Ch24 Neurologic System
Questions and Answers
- 1.
An elderly client is experiencing an alteration in his equilibrium and coordinated muscle movements. The nurse realizes that these functions are controlled by which area of the nervous system?
- A.
Cerebrum
- B.
Hypothalamus
- C.
Cerebellum
- D.
Brainstem
Correct Answer
C. CerebellumExplanation
The cerebellum is located below the cerebrum and behind the brain stem. It coordinates stimuli from the cerebral cortex to provide precise timing for skeletal muscle coordination and smooth movements. The cerebellum also assists with maintaining equilibrium and muscle tone.
The cerebrum is responsible for all conscious behavior and consists of the frontal, parietal, occipital, and temporal lobes.
The hypothalamus is the autonomic control center and influences blood pressure, heart rate, digestive motility, respirations, regulation of body temperature, water balance, and sleep cycles.
The brainstem controls blood pressure, respiratory rate, swallowing, and coughing.Rate this question:
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- 2.
A client with a head injury is demonstrating dysphagia and dysphasia. Which cranial nerve(s) might be involved with this symptom? Select all that apply.
- A.
Glossopharyngeal (CN IX)
- B.
Vagus (CN X)
- C.
Accessory (CN XI)
- D.
Facial (CN VII)
- E.
Trigeminal (CN V)
Correct Answer(s)
A. Glossopharyngeal (CN IX)
B. Vagus (CN X)Explanation
The glossopharyngeal nerve (CN IX) and the vagus nerve (CN X) are both involved in swallowing and speech. Damage to either of these cranial nerves can result in dysphagia (difficulty swallowing) and dysphasia (difficulty speaking). The glossopharyngeal nerve is responsible for sensory information from the back of the tongue and the pharynx, while the vagus nerve controls the muscles involved in swallowing and speech production. Damage to these nerves can disrupt the coordination and movement necessary for proper swallowing and speech. The other cranial nerves listed (Accessory, Facial, and Trigeminal) are not directly involved in swallowing and speech and would not typically cause these symptoms.Rate this question:
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- 3.
A client has a history of anosmia over the past three months. The nurse knows that this condition is:
- A.
Related to swallowing difficulty
- B.
Associated with ataxia
- C.
Difficulty with tongue movements
- D.
Loss of ability to smell or detect odors
Correct Answer
D. Loss of ability to smell or detect odorsExplanation
Anosmia, the absence of the sense of smell, may be due to cranial nerve dysfunction, colds, rhinitis, or zinc deficiency, or it may be genetic.
Difficulty in swallowing is called dysphagia.
Ataxia is an unsteady gait.
Difficulty with tongue movements may cause problems with swallowing or speech.Rate this question:
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- 4.
The nurse asks a client to stand with feet together and arms at the side with eyes closed. The client immediately starts to sway and moves his feet farther apart. The nurse would document this as a:
- A.
Negative Romberg's sign
- B.
Positive Romberg's sign
- C.
Cerebellar dysfunction
- D.
Vestibular dysfunction
Correct Answer
B. Positive Romberg's signExplanation
A positive Romberg's sign occurs when swaying greatly increases or the client falls when standing with feet together and eyes closed. This test assesses the vestibular apparatus and posterior columns of the spinal cord.
A normal response, Romberg negative, means that the client can stand with feet together and eyes closed with minimal swaying.
Although both the cerebellum and the vestibular apparatus are being assessed with this test, the nurse would not diagnose dysfunction with either structure based on this one finding.Rate this question:
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- 5.
The nurse asks the client to close their eyes, then moves the client's finger up and down. The client identifies the direction of movement. Which of the following is being tested?
- A.
Stereognosis
- B.
Topognosis
- C.
Kinesthesia
- D.
Graphesthesia
Correct Answer
C. KinesthesiaExplanation
Kinesthesia is awareness of position and sense of joint movement. The client should be able to identify the direction of movement with their eyes closed.
Stereognosis is the ability to identify an object placed in the hand with eyes closed.
Graphesthesia is the ability to perceive writing on the skin.
Topognosis is the ability of the client to identify an area of the body that has been touched.Rate this question:
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- 6.
During the neurologic assessment of a client the nurse would like to include questions to assess the client's ability to make health care decisions. Which tool can the nurse use to do this assessment?
- A.
Hopkins Competency Assessment
- B.
General Health Questionnaire
- C.
Mini-mental State Examination
- D.
Cornell Scale for Depression in Dementia
Correct Answer
A. Hopkins Competency AssessmentExplanation
The Hopkins Competency Assessment assesses a person's ability to make decisions about health care.
The General Health Questionnaire provides assessment of emotional disturbance in those with normal cognitive ability.
The Mini-mental State Examination (MMSE) assesses cognitive status and is conducted during the client interview.
Behavioral problems are assessed using the Cornell Scale for Depression in Dementia.Rate this question:
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- 7.
During the neurologic assessment, the nurse finds that a client is unable to calculate mathematical problems; however, the remainder of the assessment is normal. Which of the following does this finding suggest to the nurse?
- A.
The client may have an altered cognitive status.
- B.
The client could be depressed.
- C.
The client may have dementia.
- D.
The client may be nervous.
Correct Answer
D. The client may be nervous.Explanation
An inability to calculate simple problems may indicate the presence of organic brain disease, or it may simply indicate lack of exposure to mathematical concepts, nervousness, or an incomplete understanding of the examiner's language. In an otherwise unremarkable assessment, a poor response to calculations should not be considered an abnormal finding.
An inability to perform calculations may indicate altered cognitive status; however, the remainder of the assessment was normal.
Depression can have an effect on a client's ability to perform calculations; however, the remainder of the assessment was normal.
A client with dementia may exhibit difficulty in performing calculations; however, the remainder of the assessment was normal.Rate this question:
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- 8.
A client has a flattened nasolabial fold and drooping of the mouth on the left side. Which of the following cranial nerves is most likely to be involved?
- A.
Cranial nerve V (Trigeminal)
- B.
Cranial nerve VII (Facial)
- C.
Cranial nerve XII (Hypoglossal)
- D.
Cranial nerve XI (Accessory)
Correct Answer
B. Cranial nerve VII (Facial)Explanation
Cranial nerve VII (Facial) is responsible for symmetry of facial expressions such as smiling, frowning, and puffing of the cheeks.
Cranial nerve V (Trigeminal) is responsible for facial sensation and temporal and masseter muscle strength.
Cranial nerve XII (Hypoglossal) is responsible for movements of the tongue and protrusion of the tongue in the midline.
Cranial nerve XI (Accessory) is responsible for sternocleidomastoid and trapezius muscle strength.Rate this question:
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- 9.
During the assessment of sensory function of a client, the nurse learns that the client has decreased pain sensation. Which of the following should the nurse document about this finding?
- A.
Anesthesia
- B.
Analgesia
- C.
Hypalgesia
- D.
Hypoesthesia
Correct Answer
C. HypalgesiaExplanation
Hypalgesia is the term used for decreased pain sensation.
Analgesia is the absence of pain sensation.
Anesthesia is the inability to perceive the sense of touch.
Hypoesthesia is decreased, but not absent touch sensation.Rate this question:
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- 10.
The nurse is performing an assessment on a 40-year-old client and is unable to elicit a patellar reflex. Which of the following is the most appropriate initial action?
- A.
Utilize reinforcement techniques that enhance the reflex.
- B.
Complete the remainder of the assessment, then reassess the reflexes.
- C.
Consider this a normal finding for a client of this age.
Correct Answer
A. Utilize reinforcement techniques that enhance the reflex.Explanation
Before concluding that a reflex is absent or diminished, repeat the test. Encourage the client to relax. Asking the client to perform an isometric activity of a distant muscle group, which is called reinforcement, helps relax the muscle and enhance the reflex. Before documenting a 0/0-4 (absent) reflex, the nurse needs to reassess the reflex.
The nurse should reassess the reflex utilizing reinforcement techniques, not continue with the assessment and save the reflexes until the end.
The patellar reflex should be present in all age groups; however, it may be weaker in the elderly.Rate this question:
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- 11.
During an assessment of an adult client's plantar reflex, the nurse notes a normal response. Which of the following would be considered normal for this client?
- A.
Babinski response
- B.
Dorsiflexion of the foot
- C.
Plantar flexion of the foot
- D.
Fanning of the toes
Correct Answer
C. Plantar flexion of the footExplanation
When assessing the plantar reflex, observe for plantar flexion where the toes curl toward the sole of the foot.
The Babinski response is dorsiflexion of the great toe and fanning of the other toes when eliciting the plantar reflex. The Babinski response is considered abnormal in an adult and may indicate upper motor neuron disease. A positive Babinski response is considered a normal response in a child until about 2 years of age.
Dorsiflexion of the foot is not a normal plantar reflex response.
Fanning of the toes occurs with a positive Babinski.Rate this question:
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- 12.
Near the conclusion of the neurologic examination, the nurse notices a rapid muscle contraction of the client's left quadriceps muscle. Which of the following could describe this assessment finding?
- A.
This is a fasciculation.
- B.
This is a tic.
- C.
This is a tremor.
- D.
This is myoclonus.
Correct Answer
A. This is a fasciculation.Explanation
A fasciculation, or twitch, is an involuntary local visible muscular contraction that is not significant when it occurs with tired muscles. It can also be associated with motor neuron disease.
A tic, commonly called a habit, is usually psychogenic in nature. Tics are usually seen in the face, neck, or shoulders and increase during times of stress.
Tremors are rhythmic or alternating involuntary movements caused by the contraction of opposing muscle groups.
Myoclonus is a continual, rapid, short spasm involving a muscle, a part of a muscle, or even a group of muscles. Myoclonus frequently occurs in an extremity as the individual is falling asleep.Rate this question:
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- 13.
A client, seen previously for herpes zoster, comes into the clinic with ongoing neurologic changes, pain, and sensory/motor function changes. The nurse realizes that this client might be experiencing:
- A.
Myasthenia gravis
- B.
Lyme disease
- C.
Meningitis
- D.
Myelitis
Correct Answer
D. MyelitisExplanation
Myelitis is an inflammation of the spinal cord. Herpes zoster infection is a common cause.
Myasthenia gravis is a chronic neuromuscular disorder involving increasing weakness of voluntary muscles with activity, and some abatement of symptoms with rest.
Lyme disease is an infection caused by a bite from an infected deer tick. Major symptoms include arthritis, a flulike syndrome and a rash.
Meningitis is caused by a virus or bacteria that infects the meninges of the brain or spinal cord. Headache, fever, and altered levels of consciousness can occur.Rate this question:
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- 14.
The nurse is developing a community program to help prevent deaths from stroke. According to Healthy People 2020, which of the following actions should the nurse include in the program to prevent deaths from stroke? Select all that apply.
- A.
Education related to prevention
- B.
Education of the public about emergency response to symptoms
- C.
Screening for hypertension
- D.
Counseling about maintaining prescribed treatment for hypertension
- E.
Stroke treatment programs
Correct Answer(s)
A. Education related to prevention
B. Education of the public about emergency response to symptoms
C. Screening for hypertension
D. Counseling about maintaining prescribed treatment for hypertensionExplanation
Education related to prevention - Recommended to reduce stroke deaths.
Education of the public about emergency response to symptoms - Recommended to reduce stroke deaths.
Screening for hypertension - Recommended to reduce stroke deaths.
Counseling about maintaining prescribed treatment for hypertension - Recommended to reduce stroke deaths.
Stroke treatment programs - Not identified as an action to reduce stroke deaths.Rate this question:
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- 15.
During the interview, the nurse notes several problems that Mr. Phelps has experienced, leading to Parkinson’s syndrome, that have affected his musculoskeletal system. Which of the following nursing diagnoses would be the most important when the client complains of shuffling gait, falls easily, and has poor posture with forward flexion?
- A.
Pain, chronic related to disease process
- B.
Falls, risk for
- C.
Skin integrity, impaired
- D.
Mobility, wheelchair impaired
Correct Answer
B. Falls, risk forExplanation
Pain is an important nursing diagnosis, but based on the information presented (shuffling gait, falls easily, and poor posture with forward flexion) , this is not a priority nursing diagnosis.Rate this question:
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- 16.
When the nurse is interviewing the client, she knows that Parkinson’s disease affects:
- A.
8–15% of adults over 65 years of age
- B.
15–21% of adults over 65 years of age
- C.
5–25% of adults over 55 years of age
- D.
9–17% of adults over 55 years of age
Correct Answer
A. 8–15% of adults over 65 years of ageExplanation
Based on Healthy People 2010, Parkinson’s disease occurs in 8–15% of adults over 65 years of age.Rate this question:
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- 17.
When the nurse is explaining Parkinson’s disease with the client, she explains that Parkinson’s disease is a chronic disease with increasing weakness of voluntary muscles with activity and some abatement of symptoms
- A.
True
- B.
False
Correct Answer
B. FalseExplanation
Parkinson’s disease is a degeneration of the basal nuclei of the brain, which are collections of nerve cells deep within the white matter of the cerebrum. These nuclei are responsible for initiating and stopping voluntary movement. Myasthenia gravis is a chronic neuromuscular disorder involving weakness of the voluntary muscles with activity.Rate this question:
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- 18.
When the nurse is educating Mr. Phelps, she should include information regarding the use of safety equipment, including seat belts, because older adults have decreased reaction time, resulting in accident and injury.
- A.
True
- B.
False
Correct Answer
A. TrueExplanation
Based on Healthy People 2010, older adults have decreased reaction time, resulting in accident and injury; therefore, the nurse should stress safety, including use of seat belts while traveling in a car or driving, and the use of safety devices in the home and at work.Rate this question:
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- 19.
Because Mr. Phelps has difficulty with his gait, the nurse should encourage using throw rugs around the house to help cover electrical cords and extension cords to prevent injury.
- A.
True
- B.
False
Correct Answer
B. FalseExplanation
The nurse should explain to the client that the risk of injury from falls can be reduced in the home by removing throw rugs and installing handrails and grab bars.Rate this question:
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