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AGNP BOARD EXAM QUESTIONS with Answers Neurology Assessment (Questions 194) 2020

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AGNP BOARD EXAM QUESTIONS Neurology Assessment (Questions 194) Question: When eliciting deep tendon reflexes in the knee, the nurse practitioner notes an abnormal reflex in the right knee. This abno... rmality is probably consistent with a pathological lesion in which segmented level of the spine? Cervical 5 and 6 Cervical 6 and 7 Lumbar 2, 3, and 4 Sacral 1 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: 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. assess respiratory assessment. assess cardiac function. 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: When evaluating the sensory system, testing the spinothalamic tracts would include assessing sensations of: position and vibration. pain and temperature. deep touch. discriminative sensations. 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: When testing for corneal reflex, an absent blink reflex is noted. This finding may be suggestive of a lesion in which cranial nerve? Cranial Nerve II (CN II) Cranial Nerve IV (CN IV) Cranial Nerve VI (CN V) Cranial Nerve VII (CN VII) When testing for corneal reflex, an absent blink reflex would be suggestive of a lesion in cranial nerves V or VII (CN V or CN VII)-Trigeminal or facial nerves. Question: An example of symmetric weakness is: the right shoulder. the right hand. both arms. one the right side of the face. 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: One maneuver used to assess coordination is to observe the patient: dorsiflexing the ankle. walking heel-to-toe in a straight line. squeezing the examiner's fingers. counting to 10 backwards. To assess coordination, observe the patient’s performance in rapid alternating movements, point-to-point movements, gait and other related body movements, standing in specified ways. Walking heel-to-toe would be an example of observing the patient's gait. Dorsiflexion would be assessing the patient's joint function. Squeezing the examiner's fingers would be one way to assess hand grasp. Counting has nothing to do with coordination. Question: Assessment of a 70-year-old's ability to maintain personal safety would be most adversely affected by declining function in the: cardiovascular system. respiratory system. sensory perception system. gastrointestinal system. The sensory system or sensory perception involves vision, touch, taste, smell, and hearing. With the aging process these perceptions are altered and these alterations put the elderly at risk for falls, burns, inability to smell smoke, and the inability to move fast enough to get out of harm's way. These impact personal safety. Changes in the cardiovascular, gastrointestinal, and respiratory systems do not usually lead to safety issues. 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. vasovagal syncope. 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: An infant presents with an inappropriately increasing head circumference and hydrocephalus confirmed by CT scan. In addition to these findings, which one of the following would also be consistent with hydrocephalus? A soft, low-pitched cry Ability to be comforted easily Tense, bulging fontanels Appropriately increasing weight An infant with newly diagnosed hydrocephalus presents with a shrill and high-pitched cry. They are very irritable and do not comfort easily. Additionally, the infant's fontanels are tense and bulging due to the increased amount of cerebral spinal fluid (CSF) being produced or not being absorbed. These infants are very difficult feeders, so they often do not gain weight appropriately. Question: Postural tremors appear when the affected part is: at rest. moving voluntarily. is actively maintaining a posture. getting closer to its target. 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: Dysphonia 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. 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. Dysarthria refers to a defect in the muscular control of the speech apparatus (lips, tongue, palate, or pharynx). Aphasia refers to a disorder in producing or understanding language. Question: Symptoms of a migraine headache can include throbbing, nausea or vomiting, duration of one day, and be unilateral and/or disabling. How many of these symptoms should be present to classify the headache as a migraine? One of the five Two of the five Three of the five Four of the five A migraine headache is highly likely if three of the five “POUND” features are present: Pulsatile or throbbing; One-day duration, or lasts 4 to 72 hours if untreated; Unilateral; Nausea or vomiting; Disabling or intensity causing interruption of daily activity. Question: The cranial sutures are closed on the head of a 9 month old infant. This indicates: hydrocephalus. craniosynostosis. a normal finding. opisthotonos. Craniosynostosis is defined as the premature closing of the sutures in young children. When this occurs, a bony ridge can be felt along the suture line. This is not a normal finding since the sutures usually fuse between 12 and 18 months. Hydrocephalus refers to fluid on the brain and would appear as an enlarged head with sutures remaining open. Opisthotonos is a state of severe hyperextension and spasticity in which an individual's head, neck and spinal column enter into a complete "bridging" or "arching" position. This abnormal posturing is an extrapyramidal effect and is caused by spasm of the axial muscles along the spinal column. 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. superficial. intermediate. 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: The best method of detecting cognitive impairment or intellectual disability 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. 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: A term used to describe an increase in muscular bulk with diminished strength is: hypertrophy. muscular atrophy. pseudohypertrophy. muscle weakness. An increase in muscular bulk with diminished strength is known as pseudohypertrophy. Hypertrophy refers to an increase in bulk of the muscle with a proportionate increase in strength. A term used to describe muscle wasting or loss of muscle bulk is muscular atrophy. Muscular weakness is a term used to describe a lack of strength or firmness in a muscle. 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. migraine headaches. sinus headaches. 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: It is imperative to assess for suicidality and bipolar disorder in patients suspected of experiencing: delirium. autism spectrum disorder. depression. attention deficit disorder. Depression is more common in individuals with significant medical conditions, including several neurologic disorders—dementia, epilepsy, multiple sclerosis, and Parkinson disease. Patients who present with depression may actually have bipolar disorder and so screening should always take place. Patients who are depressed may be suicidal. Consequently, in order for appropriate treatment to occur, appropriate diagnosis must occur. Question: The level of consciousness that refers to the patient that remains unarousable with eyes closed without evidence of response to inner need or external stimuli is said to be in: an obtunded state. a comatose state. a lethargic state. a stuporous state. A patient that remains unarousable with eyes closed without evidence of response to inner need or external stimuli is a comatose patient. An obtunded patient opens his eyes, looks at the person speaking to him but responds slowly and appears confused. Lethargy refers to the patient that appears drowsy but can open his eyes, respond to questions, then fall back to sleep. A stuporous patient arouses from sleep only after painful stimuli. Question: Brief, repetitive, stereotyped, coordinated movements occurring at irregular intervals are consistent with: facial tics. dystonic movements. athetoid movements. oral-facial dyskinesias. 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: 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. depression. Evidence of flexed posture, tremor, rigidity, bradykinesia, micrographia, shuffling gait, and difficulty rising from a chair are symptoms consistent with Parkinson's disease. Question: When a patient complains of severe headaches that have worsened over the last few weeks but she has no other symptoms, a most likely diagnosis would be: sinusitis. a tumor. subarachnoid hemorrhage. an abscess. The most important attributes of headaches are chronologic pattern and severity. Changing or progressively severe headaches increase the likelihood of tumor, abscess, or other masses. Extremely severe headaches suggest subarachnoid hemorrhage or meningitis and these headaches require immediate intervention because they worsen rapidly, not over a "few weeks". Sinusitis does cause headache but these headaches are not usually severe. Question: The term used to describe involuntary muscle movements, such as chorea, is: dystonia. bradykinesia. akinesia. dyskinesia. Dyskinesia is the presence of involuntary muscle movements such as tics or chorea. These movements can be seen in children who have rheumatic fever. 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. 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. brainstem lesion. 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: A progressive disorder of the nervous system that affects movement is known as: delirium. functional impairment. Parkinson's disease. Alzheimer's disease. 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: 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. 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: The patient experiences a sudden loss of consciousness with falling without movements and injury may occur. This type of a seizure is consistent with: a myoclonic seizure. an absent seizure. a myoclonic atonic seizure. a focal seizure with impairment of consciousness. During a myoclonic atonic seizure, the patient experiences a sudden loss of consciousness with falling but no movements. Injury may occur. 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. 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 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 . cerebellum lesion. 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: To identify sensory deficits comparing symmetric areas, the nurse practitioner would compare the sensation: in the thumb to that in the little finger. in both arms. by mapping out the area of sensory loss. and vibration in the fingers or toes. To identify sensory deficits by comparing symmetric areas, the nurse practitioner would compare the sensation on both sides of the body. For example, the right arm should have the same perception of sensation as the left arm. An example of a comparison of the distal with proximal areas, the sensation in the thumb would be compared to that in the little finger. Mapping an area of sensory loss or hypersensitivity would be assessed by stimulating first the point of reduced sensation and moving by progressive steps until the patient detects the change. When testing vibration and position, first test the fingers and toes. Question: The three important questions that govern the neurological examination include: Is the mental status intact?, Are right-sided and left-sided findings symmetric?, and: Are deep tendon reflexes intact?. Are vital signs stable? If findings are abnormal, is the cause in the central or peripheral nervous system?. Are the cranial nerves intact?. The three important questions that govern the neurological examination include: Is the mental status intact?, Are right-sided and left-sided findings symmetric?, and If findings are abnormal, is the cause in the central or peripheral nervous system?. The other questions are also important to ask but are not included in the 3 most important ones for the neurological exam. Question: The level of consciousness that refers to the ability of the patient to respond fully and appropriately to stimuli is known as: obtundation. alertness. lethargy. stupor. The level of consciousness that refers to the ability of the patient to respond fully and appropriately to stimuli is known as alertness. An obtunded patient opens his eyes, looks at the person speaking to him but responds slowly and appears confused. Lethargy refers to the patient that appears drowsy but can open his eyes, respond to questions, then fall back to sleep. A stuporous patient arouses from sleep only after painful stimuli. Question: A transient ischemic attack is: a transient episode of neurologic dysfunction by focal brain, spinal cord, or retinal ischemia, without acute infarction. an infarction of the central nervous system tissue that may be silent or symptomatic. the abrupt onset of motor or sensory deficits. focal or asymmetric weaknesses caused by central and peripheral nerve damage. TIA is now defined as “a transient episode of neurological dysfunction caused by focal brain, spinal cord, or retinal ischemia, without acute infarction.” Ischemic stroke is “an infarction of central nervous system tissue” that may be symptomatic or silent. The other terms are not related to the new definitions. Question: A patient is noted as lying supine with the jaws clenched and the neck extended with the arms adducted and stiffly extended at the elbows. His forearms are pronated, wrists and fingers flexed. The legs are extended at the knees and the feet are plantar flexed. This position is consistent with: hemiplegia. decorticate rigidity. decerebrate rigidity. paratonia. In decerebrate rigidity, the jaws are clenched and the neck is extended with the arms adducted and stiffly extended at the elbows, with forearms pronated, wrists and fingers flexed. A patient is noted as lying supine in an abnormal posture with the upper arms flexed tight to the sides with elbows, wrists, and fingers flexed. His legs are extended and internally rotated and his feet are plantar flexed. This position is consistent with decorticate rigidity. The legs are extended at the knees and the feet are plantar flexed. Hemiplegia refers to one-sided paralysis. Paratonia refers to a form of hypertonia with an involuntary variable resistance during passive movement. 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. marijuana. opioids. 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: Hypesthesia refers to: absence of touch sensation. decreased sensitivity to touch. increased sensitivity to touch. absence of pain sensation. 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: With the adult patient lying supine, the nurse practitioner flexes the patient's leg at both the hip and the knee and then straightens the knee. Pain and increased resistance to extending the knee is noted. This is a positive: Brudzinski's sign. Kernig's sign. nuchal rigidity sign. Babinski'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 Brudzinski's sign, flex the neck. Flexion of both the hips and knees is positive for Brudzinski's. With the patient lying supine, the nurse practitioner places her hands behind the patient's head while flexing his neck forward so that his chin touches his chest. Neck stiffness with resistance to flexion is noted. This is positive for nuchal rigidity and suggestive of meningeal inflammation from meningitis or subarachnoid hemorrhage. 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 Babinski's sign. 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. polyneuropathy. myositis. neuromuscular junction disorders. 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: 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 Compare the sensation in the right arm to that in the left arm Test the sensation in the fingers and the toes Stimulate first at an area of reduced sensation and move by progressive steps until the patient detects a change 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: 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. 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. remains unarousable with eyes closed. 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: With the adult patient lying supine, the nurse practitioner flexes the patient's neck while observing the hips and knees. Flexion of both hips and knees was noted. This is a positive: Brudzinski's sign. Kernig's sign. nuchal rigidity sign. Babinski's sign. To elicit Brudzinski's sign, flex the neck. Flexion of both the hips and knees is 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. With the patient lying supine, the nurse practitioner places her hands behind the patient's head while flexing his neck forward so that his chin touches his chest. Neck stiffness with resistance to flexion is noted. This is positive for nuchal rigidity and suggestive of meningeal inflammation from meningitis or subarachnoid hemorrhage. 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: The part of the brain tissue that consists of neuronal axons that are coated with myelin is the: basal ganglion. white matter. gray matter. thalamus. 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: The inability to hop in place on each foot, could be suggestive of a: cerebellar dysfunction. corticospinal tract weakness. proximal tract weakness. weakness of the quadriceps. Inability to hop in place on each foot could denote cerebellar dysfunction, weakness, or lack of position sense. Hopping involves the proximal muscles of the legs as well as the distal ones and requires both good position sense and normal cerebellar function. 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. 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: The term used to describe an abnormal tremor consisting of involuntary jerking movements, especially in the hands is: asterixis. sciatica. dermatome. stereognosis. 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: When assessing an elderly patient for delirium, the recommended instrument with the best supportive data is the: Delirium Rating Scale (DRS). Confusion Assessment Method (CAM). Mini Mental State Examination (MMSE). Delirium Superimposed on Dementia Algorithm (DSDA). 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: Walking on the toes and heels may reveal: distal muscular weakness in the legs. ataxia. a cerebellar dysfunction. proximal weakness of the extensors of the hip. 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: Involuntary rhythmic, repetitive, bizarre movements that chiefly involve the face, mouth, jaw, and tongue are known as: facial tics. dystonic movements. athetoid movements. oral-facial dyskinesias. 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. 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. Question: Persistent blinking after glabellar tap and difficulty walking heel-to- toe are common in: Alzheimer's disease. Muscular Dystrophy. Parkinson’s disease. Multiple Sclerosis. 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: To evaluate a patient's response to light touch sensation, the nurse practitioner would ask the patient to identify: a touch on the skin in response to touching the skin with a cotton wisp. an object as being hot or cold. a vibration sensation on the big toe. pain as sharp or dull when the thumb is touched using the sharp end of a safety pin. A light touch on the skin in response to touching the skin with a cotton wisp would be an example of assessing for light touch. To evaluate for pain, a safety pin could be used to determine if the sensation is sharp or dull. To evaluate a patient's response to temperature sensation, the nurse practitioner would ask the patient to identify an object as being hot or cold. To test for vibration, use a tuning fork over the interphalangeal joint of the big toe and ask the patient if he feels the vibration. Question: A form of aphasia where articulation is good but sentences lack meaning is referred to as: Broca's aphasia. anomic aphasia. Wernicke's aphasia. global aphasia. 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. 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 global aphasia, the person has difficulty speaking and understanding words and is unable to read or write. 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) Cranial Nerve X (CN X) Touching the cornea and assessing for a reflex assesses cranial nerve V. 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. the plantar response. the ankle reflex. 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: Hyperesthesia refers to: absence of touch sensation. decreased sensitivity to touch. increased sensitivity to touch. absence of pain sensation. 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 female patient complains of weakness in her hand when opening a jar. This finding could be suggestive of which type of weakness pattern? Proximal Distal Symmetric Asymmetric 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: 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. 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: What geriatric condition is characterized by normal alertness but progressive global deterioration of cognition in multiple domains? Delirium Cognitive impairment Parkinson's disease Alzheimer's disease 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: Having the patient shrug his shoulders and elicit neck movements would be testing Cranial Nerve: VI. VII. IX. XI. Cranial Nerve XI is the spinal accessory nerve and is responsible for proper functioning of the shoulder and neck muscles. When the trapezius is paralyzed, the shoulder droops and the scapula is displaced downward and laterally. Weakness with atrophy and fasciculations indicates a peripheral nerve disorder. CN VI tests extraocular movements; CN VII tests hearing; and CN IX and X test swallowing and the gag reflex. Question: To evaluate a patient's response to temperature sensation, the nurse practitioner would ask the patient to identify: a light touch on the skin in response to touching the skin with a cotton wisp. an object as being hot or cold. a vibration sensation on the big toe. pain as sharp or dull when the thumb is touched using the sharp end of a safety pin. To evaluate a patient's response to temperature sensation, the nurse practitioner would ask the patient to identify an object as being hot or cold. A light touch on the skin in response to touching the skin with a cotton wisp would be an example of assessing for light touch. To evaluate for pain, a safety pin could be used to determine if the sensation is sharp or dull. To test for vibration, use a tuning fork over the interphalangeal joint of the big toe and ask the patient if he feels the vibration. Question: During this type of seizure activity, the patient experiences partial seizures that resemble tonic-clonic seizures. The patient may recall the aura and a unilateral neurologic deficit is present during the postictal period. This type of seizure activity is referred to as a: focal seizure with impairment of consciousness. Jacksonian seizure. focal seizure that becomes generalized. grand mal seizure. Focal seizures that become generalized are partial seizures that resemble tonic-clonic seizures. The patient may recall the aura and a unilateral neurologic deficit is present during the postictal period. 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. Tonic and then clonic movements that start unilaterally in the hand, foot, or face and spread to other body parts on the same side with the patient remaining conscious are known as Jacksonian seizures. During a grand mal seizure the person loses consciousness suddenly, sometimes with a cry, and the body stiffens into tonic extensor rigidity. Breathing stops, and the person becomes cyanotic. A clonic phase of rhythmic muscular contraction follows. 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) Cranial nerve VII (CN VII) Cranial nerve XII (CN XII) 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: A patient presents with history of temperature of 102°F, headache, and pink papules on the upper chest several hours ago. Petechiae and ecchymosis are noted on the trunk. These skin lesions may be indicative of: leukemia. meningococcemia. neurofibromatosis. hemorrhagic pancreatitis. Skin lesions associated with meningococcemia initially present as pink macules and papules. Within minutes to a few hours, petechiae, hemorrhagic petechiae, hemorrhagic bullae, and purpura fulminans become apparent. With meningococcemia meningitis, the temperature may be 102°F or greater and the patient appears very ill. Skin lesions associated with leukemia may include pallor, exfoliative erythroderma, nodules, petechiae, ecchymoses, pruritus, vasculitis, pyoderma gangrenosum, and bullous diseases. Skin lesions associated with neurofibromatosis may include, neurofibromas, cafe´-au-lait spots, freckling in the axillary and inguinal areas, and plexiform neurofibroma. Hemorrhagic pancreatitis skin lesions include Grey Turner's sign (bruising of the flanks, appearing as a blue discoloration), Cullen's sign (superficial edema and bruising in the subcutaneous fatty tissue around the umbilicus), and panniculitis (a group of diseases whose hallmark is inflammation of subcutaneous adipose tissue). Question: Aphasia 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. Aphasia refers to a disorder in producing or understanding language. Aphonia refers to a loss of voice that accompanies disease affecting the larynx or its nerve supply. Dysphonia refers to less severe impairment in the volume, quality, or pitch of the voice. Dysarthria refers to a defect in the muscular control of the speech apparatus (lips, tongue, palate, or pharynx). Question: The part of the brain that maintains homeostasis is the: basal ganglion. thalamus. hypothalamus. cerebellum. 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: Sudden, brief, rapid jerks, involving the trunk or limbs may be consistent with: a myoclonic seizure. an absent seizure. a myoclonic atonic seizure. a focal seizure with impairment of consciousness. 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: Involuntary movements of the body that involve larger portions of the body, including the trunk resulting in grotesque, twisted postures are suggestive of: facial tics. dystonic movements. athetoid movements. oral-facial dyskinesias. Dystonic movements are similar to athetoid movements, but often involve larger portions of the body, including the trunk. Grotesque, twisted postures may result. Facial tics are brief, repetitive, stereotyped, coordinated movements occurring at irregular intervals. Examples include repetitive winking, grimacing, and shoulder shrugging. 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: On examination of an eighteen-year-old which one of the following neurological signs would not be helpful if meningitis is suspected? Pain in the neck and resistance to flexion. A positive Brudzinski's sign. A positive Kernig's sign. Loss of the anal reflex. If meningitis is suspected, nuchal rigidity, positive Brudzinski sign, and Kernig's sign should all be assessed. If these meningeal signs are positive, meningitis is suspected. A loss of anal reflex would suggest a lesion in the S2, 3, and 4 reflex arc. Therefore, it would not be helpful with the differential diagnosis. Question: The term used to describe the impaired ability to adjust to one's body position is: dystonia. bradykinesia. akinesia. dyskinesia. 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. Dystonia is a neurological disorder that causes involuntary muscle spasms and twisting of the limbs. The absence or loss of control of voluntary muscle movements is akinesia. 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. 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: When assessing the cranial nerves, the nurse practitioner instructs the patient to stick out his tongue and move it from side to side. This maneuver would be used to assess which cranial nerve? Cranial Nerve V (CN V) Cranial Nerve VII (CN VII) Cranial Nerve IX (CN IX) Cranial Nerve XII (CN XII) Instructing the patient to stick out his tongue and move it from side to side would be used to assess cranial nerve XII (CN XII)-Hypoglossal nerve. Question: 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 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: Which of the following symptoms may be associated with a tumor of the eighth cranial nerve? Dizziness Inability to close the eyes Loss of the sense of smell Inability to taste sour things 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 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) Cranial Nerve XII (CN XII) Unilateral absence of the gag reflex suggests a lesion of CN IX or CN X. glossopharyngeal and vagus nerves. 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 10 Thoracic 10, 11, and 12 Lumbar 5 and Sacral 1 Sacral 2, 3, and 4 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: One way to assess cerebellar function would be to have the patient: hop on one foot. read out loud. shrug the shoulders. discriminate between light and sharp pain. 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: The term used to describe the absence or loss of control of voluntary muscle movements is: dystonia. bradykinesia. akinesia. dyskinesia. 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: A type of seizure activity that includes tonic and then clonic movements and usually starts in the hand, foot or face then spreads to other parts of the body is known as a: focal seizure with impairment of consciousness. Jacksonian seizure. focal seizure that become generalized. grand mal seizure. Tonic and then clonic movements that start unilaterally in the hand, foot, or face and spread to other body parts on the same side with the patient remaining conscious are known as Jacksonian seizures. Focal seizures with impairment of consciousness is characterized when a person appears confused. Automatisms include automatic motor behaviors such as chewing, smacking the lips, walking about, and unbuttoning clothes. Focal seizures that become generalized are partial seizures that resemble tonic-clonic seizures. The patient may recall the aura and a unilateral neurologic deficit is present during the postictal period. During a grand mal seizure the person loses consciousness suddenly, sometimes with a cry, and the body stiffens into tonic extensor rigidity. Breathing stops, and the person becomes cyanotic. A clonic phase of rhythmic muscular contraction follows. 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 muscle strength? Motor system Cerebellar system Vestibular system Sensory system 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 a two-week-old infant presents with irritability, poor appetite, and rapid head growth with distended scalp veins, one should consider: hydrocephalus. meningitis. cerebral palsy. Reye's syndrome. The combination of signs is strongly suggestive of hydrocephalus: shrill with high-pitched cry, irritability, tense and bulging fontanels due to the increased amount of CSF being produced or not being absorbed. Meningitis would include signs of sepsis/infection. The manifestations of cerebral palsy vary but may include: persistence of primitive reflexes, delayed gross motor development, and a lack of progression through developmental milestones. Reye’s syndrome is associated with an antecedent viral infection with symptoms of malaise, nausea, and vomiting, progressive neurological deterioration occurs. Question: When evaluating the sensory system, testing the posterior columns tract would include assessing sensations of: position and vibration. pain and temperature. deep touch. discriminative sensations. 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: 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. a weak vestibular system. 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: 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. an orthopedic referral. 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: The most widely used tool available to assess for dementia in an elderly patient is the: Delirium Rating Scale (DRS). Confusion Assessment Method (CAM). Mini Mental State Examination (MMSE). Delirium Superimposed on Dementia Algorithm (DSDA). The Mini Mental State Examination (MMSE)is the most widely used instrument to test cognitive function and is considered the best tool for assessing most elderly patients suspected of experiencing dementia. 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 Delirium Superimposed on Dementia Algorithm recommends a process to assess for delirium for people with a pre-existing dementia. Question: Uncontrolled electrical activity in the brain, which may produce minor physical signs, thought disturbances, or disturbed motor activity is: dystonia. bradykinesia. tremor. seizure. A seizure is an uncontrolled electrical activity in the brain which may produce minor physical signs, thought disturbances, or disturbed motor activity, or a combination of symptoms. 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. A rhythmic oscillatory movement of a body part resulting from the contraction of opposing muscle groups is a tremor. Question: A term used to describe an increase in muscular bulk with proportionate strength is: hypertrophy. muscular atrophy. pseudohypertrophy. muscle weakness. Hypertrophy refers to an increase in bulk of the muscle with a proportionate increase in strength. A term used to describe muscle wasting or loss of muscle bulk is muscular atrophy. An increase in muscular bulk with diminished strength is known as pseudohypertrophy. Muscular weakness is a term used to describe a lack of strength or firmness in a muscle. 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. cerebellum. diencephalon. 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: Symptoms indicative of Shaken Baby Syndrome are related to: poor nutrition and lack of parental bonding. vaso-occlusive crisis and cerebral infarction. uncontrollable cerebral edema and hypoxia. microcephaly and premature closures of the cranial sutures. Brain damage resulting from shaking of the body and rapid flexing and extension of the head results in hypoxia and cerebral edema leading to symptoms of blindness, inability to perform previously learned milestones, and very flaccid muscle tone. The other choices are not the culprits of this type injury/abuse. It is caused by someone shaking the child and causing irreversible brain damage in most cases. Question: Fasciculations in atrophic muscles suggest: a lower motor neuron disease. rheumatoid arthritis. peripheral nervous system disease. a central nervous system disorder. 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: 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 system Cerebellar system Vestibular system Sensory system 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: Symmetric weakness of the distal muscles of the legs suggests a: polyneuropathy. myopathy. sensory neuropathy. cerebellar disease. 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: When upper motor neuron systems are damaged below the crossover of its tracts in the medulla, motor impairment develops on the same side. This term is: ipsilateral. contralateral. superficial. intermediate. 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: The nurse practitioner instructs the patient to close his eyes and then grasps his big toe and moves the toe up or down asking the patient to ly identify the direction of the movement. This is an example of identifying: pain sensation in the big toe. vibration of the big toe. proprioception of the big toe. light touch sensation in the big toe. To evaluate proprioception or position sensation in the big toe, the nurse practitioner would grasp the patient's big toe and move it up or down while the patient has his eyes closed. The patient would identify the position of the movement. Question: Which one of the following symptoms is not associated with bulbar symptoms? Diplopia Ptosis Dysphagia Dysesthesias Dysesthesias are a distortion of any sense, especially that of touch and is associated with spinal cord injuries. Characteristics include numbness, tingling, burning, or pain felt below the level of the injury. The pons and medulla form the "bulb", or bulbar area of the brain, which controls the bulbar muscles in the throat, tongue, jaw and face. Bulbar symptoms include diplopia, ptosis, dysphagia, and dysarthria. Question: Bilateral weakness in cranial nerve V (CN V) would be suggestive of a: bilateral hemispheric disease. central nervous system lesions. pontine lesion. brainstem lesion. Bilateral weakness in cranial nerve V (CN V), the trigeminal nerve, is suggestive of a bilateral hemispheric disease. Question: To evaluate a patient's response to a vibration sensation, the nurse practitioner would ask the patient to identify: a touch on the skin in response to touching the skin with a cotton wisp. an object as being hot or cold. the sensation when the tuning fork is placed on the big toe. pain as sharp or dull when the thumb is touched using the sharp end of a safety pin. To test for vibration, use a tuning fork over the interphalangeal joint of the big toe and ask the patient if he feels the vibration. Touching the skin with a cotton wisp is an example of assessing for light touch. To evaluate a patient's response to temperature sensation, the nurse practitioner would ask the patient to identify an object as being hot or cold. To evaluate for pain, a safety pin could be used to determine if the sensation is sharp or dull. 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. suggestive of cerebellar ataxia. corticospinal track damage. 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: Intention tremors appear with movement and: worsen with stress. increase during sleep. are more pronounced when maintaining a posture. worsen as the target gets closer. 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: Intention tremors appear with movement and: worsen with stress. increase during sleep. are more pronounced when maintaining a posture. worsen as the target gets closer. 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: A form of aphasia in which the person has word-finding difficulties for speaking and writing is known as: Broca's aphasia. anomic aphasia. Wernicke's aphasia. global aphasia. 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: With Duchenne muscular dystrophy: boys inherit the condition from their father. the onset of symptoms occurs in late childhood and adolescence. symptoms include tremors, hypertonicity, and seizures. characteristics include a waddling gait, lordosis and presence of Gower's sign. Duchenne muscular dystrophy (DMD) is an X-link inherited recessive disorder and is passed from mother to male offspring. DMD is a congenital disorder with symptoms appearing during the 2nd and 3rd year of life. Tremors, hypertonicity and seizures are more consistent with cerebral palsy. Waddling gait, lordosis and Gower's maneuver are signs of DMD. Gower's sign is classic for DMD. The patient has to use his hands and arms to "walk" up his own body from a squatting position due to lack of hip and thigh muscle strength. Question: When eliciting deep tendon reflexes in the biceps, the nurse practitioner notes an abnormal reflex in the right biceps. This abnormality is probably consistent with a pathological lesion in which segmented level of the spine? Cervical 5 and 6 Cervical 6 and 7 Lumbar 2, 3, and 4 Sacral 1 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 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. sympathetic nervous system. parasympathetic nervous system. 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 term used to describe low back pain with nerve pain that radiates down the leg is: asterixis. sciatica. dermatome. stereognosis. 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: An example of tandem walking is having the patient: walk across the room. walk heel-to-toe. walk on the toes, then on the heels. walk with a shallow knee bend. 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 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. stupor. 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: Most peripheral nerves contain afferent and efferent fibers. The term efferent refers to: the cranial nerve fibers. spinal nerve fibers. sensory nerve fibers. motor nerve fibers. The peripheral nervous system includes spinal and peripheral nerves that carry impulses to and from the cord. Spinal nerve fibers co-mingle with similar fibers from other levels in plexuses outside the cord, from which peripheral nerves emerge. Most peripheral nerves contain both sensory (afferent) and motor (efferent) fibers. 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 6 Cervical 6 and 7 Lumbar 2, 3, and 4 Sacral 1 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: Ataxia, diplopia, and dysarthria can be symptoms associated with all of the following conditions except: posterior fossa tumor. vertebrobasilar transient ischemic attack. polyneuropathy. hemicranial migraine. Ataxia, diplopia, and dysarthria are suspicious for vertebrobasilar transient ischemic attack or stroke, posterior fossa tumor and vertebrobasilar or hemicranial migraine. Polyneuropathy usually presents as bilateral distal weakness. Question: A discriminative sensation that describes the ability to identify an object by feeling it is: graphesthesia. stereognosis. two point discrimination. astereognosis. 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: A band of skin innervated by the sensory root of a single spinal nerve is termed a: peripheral nerve field. dermatome. synapse asterixis. A band of skin innervated by the sensory root of a single spinal or dorsal nerve root is termed a dermatome. A peripheral nerve field refers to an area of the skin innervated by a single nerve and is described as cutaneous nerve distribution. A synapse is a structure that permits a neuron to pass an electrical or chemical signal to another cell. 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 known as flapping tremor. Question: An example of distal weakness is: the right shoulder. the right hand. both arms. one the right side of the face. 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: To evaluate a patient's response to pain sensation, the nurse practitioner would ask the patient to identify: a light touch on the skin in response to touching the skin with a cotton wisp. an object as being hot or cold. a vibration sensation on the big toe. pain as sharp or dull when the thumb is touched using the sharp end of a safety pin. To evaluate for pain, a safety pin could be used to determine if the sensation is sharp or dull. To evaluate a patient's response to temperature sensation, the nurse practitioner would ask the patient to identify an object as being hot or cold. A light touch on the skin in response to touching the skin with a cotton wisp would be an example of assessing for light touch. To test for vibration, use a tuning fork over the interphalangeal joint of the big toe and ask the patient if he feels the vibration. Question: Ptosis of the left eye would be suggestive of damage to which cranial nerve? Cranial Nerve II (CN II) Cranial Nerve III (CN III) Cranial Nerve IV (CN IV) Cranial Nerve V (CN V) Ptosis of the left eye would be suggestive of 3rd nerve palsy (CN III)-Oculomotor nerve. Question: The most common cause of viral encephalitis in children is: Herpes simplex virus Type II Picornavirus Enteroviruses Herpes simplex virus Type I Herpes simplex Type I is the most common cause of viral encephalitis in children. The other choices are . Question: An older adult presenting with signs of undernourishment, slowed motor performance, and loss of muscle mass or weakness suggests: depression. frailty. Parkinson's disease. Alzheimer's disease. Undernutrition, slowed motor performance, loss of muscle mass, or weakness suggests frailty. Question: The central nervous system extends from the medulla into the: midbrain. pons. cerebrum. spinal cord. 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 asked to visually follow a finger through the cardinal fields of gaze. Which cranial nerves are being assessed? I II, IV III, IV, VI V, VI, VII Visually following a finger through the cardinal fields of gaze is one way to assess the oculomotor (CN III), trochlear (CN IV) and abducens (CN VI) nerves. CN I is the olfactory nerve and assesses smell. CN II is the optic nerve and assesses visual acuity. CN V is the trigeminal nerve and assesses both sensory and motor functions. Question: While palpating the temporal and masseter muscles, the patient is asked to clench his teeth and move his jaw from side to side. This maneuver would be assessing which cranial nerve? Cranial Nerve III (CN III) Cranial Nerve IV (CN IV) Cranial Nerve V (CN V) Cranial Nerve VII (CN VII) Palpation of the temporal and masseter muscles, when the patient clenches his teeth and moves his jaw from side to side. This maneuver assesses the Trigeminal nerve and cranial nerve (CN V). Question: When observing for thenar atrophy of the hands, a typical observation is: furrowing in the spaces between the metacarpals. thenar eminences appear full. the hypothenar eminences would appear convex. the spaces between the metacarpals would be slightly depressed. 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: A form of aphasia in which the person has difficulty speaking and understanding words and is unable to read or write is termed: Broca's aphasia. anomic aphasia. Wernicke's aphasia. global aphasia. With global aphasia, the person has difficulty speaking and understanding words and is unable to read or write. 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. Question: A rhythmic oscillatory movement of a body part resulting from the contraction of opposing muscle groups is: dystonia. bradykinesia. a tremor. a seizure. A rhythmic oscillatory movement of a body part resulting from the contraction of opposing muscle groups is a tremor. 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. A seizure is an uncontrolled electrical activity in the brain which may produce minor physical signs, thought disturbances, or disturbed motor activity, or a combination of symptoms. Question: The straight leg raise maneuver tests for: peripheral nerve involvement. plantar response. asterixis. sciatica. The straight leg raise maneuver tests for sciatica, especially if in the S1 distribution. Question: Most peripheral nerves contain afferent and efferent fibers. The term afferent refers to: the cranial nerve fibers. spinal nerve fibers. sensory nerve fibers. motor nerve fibers. The peripheral nervous system includes spinal and peripheral nerves that carry impulses to and from the cord. Spinal nerve fibers co-mingle with similar fibers from other levels in plexuses outside the cord, from which peripheral nerves emerge. Most peripheral nerves contain both sensory (afferent) and motor (efferent) fibers. Question: Aphonia 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. Aphonia refers to a loss of voice that accompanies disease affecting the larynx or its nerve supply. Dysphonia refers to less severe impairment in the volume, quality, or pitch of the voice. Dysarthria refers to a defect in the muscular control of the speech apparatus (lips, tongue, palate, or pharynx). Aphasia refers to a disorder in producing or understanding language. Question: The part of the brain tissue that rims the surfaces of the cerebral hemispheres, forming the cerebral cortex is known as the: basal ganglion. white matter. gray matter. thalamus. 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. Basal ganglia and the thalamus are located in the gray matter. Basal ganglia affect movement and the thalamus processes sensory impulses. 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. a myoclonic atonic seizure. a focal seizure with impairment of consciousness. 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: 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 Cerebellar system Vestibular system Sensory system 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: What is an example of a disease or condition that appears in a dermatomal pattern? Fibromyalgia Shingles Diabetic neuropathy Referred pain A band of skin innervated by the sensory root of a single spinal nerve is a dermatome. Symptoms that follow a dermatome (e.g. like pain or a rash) may indicate pathology that involves the related nerve root. Viruses that lie dormant in nerve ganglia (e.g. varicella zoster virus, which causes both chickenpox and herpes zoster shingles), often cause either pain, rash or both in a pattern defined by a dermatome. However, the symptoms may not appear across the entire dermatome. Referred pain usually involves a specific "referred" location so is not associated with a dermatome. Diabetic neuropathy results from nerve damage related to high levels of glucose in the body and the resulting pain or absence of pain does not follow a dermatomal pattern. Fibromyalgia appears to result from neuro-chemical imbalances including activation of inflammatory pathways in the brain which results in abnormalities in pain processing. Question: The part of the brain that coordinates all movement and helps maintain the body upright in space is the: cerebrum. brainstem. cerebellum. diencephalon. 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: A discriminative sensation that describes the ability to identify a number drawn in the hand when the patient's eyes are closed is: graphesthesia. stereognosis. two point discrimination. astereognosis. 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 it. 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: Which one of the following senses is most often affected in patients on long-term antibiotic therapy? Touch Taste Smell Hearing Many antibiotics can produce varying degrees of ototoxicity. The other senses are rarely, if ever, affected by long - term antibiotic use. Question: The part of the peripheral nervous system that controls involuntary actions is known as the: autonomic nervous system. somatic nervous system. sympathetic nervous system. parasympathetic nervous system. The autonomic nervous system is part of the peripheral nervous system and generates autonomic reflex responses and consists of the sympathetic and parasympathetic nervous systems. 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 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 classic signs of a basilar skull fracture include hemotympanum and: intracranial hematoma. pain in the occipital area. CSF leak from nose and ears. bilateral retinal hemorrhages. Signs of a basilar skull fracture are battle's sign, raccoon eyes, rhinorrhea, otorrhea and hemotympanum (blood in the tympanic cavity). Intracranial hematoma is associated with a general skull fracture. Pain in the occipital region is associated with occipital fracture. Bilateral retinal hemorrhages are associated with shaken baby syndrome. Question: When assessing plantar reflexes, the nurse practitioner strokes the lateral aspect of the sole from the heel to the ball of the right foot. Absence of movement of the big toe is noted. This finding could be suggestive of a pathologic lesion in which segmented level of the spine? Thoracic 8, 9, and 10 Thoracic 10, 11, and 12 Lumbar 5 and Sacral 1 Sacral 2, 3, and 4 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: 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? Proximal Distal Symmetric Asymmetric To identify symmetric weakness, ask about experiencing weakness in the same area on both sides of the body. 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. temperature greater than 100.8 degrees Fahrenheit. noticeable increase in activity. bulging fontanels. 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 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 position sense? Motor system Cerebellar system Vestibular system Sensory system 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: 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. oral-facial dyskinesias. 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: Symmetric weakness of the proximal muscles of the legs suggests a: polyneuropathy. myopathy. sensory neuropathy. cerebellar disease. 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: Winging of the scapula can be noted in patients with all of the following conditions except: liver disease. injury to the long thoracic nerve. muscular dystrophy. weakness of the serratus anterior muscle. 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: 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. absent retinal hemorrhages. 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: The part of the brain that relays sensory information between brain regions and controls many autonomic functions of the peripheral nervous system is known as the: cerebrum. brainstem. cerebellum. diencephalon. 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 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. The brainstem controls most functions in the body but is mostly responsible for breathing, heart rate, and articulate speech. The cerebellum, which lies at the base of the brain, coordinates all movement and helps maintain the body upright in space. Question: An example of proximal weakness is: the right shoulder. the right hand. both arms. on the right side of the face. 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: 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 first Moves about by crawling on the abdomen or all four extremities Generally meets motor developmental milestones on schedule Presence of crossed or touching knees 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: Which of the following procedures should NOT be performed in a comatose patient? Check corneal response Check pupillary response Flex the neck Inspect the posterior pharynx The neck of a comatose patient should not be flexed if there is any question of trauma to the head or neck. The other procedures can be performed on a comatose patient. 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. 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. 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: A female patient complains of weakness in her arm when combing her hair. This finding could be suggestive of which type of weakness pattern? Proximal Distal Symmetric Asymmetric To identify proximal weakness, ask about difficulty with movements such as combing hair, reaching up to a shelf, getting up out of a chair, or climbing a high step. Question: Assessing the neurological status of a child with a ventriculoperitoneal shunt should include: use of the Glasgow coma scale. Kernig's sign. brudzinski's sign. Monroe-Kellie doctrine. 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: The level of consciousness that refers to the patient who opens his eyes, looks at the person speaking to him but responds slowly and appears confused is known as: obtundation. alertness. lethargy. stupor. 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. A stuporous patient arouses from sleep only after painful stimuli. Question: On physical exam, the soft palate does not rise, there is an absent gag reflex, and the patient complains of taste abnormalities. This requires further evaluation of the: hypoglossal nerve (CN XII). facial nerve (CN VII). glossopharyngeal nerve (IX). trigeminal nerve (CN V). The glossopharyngeal and vagus nerves assess swallowing, salivation, taste perception and voice quality. The hypoglossal nerve assesses tongue movement and swallowing. The facial nerve assesses taste on the anterior portion of the tongue and facial muscles. The trigeminal nerve assesses the corneas, nasal and oral mucosa, facial skin, the jaw and chewing muscles. 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. perspire, vomit and have diarrhea. appear shaky, hypoactive, and in respiratory distress. 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: The thalamus and the basal ganglion are located in the: spinal cord. peripheral nervous system. white matter. gray matter. Deep in the brain lie additional clusters of gray matter. These include the basal ganglia, which affect movement, and the thalamus and the hypothalamus structures in the diencephalon. The thalamus processes sensory impulses and relays them to the cerebral cortex. Question: An ischemic stroke is: a transient episode of neurologic dysfunction by focal brain, spinal cord, or retinal ischemia, without acute infarction. an infarction of the central nervous system tissue that may be silent or symptomatic. the abrupt onset of motor or sensory deficits. focal or asymmetric weaknesses caused by central and peripheral nerve damage. 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: Assessment findings in an infant with increased intracranial pressure would include: increased hunger. drowsiness. papilledema. blurred vision. 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: A teenager is being assessed for possible acute marijuana usage and appears intoxicated. Findings consistent with marijuana intoxication could include: euphoria, talkativeness, and paranoia. mild respiratory distress, ataxia, and normal blood pressure. drowsiness, constricted pupils, and memory impairment. impaired judgment, anxiety, and slurred speech. 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: 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. two point discrimination. point localization. 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: The level of consciousness that refers to the patient that arouses from sleep only after painful stimuli is known as: obtundation. alertness. lethargy. stupor. 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: 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. an amphetamine overdose. an overdose of benzodiazepines. marijuana usage. 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: Analgesia refers to: decreased sensitivity to pain. increased sensitivity to pain. absence of pain sensation. absence of touch sensation. 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 conducting a neurologic exam, which one of the following assessments is not considered part of the mental status assessment? Level of alertness Cranial Nerve II (CNII) Appropriateness of responses Orientation to time 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: The Glasgow coma scale assesses: cranial nerve response. pupillary response. motor response. auditory response. Based on motor responsiveness, verbal performance, and eye opening to appropriate stimuli, the Glasgow Coma Scale was designed and should be used to assess the depth and duration of coma and impaired consciousness. This scale helps to gauge the impact of a wide variety of conditions such as acute brain injury due to traumatic and/or vascular injuries or infections, metabolic disorders such as hepatic or renal failure, hypoglycemia, or diabetic ketoacidosis. Cranial nerve, auditory, and pupillary responses are not included in the come scale assessment. Question: An ambulatory child with spastic cerebral palsy needs a diet: high in potassium. low in fiber. low in sodium. high in calories. Every child’s nutrient needs must be assessed individually. It is important to take a number of factors into consideration when estimating energy needs: age, activity level, growth rate, and muscle tone. A child with spastic cerebral palsy (CP) who is not ambulatory will likely have lower energy requirements than a child with spastic CP who is ambulatory. A child with ambulatory spastic CP needs a diet high in calories to provide for increased metabolic needs secondary to energy lost through spastic movements and tremors. Foods rich in fiber are needed to prevent constipation and other gastrointestinal problems associated with cerebral palsy. Diet with balanced electrolytes is preferred. Question: Hyperalgesia refers to: decreased sensitivity to pain. increased sensitivity to pain. absence of pain sensation. absence of touch sensation. 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: The term used to describe a distortion of any sense, especially that of touch, is: absence of sensation. weakness. dysesthesia. paresthesia. 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: 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. Kernig's sign. nuchal rigidity sign. Babinski'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 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: Resting tremors refer to those tremors that disappear: at rest. with voluntary movement. when the affected part is actively maintaining a posture. when the target gets closer. 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: The term used to describe a lack of strength (or firmness) is: absence of sensation. weakness. dysesthesia. paresthesia. Weakness is a term used to describe a lack of strength or firmness and its presence requires further investigation. Absence of sensation would be defined as inability to feel pain or sensation when touched. Dysesthesia is defined as a distortion of any sense, especially that of touch. Paresthesia is a sensation of tingling, tickling, prickling, pricking, or burning of a person's skin. Question: Disorders of speech fall into three groups that affect all of the following except the: voice. articulation of speech. written language. comprehension of language. 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: A patient is unable to identify the smell of an orange. This inability could reflect an abnormality in cranial nerves: I. II. III. VIII. 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 ly identify the source. Cranial Nerves II and III assess vision and pupillary reaction. Cranial Nerve VIII tests the hearing and balance. Question: During this type of seizure activity, the patient appears confused. Automatisms include automatic motor behaviors such as chewing, smacking the lips, walking about, and unbuttoning clothes. This type of seizure activity is referred to as a: focal seizure with impairment of consciousness. Jacksonian seizure. focal seizure that become generalized. grand mal seizure. 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. Tonic and then clonic movements that start unilaterally in the hand, foot, or face and spread to other body parts on the same side with the patient remaining conscious are known as Jacksonian seizures. Focal seizures that become generalized are partial seizures that resemble tonic-clonic seizures. The patient may recall the aura and a unilateral neurologic deficit is present during the postictal period. During a grand mal seizure the person loses consciousness suddenly, sometimes with a cry, and the body stiffens into tonic extensor rigidity. Breathing stops, and the person becomes cyanotic. A clonic phase of rhythmic muscular contraction follows. Question: A term used to describe muscle wasting or loss of muscle bulk is: hypertrophy. muscular atrophy. pseudohypertrophy. muscle weakness. A term used to describe muscle wasting or loss of muscle bulk is muscular atrophy. Hypertrophy refers to an increase in bulk of the muscle with proportionate strength. An increase in muscular bulk with diminished strength is known as pseudohypertrophy. Muscular weakness is a term used to describe a lack of strength or firmness in a muscle. Question: Anesthesia refers to: decreased sensitivity to pain. increased sensitivity to pain. absence of pain sensation. absence of touch sensation. 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: During this type of seizure activity, the patient loses consciousness suddenly, sometimes with a cry, and the body stiffens into tonic extensor rigidity. Breathing stops, and the person becomes cyanotic. A clonic phase of rhythmic muscular contraction follows. This type of seizure activity is referred to as a: focal seizure with impairment of consciousness. Jacksonian seizure. focal seizure that become generalized. grand mal seizure. During a grand mal seizure the person loses consciousness suddenly, sometimes with a cry, and the body stiffens into tonic extensor rigidity. Breathing stops, and the person becomes cyanotic. A clonic phase of rhythmic muscular contraction follows. Focal seizures that become generalized are partial seizures that resemble tonic-clonic seizures. The patient may recall the aura and a unilateral neurologic deficit is present during the postictal period. 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. Tonic and then clonic movements that start unilaterally in the hand, foot, or face and spread to other body parts on the same side with the patient remaining conscious are known as Jacksonian seizures. Question: A patient presents with sweating, tremors, palpitations, hunger, and confusion. This patient is most likely experiencing: a syncopic event. hypoglycemia. postural hypotension. hypocapnia. A patient presenting with sweating, tremors, palpitations, hunger, headache, abnormal behavior, confusion, could be experiencing classic symptoms of hypoglycemia. Syncope could present with nausea and vomiting, dizziness, and possible fainting. Postural hypotension usually occurs after one stands up. Usually there are no prodromal symptoms. The blood pressure returns to normal when the patient lies down. Hypocapnia is decreased carbon dioxide and symptoms include dyspnea, palpitations, chest discomfort, numbness and tingling in the hands and around the mouth lasting for several minutes. Consciousness is maintained. 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. 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: The term used to describe involuntary muscle spasms and twisting of the limbs is: dystonia. bradykinesia. akinesia. dyskinesia. 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 patient is noted as lying supine in an abnormal posture with the upper arms flexed tight to the sides with elbows, wrists, and fingers flexed. His legs are extended and internally rotated and his feet are plantar flexed. This position is consistent with: hemiplegia. decorticate rigidity. decerebrate rigidity. paratonia. A patient is noted as lying supine in an abnormal posture with the upper arms flexed tight to the sides with elbows, wrists, and fingers flexed. His legs are extended and internally rotated and his feet are plantar flexed. This position is consistent with decorticate rigidity. In decerebrate rigidity, the jaws are clenched and the neck is extended with the arms adducted and stiffly extended at the elbows, with forearms pronated, wrists and fingers flexed; the legs are extended at the knees and the feet are plantar flexed. Hemiplegia refers to one-sided paralysis. Paratonia refers to a form of hypertonia with an involuntary variable resistance during passive movement. Question: Unilateral weakness in cranial nerve V (CN V) would be suggestive of a: bilateral hemispheric disease. central nervous system lesions. pontine lesion. brainstem lesion. Unilateral weakness in cranial nerve V (CN V), the trigeminal nerve, is suggestive of a pontine lesion (located in the pons). Question: Which developmental area is predominantly affected by lead poisoning? Nutrition Communication Cognition Mobility 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 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. a migraine. seizure activity. subarachnoid hemorrhage. 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: 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. anomic aphasia. Wernicke's aphasia. global aphasia. 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: A neurological assessment to evaluate neurologic input to the cerebellum is: Glasgow coma scale. abdominal reflex. babinski test. romberg test. Romberg test is performed by asking the patient to stand and with his eyes closed and feet together for at least 20 seconds and he should not sway. This test evaluates sensory input to the cerebellum to maintain truncal stability. The sensory inputs: proprioception, vision, and vestibular sense. Glasgow coma scale determines level of consciousness. An absent abdominal reflex could indicate a disease of the upper and lower neurons. A positive Babinski would indicate upper motor neuron disease in the pyramidal tract. Question: When assessing the cranial nerves, the nurse practitioner instructs the patient to raise both eyebrows, frown, and smile. These maneuvers would be assessing which cranial nerve? Cranial Nerve IV (CN II) Cranial Nerve V (CN IV) Cranial Nerve VI (CN V) Cranial Nerve VII (CN VII) Instructing the patient to raise both eyebrows, frown, and smile would be assessing the facial nerve or cranial nerve VII (CN VII). Other maneuvers could include having the patient puff out both cheeks, show upper and lower teeth, and close both eyes tightly without opening them when the examiner tries to. Question: A tension headache presents with pain in the: frontotemporal region of the head. occipital region of the head. area around and over the eyes. region by the vertex of the head. Tension headaches are usually bilateral and may be generalized, localized to the back of the head and upper neck or to the frontotemporal area of the head. Migraines may be frontal or temporal and may be occipital or generalized and a classic migraine is typically unilateral. Headaches with eye disorders usually present with pain around and over the eyes and may radiate to the occipital area. Question: Hypalgesia refers to: decreased sensitivity to pain. increased sensitivity to pain. absence of pain sensation. absence of touch sensation. 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: An abnormal or unpleasant sense of touch is termed: dysarthria. dysesthesia. metatarsalgia. paresthesia. 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 a child presents with a history of a head injury sustained within the past four hours, a subdural hematoma should be expected because: the X-ray reveals bleeding between the dura and the skull. the child is answering questions appropriately. the X-ray reveals bleeding between the dura and the cerebrum. retinal hemorrhages are absent. 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. Bleeding between the dura and the skull are consistent with the epidural bleeds. 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. 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: Which of the following procedures should NOT be performed in a comatose patient? Check corneal response Check pupillary response Dilate the pupils Inspect the posterior pharynx 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: When evaluating a patient for weakness of the upper extremities, bilateral distal weakness is noted. This finding could be suggestive of: alcohol myopathy. polyneuropathy. myositis. neuromuscular junction disorders. 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 assessing the cranial nerves, the nurse practitioner observes that the soft palate does not rise when the patient is instructed to say "ah". This finding could be suggestive of a bilateral lesion in which cranial nerve? Cranial Nerve V (CN V) Cranial Nerve VII (CN VII) Cranial Nerve IX (CN IX) Cranial Nerve X (CN X) Failure of the soft palate to rise when the patient is instructed to say "ah" or yawn could be suggestive of a bilateral lesion in cranial nerve X (CN X)-vagus nerve. Question: Discriminative sensations include all of the following except: astereognosis. stereognosis. graphesthesia. deep tendon reflexes Discriminative sensations test the ability of the sensory cortex to correlate, analyze, and interpret sensations. These include: stereognosis, graphesthesia, two-point identification, point localization, and extinction. Deep tendon reflexes evaluate the spinal nerve roots and usually include C5, C6, C7, L4, and S1. Question: Which choice is least likely to be an example of asymmetric weakness? The right shoulder The right hand Both arms One the right side of the face 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 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) Cranial Nerve V (CN V) Cranial Nerve VII (CN VII) 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: When assessing anal reflexes, the nurse practitioner strokes the four quadrants of the anus with a cotton swab. A loss of anal reflex is noted. This finding could be suggestive of a pathologic lesion in which segmented level of the spine? Thoracic 8, 9, and 10 Thoracic 10, 11, and 12 Lumbar 5 and Sacral 1 Sacral 2, 3, and 4 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: 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 6 Cervical 6 and 7 Lumbar 2, 3, and 4 Sacral 1 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 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. a spinal cord lesion. a peripheral lesion. 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. [Show More]

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