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NR 509 APEA Neurology (updated) – Chamberlain College of Nursing | NR 509 APEA Neurology (updated) – Answers and Explanations| Already Graded A

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NR 509 APEA Neurology Question 1: Sudden, brief, rapid jerks, involving the trunk or limbs may be consistent with: a myoclonic seizure. Correct an absent seizure. a myoclonic atonic seizure. ... a focal seizure with impairment of consciousness. Explanation: A patient experiencing a myoclonic seizure manifests sudden, brief, rapid jerks, involving the trunk or limbs. A sudden brief lapse of consciousness with momentary blinking, staring, or movements of the lips and hands but no falling is consistent with an absent seizure. During a myoclonic atonic seizure, the patient experiences a sudden loss of consciousness with falling but no movements. Injury may occur. Focal seizures with impairment of consciousness the person appears confused. Automatisms include automatic motor behaviors such as chewing, smacking the lips, walking about, and unbuttoning clothes. Question 2: Which of the following neurological assessment findings indicate the need for further evaluation? Lifting one foot and then the other when the infant is held upright with the feet touching a solid surface Fanning and hyperextension of the toes when the sole is stroked upward from the heel Grasping a finger placed in the neonate's palm Weak and ineffective sucking movements Correct Explanation: Weak and ineffective sucking movements would indicate the need for further evaluation since any weak, absent, asymmetrical or fine jumping movements would suggest neurological system disorders. The other choices represent common reflexes found in the normal newborn: Babinski, grasping, and stepping. Question 3: An example of proximal weakness is: the right shoulder. Correct the right hand. both arms. Incorrect on the right side of the face. Explanation: There are 4 different patterns of weakness: Proximal, distal, symmetric, and asymmetric. An example of proximal weakness is weakness in the shoulder or hip girdle. Distal weakness occurs in the hands or feet. Symmetric weakness occurs in the same areas on both sides of the body. An asymmetric weakness occurs in a portion of the face or extremity - a form of focal weakness. Question: A female patient complains of weakness in her hand when opening a jar. This finding could be suggestive of which type of weakness pattern? ProximalDistal CorrectSymmetricAsymmetric Explanation: To identify distal weakness, ask about hand movements when opening a jar, can or using scissors or a screwdriver. Another example is a problems like tripping when walking. Question: A patient presents with an altered level of consciousness. He/she is considered in a stuporous state if he/she: appears drowsy but opens the eyes, looks at the examiners, answers the questions, and then falls asleep.arouses from sleep after exposure to painful stimuli, exhibits slow verbal responses, and easily lapses into an unresponsive state. Correctremains unarousable with eyes closed. There is no evident response to inner need or external stimuli.opens the eyes and looks at the examiner, but responds slowly and is somewhat confused. Explanation: A stuporous patient arouses from sleep after exposure to painful stimuli, verbal responses are slow, and lapses into an unresponsive state. A lethargic patient appears drowsy but opens the eyes, looks at the examiners, answers the questions, and then falls asleep. An obtunded patient opens the eyes and looks at the examiner, but responds slowly and is somewhat confused. A comatose patient remains unarousable with eyes closed. There is no evident response to inner need or external stimuli. Question: One way to assess cerebellar function would be to have the patient: hop on one foot. Correctread out loud. Incorrectshrug the shoulders.discriminate between light and sharp pain. Explanation: The cerebellar function tests are used to monitor the patient's sense of equilibrium, which includes the patient's gait (walk), ability to stand upright with eyes closed (Romberg test), touch finger to nose, and move the heel to opposite knee while lying down. Other examples also include: hopping on one foot, walking heel-to-toe, and touching the examiner's finger and the examinees' nose. Reading out loud tests visual acuity; shrugging shoulders assesses the spinal accessory nerve and discriminating pain between light and sharp assesses the sensory system. Question: Hypesthesia refers to: absence of touch sensation.decreased sensitivity to touch. Correctincreased sensitivity to touch. Incorrectabsence of pain sensation. Explanation: Anesthesia is absence of touch sensation; hypesthesia is decreased sensitivity to touch; hyperesthesia is increased sensitivity to touch; and analgesia refers to absence of pain sensation. Question: When conducting a neurologic exam, which one of the following assessments is not considered part of the mental status assessment? Level of alertnessCranial Nerve II (CNII) CorrectAppropriateness of responsesOrientation to time Explanation: When conducting a neurologic exam, mental status assessment should include evaluation of the level of alertness, appropriateness of responses, and orientation to person, place, and time. Assessing cranial nerve II would be part of the cranial nerve assessment. Question: A mother reports to the nurse practitioner that her teenager might be taking drugs because earlier today the teenager had a mild seizure and now has an unstable gait and is beginning to complain of shortness of breath. These symptoms might be consistent with a possible overdose of: barbiturates.amphetamines. Correctmarijuana.opioids. Explanation: Amphetamines are central nervous system (CNS) stimulants. The teenager could exhibit signs of ataxia, respiratory distress, seizures, coma, myocardial infarction, death if he/she consumed this substance. Impaired memory, judgment, and attention, slurred speech, drowsiness, and irritability are suggestive of central nervous system depressants (CNS). Barbiturates, alcohol and benzodiazepines fall in this class. Opioids may cause euphoria, drowsiness, constricted pupils and some of the same symptoms as CNS depressants. Marijuana intoxication would present with relaxation, euphoria, detachment, talkativeness, slowed perception of time, and possible anxiety or paranoia. Question: An ischemic stroke is: a transient episode of neurologic dysfunction by focal brain, spinal cord, or retinal ischemia, without acute infarction. Incorrectan infarction of the central nervous system tissue that may be silent or symptomatic. Correctthe abrupt onset of motor or sensory deficits.focal or asymmetric weaknesses caused by central and peripheral nerve damage. Explanation: Ischemic stroke is “an infarction of central nervous system tissue” that may be symptomatic or silent. TIA is now defined as “a transient episode of neurological dysfunction caused by focal brain, spinal cord, or retinal ischemia, without acute infarction.” The other terms are not related to the new definitions. Question: By placing the patient in the supine position, the nurse practitioner raises the patient's relaxed and straightened leg while flexing the leg at the hip, then dorsiflexes the foot. This maneuver is known as: Kernig's sign.the straight-leg raise. Correctthe plantar response.the ankle reflex. Explanation: By placing the patient in the supine position, the nurse practitioner raises the patient's relaxed and straightened leg while flexing the leg at the hip, then dorsiflexes the foot. This maneuver is known as the straight leg raise and is used to evaluate sciatica. It is positive if there is pain down the back of the leg below the knee. Ipsilateral calf wasting and weak ankle dorsiflexion may be present. Question: The level of consciousness that refers to the patient that appears drowsy but can open his eyes, respond to questions, then fall back to sleep is known as: obtundation.alertness.lethargy. Correctstupor. Explanation: Lethargy refers to the patient that appears drowsy but can open his eyes, respond to questions, then fall back to sleep. An obtunded patient opens his eyes, looks at the person speaking to him but responds slowly and appears confused. The level of consciousness that refers to the ability of the patient to respond fully and appropriately to stimuli is known as alertness. A stuporous patient arouses from sleep only after painful stimuli. Question: When assessing coordination of muscle movement, four areas of the nervous system function in an integrated way. These areas include the motor, cerebellar, the vestibular, and the sensory systems. Which system coordinates a steady posture? Motor systemCerebellar system CorrectVestibular systemSensory system Explanation: Coordination of muscle movement requires that four areas of the nervous system function in an integrated way: motor system for muscle strength, cerebellar system for rhythmic movements and steady posture, vestibular system for balance and coordinating eye, head, and body movements, and sensory system for position sense. Question: An older adult presenting with signs of undernourishment, slowed motor performance, and loss of muscle mass or weakness suggests: depression.frailty. CorrectParkinson's disease.Alzheimer's disease. Explanation: Undernutrition, slowed motor performance, loss of muscle mass, or weakness suggests frailty. Question: Postural tremors appear when the affected part is: at rest.moving voluntarily. Incorrectis actively maintaining a posture. Correctgetting closer to its target. Explanation: Tremors are rhythmic oscillatory movements. Postural tremors appear when the affected part is actively maintaining a posture. Examples include the fine rapid tremor of hyperthyroidism, the tremors of anxiety and fatigue, and benign essential tremor. The other choices are not consistent with postural tremors. Question: A discriminative sensation that describes the ability to identify an object by feeling it is: graphesthesia.stereognosis. Correcttwo point discrimination.astereognosis. Incorrect Explanation: A discriminative sensation that describes the ability to identify an object by feeling it is stereognosis. The patients eyes must be closed. Graphesthesia, or number identification, is the ability to identify a number when drawn in the hand of a patient whose eyes are closed. The ability to identify an object touching 2 areas simultaneously is termed two-point discrimination. Astereognosis is a term used to describe the inability to recognize objects placed in the hand. Question: When evaluating a patient for weakness of the upper extremities, bilateral distal weakness is noted. This finding could be suggestive of: alcohol myopathy.polyneuropathy. Correctmyositis.neuromuscular junction disorders. Incorrect Explanation: Bilateral predominantly distal weakness suggests a polyneuropathy, as in diabetes. Proximal limb weakness, usually symmetric and without sensory loss, occurs in myopathies from alcohol, glucocorticoids, and inflammatory muscle disorders like myositis and dermatomyositis. In the neuromuscular junction disorder myasthenia gravis, there is proximal, typically asymmetric weakness that gets worse with effort. Question: When observing for thenar atrophy of the hands, a typical observation is: furrowing in the spaces between the metacarpals. Correctthenar eminences appear full.the hypothenar eminences would appear convex.the spaces between the metacarpals would be slightly depressed. Explanation: Flattening of the thenar and hypothenar eminences and furrowing between the metacarpals suggests atrophy. Localized atrophy of the thenar and hypothenar eminences suggests damage to the median and ulnar nerves. Normally, the metacarpal spaces are full and slightly depressed and the thenar and hypothenar appear full and convex. Motor neuron disease, rheumatoid arthritis, and protein-calorie malnutrition can cause atrophy in the hand. Question: Fasciculations in atrophic muscles suggest: a lower motor neuron disease. Correctrheumatoid arthritis. Incorrectperipheral nervous system disease.a central nervous system disorder. Explanation: Fasciculations are small muscle twitches and can be found in any muscle of the body. Fasciculations are not usually serious but can be annoying. If they occur in atrophic muscles, this may suggest a lower motor neuron disease. They are not seen in central or peripheral nervous system disease or rheumatoid arthritis. Question: The part of the brain that controls most functions in the body and is responsible for breathing, heart rate, and articulate speech is the: cerebrum.brainstem. Correctcerebellum.diencephalon. Explanation: The nerve connections of the motor and sensory systems from the main part of the brain to the rest of the body pass through the brainstem. The brainstem controls most functions in the body but mostly responsible for breathing, heart rate, and articulate speech. The cerebrum controls all voluntary actions of the body with the aid of the cerebellum. The diencephalon relays sensory information between brain regions and controls many autonomic functions of the peripheral nervous system. It also connects structures of the endocrine system with the nervous system and works in conjunction with limbic system structures to generate and manage emotions and memories. The cerebellum, which lies at the base of the brain, coordinates all movement and helps maintain the body upright in space. Question: Assessing the neurological status of a child with a ventriculoperitoneal shunt should include: use of the Glasgow coma scale. CorrectKernig's sign.brudzinski's sign.Monroe-Kellie doctrine. Incorrect Explanation: The Glasgow coma scale addresses eye, verbal, and motor responses to determine a neurological assessment score and is the first sign of improvement or deterioration in neurological status. Also, signs of increased intracranial pressure should be assessed. Kernig's sign is any resistance or pain when the child is supine and the leg is extended and knee bent. A positive sign is more consistent with meningitis. Brudzinski's sign is an involuntary flexion of the knee or hip when the child is in the supine position and the neck is flexed and is also consistent with meningitis. The Monroe-Kellie Doctrine states that the sum of brain, CSF, and blood within the cranial vault is constant. So an increase or decrease in one causes a compensatory increase or decrease in one or both of the others. It is an hypothesis and not an assessment. Question: What geriatric condition is characterized by normal alertness but progressive global deterioration of cognition in multiple domains? DeliriumCognitive impairmentParkinson's diseaseAlzheimer's disease Correct Explanation: Alzheimer's disease is a geriatric condition in which normal alertness is present but progressive global deterioration of cognition occurs in multiple domains, including short-term memory, but with sparing of memory for remote events, subtle language errors, visuospatial perceptual difficulties, and changes in executive function, or the ability to perform sequential tasks such as instrumental activities of daily living (IADLs). Delirium is a serious disturbance in a person's mental abilities that results in a decreased awareness of one's environment and confused thinking. Cognitive impairment is an intermediate stage between the expected cognitive decline of normal aging and the more serious decline of dementia. Parkinson's disease is a progressive disorder of the nervous system that affects movement. Question: An abnormal or unpleasant sense of touch is termed: dysarthria.dysesthesia. Correctmetatarsalgia.paresthesia. Explanation: An abnormal or unpleasant sense of touch is termed dysesthesia. Dysarthria is the term used to describe difficulty forming words. Paresthesia is a sensation of tingling, tickling, prickling, pricking, or burning of a person's skin. Metatarsalgia is a term used to describe pain and tenderness in the metatarsals. Question: When eliciting deep tendon reflexes in the knee, the nurse practitioner notes an abnormal reflex in the right knee. This abnormality is probably consistent with a pathological lesion in which segmented level of the spine? Cervical 5 and 6Cervical 6 and 7 Lumbar 2, 3, and 4 CorrectSacral 1 Explanation: The segmented levels of the deep tendon reflexes are: Ankle: sacral 1; knee: lumbar 2,3, & 4; Supinator and biceps: cervical 5 & 6; and triceps: cervical 6 & 7. Question: When evaluating a patient for weakness of the upper extremities, bilateral proximal limb weakness without sensory loss is noted. This finding could be suggestive of: alcohol myopathy. Correctpolyneuropathy.myositis.neuromuscular junction disorders. Explanation: Proximal limb weakness, usually symmetric and without sensory loss, occurs in myopathies from alcohol, glucocorticoids, and inflammatory muscle disorders like myositis and dermatomyositis. Bilateral predominantly distal weakness suggests a polyneuropathy, as in diabetes. In the neuromuscular junction disorder myasthenia gravis, there is proximal, typically asymmetric weakness that gets worse with effort. Question: The term used to describe involuntary muscle spasms and twisting of the limbs is: dystonia. Correctbradykinesia.akinesia.dyskinesia. Explanation: Dystonia is a neurological disorder that causes involuntary muscle spasms and twisting of the limbs. Bradykinesia is the term used to describe the impaired ability to adjust to one's body position. This symptom is noted in patients who have Parkinson's disease. The absence or loss of control of voluntary muscle movements is akinesia. Dyskinesia is defined as the presence of involuntary muscle movements such as tics or chorea. These movements can be seen in children who have rheumatic fever. Question: A 40-year-old male presents with complaints of headaches. History reveals headaches that occurred daily for about 4-6 weeks. He had relief for 6 months but now they are recurring. These are most likely: tension headaches.cluster headaches. Correctmigraine headaches.sinus headaches. Explanation: Headaches that are episodic with several each day for 4-6 weeks with an extended period of relief for 6-12 months are most likely cluster headaches. Cluster headaches are more common in men than women. Question: Which of the following symptoms may be associated with a tumor of the eighth cranial nerve? Dizziness CorrectInability to close the eyesLoss of the sense of smellInability to taste sour things Explanation: The eighth cranial nerve (CN) is the vestibulocochlear nerve and it is responsible for hearing and balance. The main symptoms of an acoustic neuroma are hearing loss and tinnitus. They are caused by a tumor affecting the auditory nerve. Inability to close the eye would reflect an abnormality of CN VII, the facial nerve. CN I, the olfactory nerve, is responsible for the sense of smell. Two cranial nerves are responsible for the taste, CN VII and X. Question: When trying to determine the level of consciousness in a patient whose level of consciousness is altered, a comatose patient: opens the eyes and looks at the examiner, responds slowly, and is somewhat confused.appears drowsy but opens the eyes, looks at the examiners, answers the questions, and then falls asleep.arouses from sleep after exposure to painful stimuli, exhibits slow verbal response, and easily lapses into an unresponsive state.remains unarousable with eyes closed. Correct Explanation: A comatose patient remains unarousable with eyes closed. There is no evident response to inner need or external stimuli. A lethargic patient appears drowsy but opens the eyes, looks at the examiners, answers the questions, and then falls asleep. An obtunded patient opens the eyes and looks at the examiner, but responds slowly and is somewhat confused. A stuporous patient arouses from sleep after exposure to painful stimuli, verbal responses are slow, and lapses into an unresponsive state. Question: A female patient complaints of weakness in both arms when transferring the wet clothes from the washer and placing them in the dryer. This finding could be suggestive of which type of weakness pattern? ProximalDistalSymmetric CorrectAsymmetric Explanation: To identify symmetric weakness, ask about experiencing weakness in the same area on both sides of the body. Question: Which developmental area is predominantly affected by lead poisoning? NutritionCommunicationCognition CorrectMobility Explanation: Lead is a naturally-occurring element that can be harmful to humans when ingested or inhaled, particularly to children under the age of 6 years. Lead poisoning can cause a number of adverse human health effects, but is particularly detrimental to the neurological development of children. Question: A form of aphasia in which the person has word-finding difficulties for speaking and writing is known as: Broca's aphasia.anomic aphasia. CorrectWernicke's aphasia.global aphasia. Explanation: With anomic aphasia, the person has word-finding difficulties and because of the difficulties, the person struggles to find the right words for speaking and writing. In Broca's aphasia, speech is confluent, slow, with few words and laborious effort. Inflection and articulation are impaired but words are meaningful, with nouns, transitive verbs, and important adjectives. Small grammatical words are often dropped. With Wernicke's aphasia, speech is fluent, often rapid, voluble, and effortless. Inflection and articulation are good, but sentences lack meaning and words are malformed (paraphasias) or invented (neologisms). Speech may be totally incomprehensible. With global aphasia, the person has difficulty speaking and understanding words and is unable to read or write. Question: A patient presents with an altered level of consciousness. He/she is considered in an obtunded state if he/she: arouses from sleep after exposure to painful stimuli, exhibits slow verbal responses, and easily lapses into an unresponsive state.appears drowsy but opens eyes, looks at the examiners, answers the questions, and then falls asleep.remains unarousable with eyes closed. There is no evident response to inner need or external stimuli.opens the eyes and looks at the examiner, but responds slowly and is somewhat confused. Correct Explanation: An obtunded patient opens the eyes and looks at the examiner, but responds slowly and is somewhat confused. A lethargic patient appears drowsy but opens the eyes, looks at the examiners, answers the questions, and then falls asleep. A stuporous patient arouses from sleep after exposure to painful stimuli, verbal responses are slow, and lapses into an unresponsive state. A comatose patient remains unarousable with eyes closed. There is no evident response to inner need or external stimuli. Question: With the patient lying supine, the nurse practitioner places her hands behind the patient's head while flexing his neck forward until his chin touches his chest. Neck stiffness with resistance to flexion is noted. This is a positive: Brudzinski's sign. IncorrectKernig's sign.nuchal rigidity sign. CorrectBabinski's sign. Explanation: With the patient lying supine, the nurse practitioner places her hands behind the patient's head while flexing his neck forward until his chin touches his chest. Neck stiffness with resistance to flexion is positive for nuchal rigidity and suggestive of meningeal inflammation from meningitis or subarachnoid hemorrhage. To elicit Brudzinski's sign, flex the neck. Flexion of both the hips and knees is a positive for Brudzinski's sign. To test for Kernig's sign, flex the patient's leg at both the hip and the knee and then straighten the knee. Pain and increased resistance to extending the knee are positive for Kernig's sign. To elicit the Babinski response, stroke the lateral aspect of the sole from the heel to the ball of the foot with the end of an applicator stick, plantar flexion is normal. Dorsiflexion of the big toe is a positive Babinski's sign. Question: Which of the following procedures should NOT be performed in a comatose patient? Check corneal responseCheck pupillary responseDilate the pupils CorrectInspect the posterior pharynx Explanation: When assessing a comatose patient, the nurse practitioner should not dilate the eyes because pupillary reaction is the single most important clue to the underlying cause of the coma: structural or metabolic. The other procedures can be performed on a comatose patient. Question: The term used to describe a distortion of any sense, especially that of touch, is: absence of sensation.weakness.dysesthesia. Correctparesthesia. Explanation: Dysesthesia is defined as a distortion of any sense, especially that of touch. Absence of sensation is the inability to feel pain or sensation when touched. Weakness is a term used to describe a lack of strength or firmness and its presence requires further investigation. Paresthesia is a sensation of tingling, tickling, prickling, pricking, or burning of a person's skin. Question: Winging of the scapula can be noted in patients with all of the following conditions except: liver disease. Correctinjury to the long thoracic nerve.muscular dystrophy.weakness of the serratus anterior muscle. Explanation: Normally, the scapulae lie close to the thorax. However, in winging of the scapula the medial border of the scapula juts backward. It suggests weakness of the serratus anterior muscle, seen in muscular dystrophy or injury to the long thoracic nerve. Winging is not characteristic of liver disease. Question: Resting tremors refer to those tremors that disappear: at rest.with voluntary movement. Correctwhen the affected part is actively maintaining a posture.when the target gets closer. Explanation: Tremors are rhythmic oscillatory movements. Resting tremors are most prominent at rest and may decrease or disappear with voluntary movement. These type tremors are characteristic of the patient with Parkinson's disease. The other choices are not consistent with resting tremors. Question: A patient is instructed to stand, close both eyes, and extend both arms forward with the palms facing upward for 20-30 seconds. If the forearm drifts downward, this would indicate: a normal finding.lower motor neuron disease.corticospinal tract lesion . Correctcerebellum lesion. Explanation: A patient is instructed to stand, close both eyes, and extend both arms forward with the palms facing upward for 20-30 seconds. If the forearm drifts downward, this would indicate a corticospinal lesion originating in the contralateral hemisphere. An upward drift would be indicative of a lesion in the cerebellum. This test is called the Test for Pronator Drift and is used to test for upper motor neuron disease. Question: A progressive disorder of the nervous system that affects movement is known as: delirium.functional impairment.Parkinson's disease. CorrectAlzheimer's disease. Explanation: Parkinson's disease is a progressive disorder of the nervous system that affects movement. Delirium is a serious disturbance in a person's mental abilities that results in a decreased awareness of one's environment and confused thinking. Cognitive impairment is an intermediate stage between the expected cognitive decline of normal aging and the more serious decline of dementia. Alzheimer's disease is a geriatric condition in which normal alertness is present but progressive global deterioration of cognition occurs in multiple domains, including short-term memory, but with sparing of memory for remote events, subtle language errors, visuospatial perceptual difficulties, and changes in executive function, or the ability to perform sequential tasks such as instrumental activities of daily living (IADLs). Question: While assessing the trigeminal nerve V (CN V) for sensory function, the patient reports a pain sensation on the right cheek. This finding could be consistent with a: bilateral hemispheric disease. central nervous system lesions.cranial nerve disorder. Correctbrainstem lesion. Incorrect Explanation: While assessing the trigeminal nerve, cranial nerve V (CN V) for sensory function, the patient reports a pain sensation on the right cheek. This finding could be consistent with a cranial nerve disorder, such as trigeminal neuralgia. Question: When assessing the cranial nerves, the nurse practitioner uses the tongue blade to gently stimulate the back of the throat on each side. A unilateral absence of the gag reflex is noted. This finding could be suggestive of a unilateral lesion in which cranial nerve? Cranial Nerve V (CN V)Cranial Nerve VII (CN VII)Cranial Nerve IX (CN IX) CorrectCranial Nerve XII (CN XII) Explanation: Unilateral absence of the gag reflex suggests a lesion of CN IX or CN X. glossopharyngeal and vagus nerves. Question: On examination of the adult patient, symptoms of flexed posture, tremor, rigidity, and shuffling gait are observed. These findings are consistent with: drug induced reaction.functional impairment.Parkinson's disease. Correctdepression. Explanation: Evidence of flexed posture, tremor, rigidity, bradykinesia, micrographia, shuffling gait, and difficulty rising from a chair are symptoms consistent with Parkinson's disease. Question: Brief, repetitive, stereotyped, coordinated movements occurring at irregular intervals are consistent with: facial tics. Correctdystonic movements.athetoid movements.oral-facial dyskinesias. Explanation: Facial tics are brief, repetitive, stereotyped, coordinated movements occurring at irregular intervals. Examples include repetitive winking, grimacing, and shoulder shrugging. Dystonic movements are similar to athetoid movements, but often involve larger portions of the body, including the trunk. Grotesque, twisted postures may result. Athetoid movements are slower and more twisting and writhing than choreiform movements, and have a larger amplitude. They most commonly involve the face and the distal extremities. Oral–facial dyskinesias are rhythmic, repetitive, bizarre movements that chiefly involve the face, mouth, jaw, and tongue: grimacing, pursing of the lips, protrusions of the tongue, opening and closing of the mouth, and deviations of the jaw. These are involuntary movements. Question: A sudden brief lapse of consciousness with momentary blinking, staring, or movements of the lips and hands but no falling is consistent with: a myoclonic seizure.an absent seizure. Correcta myoclonic atonic seizure.a focal seizure with impairment of consciousness. Explanation: A sudden brief lapse of consciousness, with momentary blinking, staring, or movements of the lips and hands but no falling is consistent with an absent seizure. A patient experiencing a myoclonic seizure manifests sudden, brief, rapid jerks, involving the trunk or limbs. During a myoclonic atonic seizure, the patient experiences a sudden loss of consciousness with falling but no movements. Injury may occur. Focal seizures with impairment of consciousness the person appears confused. Automatisms include automatic motor behaviors such as chewing, smacking the lips, walking about, and unbuttoning clothes. Question: Physical exam of a well two-week-old infant reveals a little dimple with a small amount of hair just above the sacral area. This could be: an unusual finding but within normal limits.hirsutism.Arnold -Chiari malformation. spina bifida occulta. Correct Explanation: There are four types of spina bifida: occulta, closed neural tube defects, meningocele, and myelomeningocele. Occulta is the mildest and most common form in which one or more vertebrae are malformed. The name “occulta,” which means “hidden,” indicates that a layer of skin covers the malformation, or opening in the vertebrae. This form of spina bifida, present in 10-20 percent of the general population, rarely causes disability or symptoms. Closed neural tube defects are often recognized early in life due to an abnormal tuft or clump of hair or a small dimple or birthmark on the skin at the site of the spinal malformation. Meningocele and myelomeningocele generally involve a fluid-filled sac—visible on the back—protruding from the spinal canal. In meningocele, the sac may be covered by a thin layer of skin. In most cases of myelomeningocele, there is no layer of skin covering the sac and an area of abnormally developed spinal cord tissue is usually exposed. Hirsutism is an excessive amount of hair on the body usually caused by a hormonal imbalance. An Arnold-Chiari malformation is a cyst-like formation in the fourth ventricle, cerebellum or brainstem. Question: Persistent blinking after glabellar tap and difficulty walking heel-to- toe are common in: Alzheimer's disease.Muscular Dystrophy.Parkinson’s disease. CorrectMultiple Sclerosis. Explanation: Glabellar tap is a primitive reflex that is characterized by blinking eyes when a patient is lightly tapped between the eyebrows. In less that 5 taps, a normal individual will stop blinking. In Parkinson's disease, persistent blinking will occur until the examiner stops tapping. Difficulty walking heel-to-toe are common in Parkinson's disease. Question: An example of distal weakness is: the right shoulder. the right hand. Correctboth arms.one the right side of the face. Explanation: There are 4 different patterns of weakness: Proximal, distal, symmetric, and asymmetric. An example of proximal weakness is weakness in the shoulder or hip girdle. Distal weakness occurs in the hands or feet. Symmetric weakness occurs in the same areas on both sides of the body. An asymmetric weakness occurs in a portion of the face or extremity - a form of focal weakness. Question: A teenager presents with signs of being gleeful, somewhat drowsy, and unable to focus. On examination , B/P 90/65, pupils constricted, and speech slurred. These symptoms are consistent with: opioid intoxication. Correctan amphetamine overdose.an overdose of benzodiazepines. Incorrectmarijuana usage. Explanation: Opioid intoxication may cause euphoria, drowsiness, constricted pupils, memory and judgment impairment, and slurred speech. Impaired memory, poor judgment, and inattention, slurred speech, drowsiness, and irritability are suggestive of central nervous system depressants (CNS). Barbiturates, alcohol and benzodiazepines fall in this class. Amphetamines are CNS stimulants. The teenager would exhibit signs of ataxia, respiratory distress, seizures, coma, myocardial infarction, or death. Marijuana intoxication would present with relaxation, euphoria, detachment, talkativeness, slowed perception of time, and possible anxiety or paranoia. Question: An 8-month-old with a significant head lag would suggest the need for: exercises that strengthen the neck muscles.a follow-up visit in 2 months.a neurological evaluation. Correctan orthopedic referral. Explanation: A baby typically should be able to control the neck muscles by around 4 months of age, so that when pulling from a lying to a sitting position the head should remain in line with the torso and not flop back. Delays in reaching this developmental milestone have been observed in premature babies and in those with cerebral palsy; all others should be referred to a pediatric neurologist for further evaluation. The other choices do not address the issue or the cause. Early interventions result in better outcomes. Question: Symptoms of a subdural hematoma include: noticeable bleeding between the dura and the skull on X-ray. appropriate responses to questions.noticeable bleeding between the dura and the cerebrum on X-ray. Correctabsent retinal hemorrhages. Explanation: Classic symptoms of subdural hemorrhages include: bleeding between the dura and the cerebrum, retinal hemorrhages, confusion, drowsiness, headaches, and possible seizures. Because this is a slow bleed, symptoms may develop slowly over several days or weeks. Bleeding between the dura and the skull are consistent with epidural bleeds. Question: Assessment findings in an infant with increased intracranial pressure would include: increased hunger.drowsiness. Correctpapilledema.blurred vision. Explanation: Symptoms of increased intracranial pressure in an infant include: drowsiness, separated sutures on the skull, bulging fontanel, and vomiting. Papilledema can be observed in people of any age, but is relatively uncommon in infants because the bones of the skull are not fully fused together at this age. Question: When evaluating the sensory system, testing the posterior columns tract would include assessing sensations of: position and vibration. Correctpain and temperature.deep touch.discriminative sensations. Explanation: When evaluating the sensory system, testing the spinothalamic tracts would include assessing sensations of pain and temperature. Assessing position and vibration evaluate the posterior columns. Light touch assesses both the spinothalamic and posterior column tracts. To assess discriminative sensation, both the spinothalamic and posterior columns tracts as well as the cortex would be assessed. Question: The term used to describe low back pain with nerve pain that radiates down the leg is: asterixis.sciatica. Correctdermatome.stereognosis. Explanation: The term used to describe low back pain with nerve pain that radiates down the leg is sciatica. Asterixis refers to an abnormal tremor consisting of involuntary jerking movements, especially in the hands, frequently occurring with impending hepatic coma and other forms of metabolic encephalopathy. This is also called flapping tremor. A dermatome is a band of skin innervated by the sensory root of a single spinal nerve. Stereognosis refers to the ability to identify an object by feeling it. Question: A form of aphasia in which the speech is confluent, slow, with few words and laborious effort and inflection and articulation are impaired but words are meaningful, is termed: Broca's aphasia. Correctanomic aphasia.Wernicke's aphasia.global aphasia. Explanation: In Broca's aphasia, speech is confluent, slow, with few words and laborious effort. Inflection and articulation are impaired but words are meaningful, with nouns, transitive verbs, and important adjectives. Small grammatical words are often dropped. With anomic aphasia, the person has word-finding difficulties and because of the difficulties, the person struggles to find the right words for speaking and writing. With Wernicke's aphasia, speech is fluent, often rapid, voluble, and effortless. Inflection and articulation are good, but sentences lack meaning and words are malformed (paraphasias) or invented (neologisms). Speech may be totally incomprehensible. With global aphasia, the person has difficulty speaking and understanding words and is unable to read or write. Question: Symmetric weakness of the distal muscles of the legs suggests a: polyneuropathy. Correctmyopathy.sensory neuropathy.cerebellar disease. Explanation: Polyneuropathy would present as symmetric weakness in the distal muscles. Symmetric weakness of the proximal muscles of the legs suggests a myopathy. Nystagmus, dysarthria, hypotonia, and ataxia would be characteristic of cerebellar disease. Sensory neuropathy usually presents as numbness, tingling, and pain. Question: Symmetric weakness of the proximal muscles of the legs suggests a: polyneuropathy.myopathy. Correctsensory neuropathy.cerebellar disease. Explanation: Symmetric weakness of the proximal muscles of the legs suggests a myopathy. Polyneuropathy would exhibit symptoms of symmetric weakness in the distal muscles. Nystagmus, dysarthria, hypotonia, and ataxia would be characteristic of cerebellar disease. Sensory neuropathy usually presents as numbness, tingling, and pain. Question: Dysarthria refers to: the inability to produce or understand language.the loss of voice.an impairment in volume of the voice.a defect in the muscular control of the speech apparatus. Correct Explanation: Dysarthria refers to a defect in the muscular control of the speech apparatus (lips, tongue, palate, or pharynx). Dysphonia refers to less severe impairment in the volume, quality, or pitch of the voice. Aphonia refers to a loss of voice that accompanies disease affecting the larynx or its nerve supply. Aphasia refers to a disorder in producing or understanding language. Question: Walking on the toes and heels may reveal: distal muscular weakness in the legs. Correctataxia.a cerebellar dysfunction.proximal weakness of the extensors of the hip. Explanation: Walking on the toes and heels may reveal distal muscular weakness in the legs. Inability to heel-walk is a sensitive test for corticospinal tract weakness. An ataxia would be suspected if the patient was unable to walk heel-to-toe in a straight line. Inability to hop in place on each foot would denote cerebellar dysfunction. Difficulty performing a shallow knee bend would suggest proximal weakness in the extensors of the hip, weakness of the quadriceps, extensors of the knee, or both. Question: When upper motor neuron systems are damaged above the crossover of its tracts in the medulla, motor impairment develops on the opposite side. This term is: ipsilateral.contralateral. Correctsuperficial.intermediate. Explanation: When upper motor neuron systems are damaged above the crossover of its tracts in the medulla, motor impairment develops on the opposite side. This term is contralateral. In damage below the crossover, motor impairment would occur on the same side or ipsilateral side. Superficial refers to the outer surface of something. Intermediate is a term used to denote something between two other structures. Question: An infant with fetal alcohol syndrome would: appear calm, happy and cooing in the hospital crib.be irritable, hyperactive and exhibit a high-pitched cry. Correctperspire, vomit and have diarrhea.appear shaky, hypoactive, and in respiratory distress. Explanation: A baby with fetal alcohol syndrome may have the following symptoms: poor intrauterine growth, delayed growth after birth, decreased muscle tone and poor coordination, delayed development and problems in three or more major areas: thinking, speech, movement, or social skills; heart defects; structural problems of the face; irritability, hyperactive and a high-pitched cry. The other symptoms are not consistent with fetal alcohol syndrome. Question: Involuntary movements of the body that are slower and more twisting and writhing than choreiform movements, and have a larger amplitude are suggestive of: facial tics.dystonic movements.athetoid movements. Correctoral-facial dyskinesias. Explanation: Athetoid movements are slower and more twisting and writhing than choreiform movements, and have a larger amplitude. They most commonly involve the face and the distal extremities. Facial tics are brief, repetitive, stereotyped, coordinated movements occurring at irregular intervals. Examples include repetitive winking, grimacing, and shoulder shrugging. Dystonic movements are similar to athetoid movements, but often involve larger portions of the body, including the trunk. Grotesque, twisted postures may result. Oral–facial dyskinesias are rhythmic, repetitive, bizarre movements that chiefly involve the face, mouth, jaw, and tongue: grimacing, pursing of the lips, protrusions of the tongue, opening and closing of the mouth, and deviations of the jaw. These are involuntary movements. Question: An example of symmetric weakness is: the right shoulder. the right hand.both arms. Correctone the right side of the face. Explanation: There are 4 different patterns of weakness: Proximal, distal, symmetric, and asymmetric. An example of proximal weakness is weakness in the shoulder or hip girdle. Distal weakness occurs in the hands or feet. Symmetric weakness occurs in the same areas on both sides of the body. An asymmetric weakness occurs in a portion of the face or extremity - a form of focal weakness. Question: Anesthesia refers to: decreased sensitivity to pain.increased sensitivity to pain.absence of pain sensation. Incorrectabsence of touch sensation. Correct Explanation: Analgesia refers to absence of pain sensation; hypalgesia to decreased sensitivity to pain; hyperalgesia to increased sensitivity; and anesthesia to absence of touch sensation. Question: When assessing an elderly patient for delirium, the recommended instrument with the best supportive data is the: Delirium Rating Scale (DRS). IncorrectConfusion Assessment Method (CAM). CorrectMini Mental State Examination (MMSE). Delirium Superimposed on Dementia Algorithm (DSDA). Explanation: Confusion Assessment Method (CAM), a screening tool specifically designed to detect delirium, is the most recommended because it provides the best supportive data for bedside use and takes 5 minutes to complete. The Delirium Rating Scale (DRS) covers a range of symptoms relating to delirium, and is useful for diagnostic purposes and for assessing severity and distinguishing delirium from other disorders. It is very complex and requires advanced training to administer. The MMSE is the most widely used instrument to test cognitive function. The Delirium Superimposed on Dementia Algorithm recommends a process to assess for delirium for people with a pre-existing dementia. Question: An indication that there is a malfunction of a ventriculoperitoneal (VP) shunt in an older child would be the presence of a: headache upon awakening. Correcttemperature greater than 100.8 degrees Fahrenheit.noticeable increase in activity.bulging fontanels. Explanation: Headache and projectile vomiting are associated with shunt malfunction as well as signs of increased intracranial pressure. Fever can be associated with shunt infection. Older children's fontanels and sutures are closed, so they do not present with bulging fontanels. Question: When assessing abdominal cutaneous reflexes, the nurse practitioner strokes the lower abdomen, the localized twitch is absent. This finding could be suggestive of a pathologic lesion in which segmented level of the spine? Thoracic 8, 9, and 10Thoracic 10, 11, and 12 CorrectLumbar 5 and Sacral 1Sacral 2, 3, and 4 Explanation: Superficial (cutaneous) reflexes and their corresponding spinal segments include the following: Abdominal reflexes: upper thoracic 8, 9, 10 and lower thoracic 10, 11, 12; Plantar: lumbar 5 and sacral 1; and Anal: sacral 2, 3, 4. Question: While assessing the cranial nerves, the nurse practitioner touches the cornea lightly with a wisp of cotton. This maneuver assesses which cranial nerve? Cranial Nerve II (CN II)Cranial Nerve IV (CN IV)Cranial Nerve V (CN V) CorrectCranial Nerve X (CN X) Explanation: Touching the cornea and assessing for a reflex assesses cranial nerve V. Question: The level of consciousness that refers to the patient that arouses from sleep only after painful stimuli is known as: obtundation.alertness.lethargy.stupor. Correct Explanation: A stuporous patient arouses from sleep only after painful stimuli. An obtunded patient opens his eyes, looks at the person speaking to him but responds slowly and appears confused. The level of consciousness that refers to the ability of the patient to respond fully and appropriately to stimuli is known as alertness. Lethargy refers to the patient that appears drowsy but can open his eyes, respond to questions, then fall back to sleep. Question: When evaluating the sensory system, testing the spinothalamic tracts would include assessing sensations of: position and vibration.pain and temperature. Correctdeep touch.discriminative sensations. Explanation: When evaluating the sensory system, testing the spinothalamic tracts would include assessing sensations of pain and temperature. Assessing position and vibration evaluate the posterior columns. Light touch assesses both the spinothalamic and posterior column tracts. To assess discriminative sensation, both the spinothalamic and posterior columns tracts as well as the cortex would be assessed. Question: Hypalgesia refers to: decreased sensitivity to pain. Correctincreased sensitivity to pain.absence of pain sensation.absence of touch sensation. Explanation: Analgesia refers to absence of pain sensation; hypalgesia to decreased sensitivity to pain; hyperalgesia to increased sensitivity; and anesthesia to absence of touch sensation. Question: Which choice is least likely to be an example of asymmetric weakness? The right shoulder The right handBoth arms CorrectOne the right side of the face Explanation: There are 4 different patterns of weakness: Proximal, distal, symmetric, and asymmetric. An example of proximal weakness is weakness in the shoulder or hip girdle. Distal weakness occurs in the hands or feet. Symmetric weakness occurs in the same areas on both sides of the body. An asymmetric weakness occurs in a portion of the face or extremity - a form of focal weakness. Question: When assessing coordination of muscle movement, four areas of the nervous system function in an integrated way. These areas include the motor, cerebellar, the vestibular, and the sensory systems. Which system coordinates head movements? Motor system IncorrectCerebellar systemVestibular system CorrectSensory system Explanation: Coordination of muscle movement requires that four areas of the nervous system function in an integrated way: motor system for muscle strength, cerebellar system for rhythmic movements and steady posture, vestibular system for balance and coordinating eye, head, and body movements, and sensory system for position sense. Question: When comparing two sides of the body for symmetric sensation a symmetrical distal sensory loss would be suggestive of : a lesion in the opposite cerebral hemisphere.polyneuropathy. Correcta spinal cord lesion.a peripheral lesion. Explanation: When comparing two sides of the body for symmetric sensation a symmetrical distal sensory loss would be suggestive of polyneuropathy. A hemisensory loss pattern would suggest a lesion in the opposite cerebral hemisphere. Spinal cord lesions would present with sensory loss from tract damage below the level of the lesion. A peripheral lesion with sensory loss would present with a stocking - glove distribution. Question: A 80 year old male visits the nurse practitioner for an annual well exam. History reveals two falls in the prior 12 months and difficulty with balance. The next step the nurse practitioner should take is: reassess the patient in 6 months.obtain cognitive and functional assessment. Correctassess respiratory assessment.assess cardiac function. Explanation: High-risk older adults, namely those with a single fall in the past 12 months with abnormal gait and balance and those with two or more falls in the prior 12 months, an acute fall, and/or difficulties with gait and balance, require further assessment to determine the reasons for the falls. Obtaining relevant medical history, physical exam, cognitive and functional assessment and determining multifactorial fall risks are essential to the preventing future falls. Question: The principal muscles involved when closing the mouth are innervated by which Cranial nerve? Cranial nerve III (CN III)Cranial nerve V (CN V) CorrectCranial nerve VII (CN VII) IncorrectCranial nerve XII (CN XII) Explanation: The muscles responsible for closing the mouth are innervated by Cranial nerve V (trigeminal nerve). Cranial nerve V innervates the masseter, the temporalis, and the internal pterygoids. Question: The best method of detecting cognitive impairment or mental retardation at an early age is by: performing neuropsychological testing of intelligence.administration of an IQ test of cognitive abilities.radiographic evaluation of the brain and brainstem.assessment of the achievement of developmental milestones. Correct Explanation: The least invasive, least expensive, most efficient strategy used to detect cognitive and developmental deficits in infants and children is assessing for achievement of developmental milestones. Delay in achievement of developmental milestones is a cardinal sign of deficits/disabilities. The other three choices may be done at a later date as the child gets older and after the child is identified as having delayed or failure to achieve milestones. Question: When trying to determine the level of consciousness in a patient whose level of consciousness is altered, a lethargic patient: opens the eyes and looks at the examiner, responds slowly, and is somewhat confused. Incorrectappears drowsy but opens the eyes, looks at the examiners, answers the questions, and then falls asleep. Correctarouses from sleep after exposure to painful stimuli, exhibits slow verbal responses, and easily lapses into an unresponsive state.remains unarousable with eyes closed. Explanation: A lethargic patient appears drowsy but opens his eyes, looks at the examiners, answers the questions, and then falls asleep. An obtunded patient opens the eyes and looks at the examiner, but responds slowly and is somewhat confused. A stuporous patient arouses from sleep after exposure to painful stimuli, exhibits slow verbal responses, and easily lapses into an unresponsive state. A comatose patient remains unarousable with eyes closed. There is no evident response to inner need or external stimuli. Question: When eliciting deep tendon reflexes in the ankle, the nurse practitioner notes an abnormal reflex in the right ankle. This abnormality is probably consistent with a pathological lesion in which segmented level of the spine? Cervical 5 and 6Cervical 6 and 7 Lumbar 2, 3, and 4 IncorrectSacral 1 Correct Explanation: The segmented levels of the deep tendon reflexes are: Ankle: sacral 1; knee: lumbar 2,3, & 4; Supinator and biceps: cervical 5 & 6; and triceps: cervical 6 & 7. Question: The term used to describe the absence or loss of control of voluntary muscle movements is: dystonia.bradykinesia.akinesia. Correctdyskinesia. Explanation: The absence or loss of control of voluntary muscle movements is akinesia. Dystonia is a neurological disorder that causes involuntary muscle spasms and twisting of the limbs. Bradykinesia is the term used to describe the impaired ability to adjust to one's body position. This symptom is noted in patients who have Parkinson's disease. Dyskinesia is the presence of involuntary muscle movements such as tics or chorea. These movements can be seen in children who have rheumatic fever. Question: With the adult patient lying supine, the nurse practitioner strokes the lateral aspect of the sole from the heel to the ball of the foot with the end of an applicator stick. Dorsiflexion of the big toe was noted. This is a positive: Brudzinski's sign.Kernig's sign.nuchal rigidity sign.Babinski's sign. Correct Explanation: To elicit Babinski sign, stroke the lateral aspect of the sole from the heel to the ball of the foot with the end of an applicator stick. Plantar flexion is normal. Dorsiflexion of the big toe is a positive Babinski's sign. To elicit Brudzinski's sign, flex the neck. Flexion of both the hips and knees is positive for Brudzinski's. To test for Kernig's sign, flex the patient's leg at both the hip and the knee and then straighten the knee. Pain and increased resistance to extending the knee are positive for a Kernig's sign. With the patient lying supine, the nurse practitioner places her hands behind the patient's head while flexing his neck forward until his chin touches his chest. Neck stiffness with resistance to flexion is noted. This is positive nuchal rigidity and suggestive of meningeal inflammation from meningitis or subarachnoid hemorrhage. Question: The part of the peripheral nervous system that regulates muscle movement and response to the sensations of pain and touch is the: autonomic nervous system.somatic nervous system. Correctsympathetic nervous system.parasympathetic nervous system. Explanation: The part of the peripheral nervous system that regulates muscle movement and response to the sensations of pain and touch is the somatic nervous system. The autonomic nervous system generates autonomic reflex responses and consists of the sympathetic and parasympathetic nervous systems. The sympathetic nervous system mobilizes organs and their functions during times of stress and arousal. The parasympathetic nervous system conserves energy and resources during times of rest and relaxation. Question: The part of the brain that coordinates all movement and helps maintain the body upright in space is the: cerebrum.brainstem.cerebellum. Correctdiencephalon. Explanation: The cerebellum, which lies at the base of the brain, coordinates all movement and helps maintain the body upright in space. The cerebrum controls all voluntary actions of the body with the aid of the cerebellum. The nerve connections of the motor and sensory systems from the main part of the brain to the rest of the body pass through the brainstem. Brainstem controls most functions in the body but mostly responsible for breathing, heart rate, and articulate speech. The diencephalon relays sensory information between brain regions and controls many autonomic functions of the peripheral nervous system. It also connects structures of the endocrine system with the nervous system and works in conjunction with limbic system structures to generate and manage emotions and memories. Question: The part of the brain tissue that consists of neuronal axons that are coated with myelin is the: basal ganglion.white matter. Correctgray matter.thalamus. Explanation: Brain tissue may be gray or white. Gray matter consists of aggregations of neuronal cell bodies. It rims the surfaces of the cerebral hemispheres, forming the cerebral cortex. White matter consists of neuronal axons that are coated with myelin. The myelin sheaths, which create the white color, allow nerve impulses to travel more rapidly. Question: A patient complains of experiencing symptoms of nausea, diaphoresis, and pallor triggered by a fearful or unpleasant event. These symptoms are most likely associated with: subarachnoid hemorrhage.stroke.neurocardiogenic syncope. Incorrectvasovagal syncope. Correct Explanation: In vasovagal syncope, a common cause of syncope, a prodrome of nausea, diaphoresis, and pallor are triggered by a fearful or unpleasant event, then vagally mediated hypotension, often with slow onset and offset. In syncope from arrhythmias, onset and offset are often sudden, reflecting loss and recovery of cerebral perfusion. Stroke or subarachnoid hemorrhage are unlikely to cause syncope unless there are focal findings and damage to both hemispheres. Question: The patient has his eyes closed and an area on his right leg is briefly touched by the nurse practitioner. The patient is instructed to open his eyes and point to the area that was touched. This is an example of the discriminative sensation known as: graphesthesia.stereognosis. Incorrecttwo point discrimination.point localization. Correct Explanation: Graphesthesia, or number identification is the ability to identify a number when drawn in the hand of a patient whose eyes are closed. A discriminative sensation, stereognosis, is the ability to identify an object by feeling. The ability to identify an object touching 2 areas simultaneously is termed two-point discrimination. Point localization refers to the ability of the patient to identify the area of the body that was touched when his eyes were closed. Question: Hyperesthesia refers to: absence of touch sensation.decreased sensitivity to touch.increased sensitivity to touch. Correctabsence of pain sensation. Explanation: Anesthesia is absence of touch sensation; hypesthesia is decreased sensitivity to touch; hyperesthesia is increased sensitivity to touch; and analgesia refers to absence of pain sensation. Question: A patient who is being evaluated for frequent headaches, mentions that the headache worsens with coughing, sneezing, or when changing positions. Increasing pain with these maneuvers may be suggestive of: a brain tumor. Correcta migraine.seizure activity.subarachnoid hemorrhage. Explanation: If coughing, sneezing, or changing positions increases the pain associated with the headache, sinusitis or a brain tumor may be considered. Migraines may present with symptoms of nausea and vomiting. Brain tumors and subarachnoid hemorrhages can also present with nausea and vomiting. Question: The term used to describe an abnormal tremor consisting of involuntary jerking movements, especially in the hands is: asterixis. Correctsciatica.dermatome.stereognosis. Explanation: Asterixis refers to an abnormal tremor consisting of involuntary jerking movements, especially in the hands, frequently occurring with impending hepatic coma and other forms of metabolic encephalopathy. This is also called flapping tremor. The term used to describe low back pain with nerve pain that radiates down the leg is sciatica. A dermatome is a band of skin innervated by the sensory root of a single spinal nerve. Stereognosis refers to the ability to identify an object by feeling it. Question: Which one of the following assesses pain, temperature, and sensation using the distal and proximal areas testing pattern? Test the sensation in the thumbs and little fingers CorrectCompare the sensation in the right arm to that in the left arm IncorrectTest the sensation in the fingers and the toesStimulate first at an area of reduced sensation and move by progressive steps until the patient detects a change Explanation: When testing pain, temperature, and touch sensation, also compare the distal with the proximal areas of the extremities. Further, scatter the stimuli so as to sample most of the dermatomes and major peripheral nerves. An example would be to test the thumbs and fingers (C6 and C8). Comparing the sensation in the right arm with that in the left arm would be an example of the testing pattern of comparing symmetric areas. Testing the fingers and toes is an example of testing pattern for vibration and position sense. By stimulating an area of reduced sensation and moving by progressive steps until the patient detects a change is an example of the pattern of mapping out the boundaries for sensory loss. Question: The part of the brain that maintains homeostasis is the: basal ganglion.thalamus.hypothalamus. Correctcerebellum. Explanation: The hypothalamus maintains homeostasis and regulates temperature, heart rate, and blood pressure. The hypothalamus affects the endocrine system and governs emotional behaviors such as anger and sexual drive. Hormones secreted in the hypothalamus act directly on the pituitary gland. Question: An example of tandem walking is having the patient: walk across the room.walk heel-to-toe. Correctwalk on the toes, then on the heels.walk with a shallow knee bend. Explanation: Walking heel-to-toe in a straight line is called tandem walking. If the patient is unable to accomplish this, it may reveal ataxia. The other examples are not examples of tandem walking. Question: The central nervous system extends from the medulla into the: midbrain.pons. Incorrectcerebrum.spinal cord. Correct Explanation: Below the medulla, the central nervous system extends into the elongated spinal cord, encased within the bony vertebral column and terminating at the first or second lumbar vertebra. Question: A patient is unable to identify the smell of an orange. This inability could reflect an abnormality in cranial nerves: I. CorrectII.III.VIII. Explanation: Cranial Nerve I is the olfactory nerve responsible for the sense of smell. To test the sense of smell, the examiner presents the patient with familiar and nonirritating odors. A person should normally perceive odor on each side and correctly identify the source. Cranial Nerves II and III assess vision and pupillary reaction. Cranial Nerve VIII tests the hearing and balance. Question: When assessing the patient's sense of position, instruct the patient to first stand with his feet together and eyes open, then instruct him to close both eyes for 30-60 seconds. If he loses his balance with his eyes closed, this is: considered a normal finding.suggestive of ataxia related to dorsal column disease. Correctsuggestive of cerebellar ataxia. corticospinal track damage. Explanation: When assessing the patient's sense of position, instruct the patient to first stand with his feet together and eyes open, then instruct him to close both eyes for 30-60 seconds. If he loses his balance with his eyes closed, this is a positive Romberg test and suggestive of ataxia related to a dorsal column disease. In cerebellar ataxia, the patient has difficulty standing with feet together whether the eyes are open or closed. With corticospinal tract damage, the gait is affected and the patient is unable to heel-walk. Question: When evaluating the six cardinal directions of gaze, a loss of conjugate movements is noted when the patient looks to his left. This finding could be consistent with damage to which cranial nerve? Cranial Nerve II (CN II)Cranial Nerve IV (CN IV) CorrectCranial Nerve V (CN V)Cranial Nerve VII (CN VII) Explanation: To evaluate the extraocular movements in the six cardinal directions of gaze, the examiner should look for loss of conjugate movements in any of the six directions. If there is discongruent gaze, this could be suggestive of damage to cranial nerves CN III, IV, and VI - Oculomotor, Trochlear, and Abducens nerves. Question: Dysarthria refers to: the inability to produce or understand language. Incorrectthe loss of voice.an impairment in volume of the voice.a defect in the muscular control of the speech apparatus. Correct Explanation: Dysarthria refers to a defect in the muscular control of the speech apparatus (lips, tongue, palate, or pharynx). Dysphonia refers to less severe impairment in the volume, quality, or pitch of the voice. Aphonia refers to a loss of voice that accompanies disease affecting the larynx or its nerve supply. Aphasia refers to a disorder in producing or understanding language. Question: Disorders of speech fall into three groups that affect all of the following except the: voice.articulation of speech.written language. Correctcomprehension of language. Explanation: Disorders of speech fall into three groups affecting: (1) the voice, (2) the articulation of words, and (3) the production and comprehension of language. The written language is not included in the disorders of speech. Question: Unilateral weakness in cranial nerve V (CN V) would be suggestive of a: bilateral hemispheric disease. central nervous system lesions.pontine lesion. Correctbrainstem lesion. Incorrect Explanation: Unilateral weakness in cranial nerve V (CN V), the trigeminal nerve, is suggestive of a pontine lesion (located in the pons). Question: The most common cause of viral encephalitis in children is: Herpes simplex virus Type IIPicornavirusEnterovirusesHerpes simplex virus Type I Correct Explanation: Herpes simplex Type I is the most common cause of viral encephalitis in children. The other choices are incorrect. Question: The principal muscles involved when closing the mouth are innervated by which Cranial nerve? Cranial nerve III (CN III)Cranial nerve V (CN V) CorrectCranial nerve VII (CN VII)Cranial nerve XII (CN XII) Explanation: The muscles responsible for closing the mouth are innervated by Cranial nerve V (trigeminal nerve). Cranial nerve V innervates the masseter, the temporalis, and the internal pterygoids. Question: Intention tremors appear with movement and: worsen with stress. Incorrectincrease during sleep. are more pronounced when maintaining a posture.worsen as the target gets closer. Correct Explanation: Tremors are rhythmic oscillatory movements. Intention tremors, absent at rest, appear with movement and often worsen as the target gets closer. Causes include disorders of cerebellar pathways, as in multiple sclerosis, or any other disease of the cerebellum. The other choices are not consistent with intention tremors. Question: When assessing coordination of muscle movement, four areas of the nervous system function in an integrated way. These areas include the motor, cerebellar, the vestibular, and the sensory systems. Which system coordinates a steady posture? Motor systemCerebellar system CorrectVestibular system IncorrectSensory system Explanation: Coordination of muscle movement requires that four areas of the nervous system function in an integrated way: motor system for muscle strength, cerebellar system for rhythmic movements and steady posture, vestibular system for balance and coordinating eye, head, and body movements, and sensory system for position sense. Question: Sudden, brief, rapid jerks, involving the trunk or limbs may be consistent with: a myoclonic seizure. Correctan absent seizure.a myoclonic atonic seizure. Incorrecta focal seizure with impairment of consciousness. Explanation: A patient experiencing a myoclonic seizure manifests sudden, brief, rapid jerks, involving the trunk or limbs. A sudden brief lapse of consciousness with momentary blinking, staring, or movements of the lips and hands but no falling is consistent with an absent seizure. During a myoclonic atonic seizure, the patient experiences a sudden loss of consciousness with falling but no movements. Injury may occur. Focal seizures with impairment of consciousness the person appears confused. Automatisms include automatic motor behaviors such as chewing, smacking the lips, walking about, and unbuttoning clothes. Question: A patient experiences difficulty rising from a sitting position without arm support. This would be suggestive of: distal muscle weakness of the pelvic girdle and legs.poor muscle coordination.proximal muscle weakness of the pelvic girdle and legs. Correcta weak vestibular system. Incorrect Explanation: A patient who experiences difficulty rising from a sitting position without arm support or is unable to step up on a sturdy stool without support suggests proximal muscle weakness of the pelvic girdle and legs. Question: Common physical findings in a young child with cerebral palsy include which one of the following? Walks by placing the heels of the feet down firstMoves about by crawling on the abdomen or all four extremitiesGenerally meets motor developmental milestones on schedulePresence of crossed or touching knees Correct Explanation: Cerebral palsy (CP) is a group of disorders that can involve the brain and nervous system functions, such as movement, learning, hearing, seeing, and thinking. There are several different types of cerebral palsy, including spastic, dyskinetic, ataxic, hypotonic, and mixed. Symptoms usually depend on the type and can be seen before a child is 2 years old, and sometimes as early as 3 months. Symptoms may include delays in reaching and in developmental stages such as sitting, rolling, crawling, or walking, or abnormal gait. Arms may be tucked in toward the sides, knees may be crossed or touching, legs may make "scissor" movements, and child may walk on toes. Additionally, newborn reflexes may persist beyond the expected time frame for their disappearance. Question: A teenager is being assessed for possible acute marijuana usage and appears intoxicated. Findings consistent with marijuana intoxication could include: euphoria, talkativeness, and paranoia. Correctmild respiratory distress, ataxia, and normal blood pressure.drowsiness, constricted pupils, and memory impairment.impaired judgment, anxiety, and slurred speech. Incorrect Explanation: Marijuana intoxication could present with euphoria, detachment, talkativeness, slowed perception of time, and possible anxiety or paranoia. Amphetamines are CNS stimulants and the teenager could exhibit signs of ataxia, respiratory distress, seizures, coma, myocardial infarction, or death. Opioids may cause euphoria, drowsiness, constricted pupils and similar same symptoms as CNS depressants. Impaired memory, judgment, attention, slurred speech, drowsiness, and irritability are suggestive of central nervous system depressants (CNS). Barbiturates, alcohol and benzodiazepines fall in this class. Question: When eliciting deep tendon reflexes in the triceps, the nurse practitioner notes an abnormal reflex in the right triceps. This abnormality is probably consistent with a pathological lesion in which segmented level of the spine? Cervical 5 and 6Cervical 6 and 7 CorrectLumbar 2, 3, and 4Sacral 1 Explanation: The segmented levels of the deep tendon reflexes are: Ankle: sacral 1; knee: lumbar 2,3, & 4; Supinator and biceps: cervical 5 & 6; and triceps: cervical 6 & 7. Question: The central nervous system extends from the medulla into the: midbrain.pons.cerebrum. Incorrectspinal cord. Correct Explanation: Below the medulla, the central nervous system extends into the elongated spinal cord, encased within the bony vertebral column and terminating at the first or second lumbar vertebra. Question: Which nerve runs from the spine through the neck, the axilla, and into the arm? Median nerveUlnar nerveRadial nerveBrachial plexus Correct Explanation: The brachial plexus is a network of nerve fibers that runs from the spine through the neck, the axilla, and into the arm. This network of nerves passes through the cervico-axillary canal to reach the axilla and innervates brachium (upper arm), antebrachium (forearm), and hand. The radial nerve originates in the axilla and travels down the arm in a shallow depression (radial groove) on the surface of the humerus. The median nerve is located on the ventral forearm and is just medial to the brachial artery in the antecubital fossa. The ulnar nerve runs posteriorly in the ulnar groove between the medial epicondyle and the olecranon process. [Show More]

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