor of the fourth ventricle
4, 5
A client asks the nurse what the difference is between Parkinson disease and secondary parkinsonism. Which response by the nurse is best? a. "Parkinson disease is not curable, but secondary parkinsonism is usually reversible." b. "Parkinson disease is a genetically inherited disorder affecting chromosome 4." c. "Secondary parkinsonism is caused by neuritic plaques and neurofibrillary tangles." d. "Secondary parkinsonism occurs as a side effect of drugs used to treat Parkinson disease."
a
A client has a central nervous system injury and starts to vomit. Which condition does the nurse suspect is causing the vomiting? a. Injury involving the vestibular nuclei b. Injury resulting in paraplegia of the extremities c. Injury causing a decrease in intracranial pressure d. Injury impinging directly on the floor of the third ventricle
a
An adult client presents with weakness of the facial muscles, impaired articulation of r, n, l, and raspy voice. On physical examination, the pharyngeal reflexes are diminished. Which diagnosis is supported by the assessment data? a. Bulbar palsy b. Tardive dyskinesia c. Tourette syndrome d. Locked-in syndrome
a
Upon assessment, a client is experiencing difficulty in recognizing a pencil. Based on the nurse's observations, the client is exhibiting which condition? a. Agnosia b. Aphasia c. Dystonia d. Dysphasia
a
When assessing intentional tremors, what will the nurse observe when a client has myoclonus? a. Spasm of a muscle b. Loss of facial expressions c. Irregular flapping movement d. Uncoordinated muscle movements
a
Which client is at greatest risk for aspiration? a. A client with bulbar palsy b. A client with hemiparesis c. A client with tardive dyskinesia d. A client with Tourette syndrome
a
Which client would most likely be diagnosed with a noncommunicating hydrocephalus? a. 6 year old b. 19 year old c. 48 year old d. 82 year old
a
Which clinical manifestation should indicate to the nurse that the client is experiencing early intracranial hypertension? a. Confusion b. Bounding pulse c. Small, reactive pupils d. Increased pulse pressure
a
A nurse is caring for a client with Alzheimer disease. Which of these pathophysiologic changes are consistent with Alzheimer disease? . a. Neuritic plaques b. Acetylcholine loss c. Epileptogenic focus d. Excitation of neurons e. Neurofibrillary tangles f. Focal cerebral edema
a, b, e
Which characteristics of Alzheimer disease should the nurse expect to find upon assessment of a client? a. Anxiety and depression b. Rapid onset of symptoms c. Progressively more forgetfulness d. Increased irritability and agitation e. Remissions resulting in cognitive clarity
a, c, d
Which assessment findings will the nurse expect to observe in a client with Parkinson disease? a. Rigidity b. Chorea c. Resting tremors d. Difficulty walking e. Postural abnormalities
a, c, d, e
Which reflexes, if exhibited by the client, would indicate loss of cortical inhibition? a. Grasp b. Corneal c. Sucking d. Swallow e. Palmomental
a, c, e
A client was found at home in the fetal position reporting severe, sudden onset headache. Assessments in the emergency department reveal confusion, disorientation, and one dilated pupil. Which reflex needs to be evaluated initially? a. Agnosia b. Pupillary reaction c. Epileptogenic focus d. Oculovestibular reflex
b
A client who fell 2 days ago had a head injury. Upon assessment the nurse finds the client restless, irritable, and incoherent. Which condition does the nurse suspect the client is experiencing? a. Coma b. Delirium c. Dementia d. Spinal shock
b
A client's arms are flexed at the elbows and held close to the body, and the legs are externally rotated and extended. Which term will the nurse use to document this type of dystonia? a. Dysfunctional postural fixation b. Decorticate posture c. Decerebrate posture d. Basal ganglion posture
b
Which client is most at risk for the sudden development of secondary parkinsonism? a. The client that initiated the use of salt substitutes. b. The client that was prescribed a neuroleptic medication. c. The client that started taking an herbal supplement to treat depression. d. The client that abruptly stopped taking a medication used to treat epilepsy.
b
Which clinical manifestation should the nurse expect to observe in a client diagnosed with hypermimesis? a. Improper use of tools b. Inappropriate laughter c. Difficulty writing a letter d. Inability to express anger
b
Which mechanism causes rigidity in a client with Parkinson disease? a. Lewy body formation b. Excess cholinergic activity c. Lower motor neuron destruction d. Gamma-aminobutyric acid depletion
b
Which mechanism causes uncontrolled, excessive movements in a client with Huntington disease? a. Excessive production of dopamine b. Gamma-aminobutyric acid depletion c. Inadequate availability of catecholamines d. Altered function at the myoneural junction
b
Which statement, made by the client recently diagnosed with Huntington disease, will indicate successful teaching about the condition? a. "My memory will not be affected by this disease." b. "I can expect to have involuntary muscle movements." c. "If the disease is diagnosed early, there is a good chance for a cure." d. "This disease is caused by a virus that destroys certain groups of muscles."
b
Which term will the nurse use to describe a client who sustains a cerebrovascular accident with paralysis on the left side? a. Left paraplegia b. Left hemiplegia c. Right hemiplegia d. Right paraplegia
b
Which term will the nurse use to describe a gait in which the legs are adducted and swing around the body? a. Spastic gait b. Scissor gait c. Cerebellar gait d. Basal ganglion gait
b
Which information should the nurse include when discussing attention deficit hyperactivity disorder (ADHD)? a. Working memory is not affected. b. It is a common childhood disorder. c. Impulsivity is often a characteristic. d. Inability to maintain sustained attention is common. e. The disorder generally goes into remission by adulthood.
b, c, d
A nurse is teaching the staff about the neural systems that are essential to cognitive functioning. Which systems should the nurse include? a. Cardiac systems b. Affective systems c. Memory systems d. Language systems e. Attentional systems
b, c, d, e
A nurse is assessing a client with suspected normal-pressure hydrocephalus. Which findings would be consistent with this diagnosis? a. Delirium b. Incontinence c. Declining memory d. Abrupt occurrence e. Unsteady gait with falling
b, c, e
A client has Wernicke dysphasia. Which type of dysphasia is the client exhibiting? a. Motor b. Sensory c. Broca d. Receptive e. Expressive f. Transcortical
b, d
A nurse is teaching the staff about upper motor neuron syndromes. Which information should the nurse include in the teaching session? a. Bulbar palsy b. Multiple sclerosis c. Myasthenia gravis d. Parkinson disease e. Muscular dystrophy
b, d
A client diagnosed with a cerebellar motor syndrome is likely to demonstrate which clinical finding upon assessment? a. Oral temperature of 96° F b. Respirations of 8 per minute c. Difficulty standing on one foot d. Pathologic laughter or crying
c
A client has a seizure disorder. When the client experiences symptoms such as headache, malaise, and a sense of depression, which term should the nurse use to describe these symptoms? a. Aura b. Postictal c. Prodroma d. Status epilepticus
c
A client has sustained a traumatic brain injury. The client is unable to move muscles except for the eyes and communicates with vertical eye movement and blinking. Which term should the nurse use to describe this condition when giving report to the oncoming shift? a. Deep coma b. Minimally conscious c. Locked-in syndrome d. Persistent vegetative state
c
A client is diagnosed with Parkinson disease. Which clinical manifestation will the nurse expect to observe? a. Paralysis b. Hydrocephalus c. Flexed, forward leaning posture d. Increased intracranial pressure
c
A client is diagnosed with spinal shock. Which assessment findings should the nurse expect to observe? a. Muscle spasms and clonus b. Hyperactive reflexes and hypertonia c. Flaccid paralysis and absent reflexes d. Extreme weakness of the lower extremities
c
A client was found at home in the fetal position reporting a severe, sudden onset headache. Assessments in the emergency department reveal confusion, disorientation, and one dilated pupil. While waiting, the family notices cyclic breathing with increasing then decreasing rates and depths and then short periods of not breathing. Which type of breathing pattern is occurring? a. Cluster breathing b. Ataxic respirations c. Cheyne-Stokes respirations d. Central neurogenic hyperventilation
c
A client's arms and legs are held in rigid extension. Which term will the nurse use to document this position? a. Dystonic posture b. Decorticate posture c. Decerebrate posture d. Basal ganglion posture
c
Assessments of a client in the emergency department reveal confusion, disorientation, and one dilated pupil. A computed tomography (CT) scan of the brain reveals a severe cerebral aneurysm. The client has cyclic respiratory rate and depth changes, hiccups, a full and bounding pulse, and a pulse pressure greater than 80. After the primary healthcare provider talks to the family about the stage and treatment option, which stage and treatment option should the nurse reinforce? a. Early Stage 1 of intracranial hypertension; primary healthcare provider to insert pressure monitor and continue to monitor for increasing pressures b. Early Stage 2 of intracranial hypertension; schedule surgery for the morning and assure family that the surgery is precautionary c. Late Stage 3/Early Stage 4 of intracranial hypertension; beginning decompensation, immediate surgery required d. Very Late Stage 4 of intracranial hypertension; decompensation (herniation), impending death, surgery futile
c
The nurse receives a report from a licensed practical nurse about care provided to clients on a neurologic unit. It is most important for the nurse to follow up on which statement first? a. "The 84-year-old client with Alzheimer disease is depressed and anxious." b. "The 45-year-old client with Huntington disease has writhing movements of both hands." c. "The 72-year-old client with Parkinson disease reports dizziness when standing up." d. "The 15-year-old client with Tourette syndrome is repeating words over and over again."
c
Upon assessment of an adult client with Huntington disease, which findings are typical? a. Pill-rolling tremor and shuffling gait b. Lower limb paralysis and paresthesias c. Chorea in the face and arms and dementia d. Decreased level of consciousness and nausea
c
Which client is exhibiting early clinical manifestations of an acute confusional state? a. A client who has unpleasant dreams and hallucinations b. A client who has progressive decline in memory and orientation c. A client who has an abrupt onset of restlessness and problems concentrating d. A client who has an insidious onset of an inability to perform activities of daily living
c
Which diagnostic will the nurse expect to be performed to evaluate a client for Parkinson disease? a. Muscle biopsy b. Electromyography c. History and physical d. Intracranial pressure measurement
c
Which finding will indicate to the nurse that the client is in the tonic phase of a seizure? a. Aura and prodromal signs b. Cessation of seizure activity c. Excessive muscle contraction d. Alternating muscle contraction and relaxation
c
Which pupillary changes would the nurse expect when caring for a client who experienced a respiratory arrest that lasted 10 minutes? a. Pinpoint b. Sluggish c. Fixed and dilated d. Small and reactive
c
A client has sustained a traumatic brain injury but is able to follow simple commands and can manipulate objects and blink. Which term will the nurse use in report to describe this state? a. Coma b. Vegetative state c. Locked-in syndrome d. Minimally conscious
d
A client has upper motor neuron paralysis. Which term will the nurse use to document this condition? a. Diplegia b. Hemiplegia c. Quadriparesis d. Spastic paralysis
d
A client is diagnosed with Parkinson disease. Which information should the nurse include when teaching the client about the pathophysiology of this medical condition? a. "Excessive amounts of dopamine are produced by structures in the brain." b. "It is a genetic disease; one of your parents passed the mutated gene on to you." c. "Guillain-Barré syndrome usually occurs 3 months before symptoms are noticed." d. "The disease is caused by decreased production of a neurotransmitter in the brain."
d
A nurse is asked to define spinal shock. How should the nurse respond? a. Slow destruction of efferent pathways b. Presence of hyperactive deep tendon reflexes c. Increased spinal reflexes resulting in a hypertensive crisis d. Complete cessation of spinal cord function below the lesion
d
A nurse is caring for clients with various types of dementia. Which assessment finding is consistent for all clients with dementias? a. Seizures b. Abrupt onset c. Receptive dysphasia d. Progressive deterioration
d
Which client has the lowest level of consciousness (LOC)? a. A 49-year-old client who is not oriented to person or place b. A 36-year-old client who falls asleep unless touched by the nurse c. A 52-year-old client who answers questions with a yes or no response d. A 28-year-old client who responds by withdrawing from a painful stimulus
d
Which client is at highest risk for developing dementia and mental status changes? a. A 42-year-old client who has a history of spinal shock b. A 58-year-old client who has upper motor neuron syndrome c. A 65-year-old client who has a history of Guillain-Barré syndrome d. A 74-year-old client who takes several medications to treat Parkinson disease
d
Which clinical manifestation will the nurse expect to observe in a client diagnosed with a severe injury to the brain and brainstem? a. Dyspraxia b. Hypermimesis c. Hemiplegic posture d. Decerebrate posture
d
Which structure is essential for the client to have a state of awakeness? a. Renal system b. Cardiac system c. Memory system d. Reticular activating system
d
