TB-Chapter 24 Neurologic System PDF

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PHYSICAL EXAMINATION AND HEALTH ASSESSMENT 8TH EDITION JARVIS TEST BANK

TestBank-PhysicalExaminationandHealthAssessment8e(byJarvis)

358

Chapter24:NeurologicSystem MULTIPLECHOICE 1.Thetwopartsofthenervoussystemarethe: a.

Motorandsensory.

b.

Centralandperipheral.

c.

Peripheralandautonomic.

d.

Hypothalamusandcerebral.

ANS:B Thenervoussystemcanbedividedintotwopartscentralandperipheral.Thecentralnervoussystemincludes thebrainandspinalcord.Theperipheralnervoussystemincludesthe12pairsofcranialnerves(CNs),the31 pairsofspinalnerves,andalloftheirbranches. DIF:CognitiveLevel:Remembering(Knowledge) MSC:ClientNeeds:General 2.Thewifeofa65-year-oldmantellsthenursethatsheisconcernedbecauseshehasnoticedachangeinher husbandspersonalityandabilitytounderstand.Healsocriesveryeasilyandbecomesangry.Thenurserecalls NURSINGTB.COM thatthecerebralloberesponsibleforthesebehaviorsisthe__________lobe. a.

Frontal

b.

Parietal

c.

Occipital

d.

Temporal

ANS:A Thefrontallobehasareasresponsibleforpersonality,behavior,emotions,andintellectualfunction.The parietallobehasareasresponsibleforsensation;theoccipitallobeisresponsibleforvisualreception;andthe temporallobeisresponsibleforhearing,taste,andsmell. DIF:CognitiveLevel:Understanding(Comprehension) MSC:ClientNeeds:PhysiologicIntegrity:PhysiologicAdaptation 3.Whichstatementconcerningtheareasofthebrainistrue? a.

Thecerebellumisthecenterforspeechandemotions.

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b.

Thehypothalamuscontrolsbodytemperatureandregulatessleep.

c.

Thebasalgangliaareresponsibleforcontrollingvoluntarymovements.

d.

Motorpathwaysofthespinalcordandbrainstemsynapseinthethalamus.

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ANS:B Thehypothalamusisavitalareawithmanyimportantfunctions:bodytemperaturecontroller,sleepcenter, anteriorandposteriorpituitaryglandregulator,andcoordinatorofautonomicnervoussystemactivityand emotionalstatus.Thecerebellumcontrolsmotorcoordination,equilibrium,andbalance.Thebasalganglia controlautonomicmovementsofthebody.Themotorpathwaysofthespinalcordsynapseinvariousareasof thespinalcord,notinthethalamus. DIF:CognitiveLevel:Understanding(Comprehension) MSC:ClientNeeds:General 4.Theareaofthenervoussystemthatisresponsibleformediatingreflexesisthe: a.

Medulla.

b.

Cerebellum.

c.

Spinalcord. NURSINGTB.COM

d.

Cerebralcortex.

ANS:C Thespinalcordisthemainhighwayforascendinganddescendingfibertractsthatconnectthebraintothe spinalnerves;itisresponsibleformediatingreflexes. DIF:CognitiveLevel:Remembering(Knowledge) MSC:ClientNeeds:General 5.Whilegatheringequipmentafteraninjection,anurseaccidentallyreceivedaprickfromanimproperly cappedneedle.Tointerpretthissensation,whichoftheseareasmustbeintact? a.

Corticospinaltract,medulla,andbasalganglia

b.

Pyramidaltract,hypothalamus,andsensorycortex

c.

Lateralspinothalamictract,thalamus,andsensorycortex

d.

Anteriorspinothalamictract,basalganglia,andsensorycortex

ANS:C

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Thespinothalamictractcontainssensoryfibersthattransmitthesensationsofpain,temperature,andcrudeor lighttouch.Fiberscarryingpainandtemperaturesensationsascendthelateralspinothalamictract,whereasthe sensationsofcrudetouchformtheanteriorspinothalamictract.Atthethalamus,thefiberssynapsewith anothersensoryneuron,whichcarriesthemessagetothesensorycortexforfullinterpretation.Theother optionsarenotcorrect. DIF:CognitiveLevel:Applying(Application) MSC:ClientNeeds:General 6.Apatientwithalackofoxygentohisheartwillhavepaininhischestandpossiblyintheshoulder,arms,or jaw.Thenurseknowsthatthebestexplanationwhythisoccursiswhichoneofthesestatements? a.

Aproblemexistswiththesensorycortexanditsabilitytodiscriminatethelocation.

b.

Thelackofoxygeninhishearthasresultedindecreasedamountofoxygentotheareas experiencingthepain.

c.

Thesensorycortexdoesnothavetheabilitytolocalizepainintheheart;consequently,thepainis feltelsewhere.

d.

Alesionhasdevelopedinthedorsalroot,whichispreventingthesensationfrombeingtransmitted normally.

ANS:C NURSINGTB.COM

Thesensorycortexisarrangedinaspecificpattern,formingacorrespondingmapofthebody.Painintheright handisperceivedataspecificspotonthemap.Someorgans,suchastheheart,liver,andspleen,areabsent fromthebrainmap.Painoriginatingintheseorgansisreferredbecausenofeltimageexistsinwhichtohave pain.Painisfeltbyproxy,thatis,byanotherbodypartthatdoeshaveafeltimage.Theotherresponsesarenot correctexplanations. DIF:CognitiveLevel:Understanding(Comprehension) MSC:ClientNeeds:PhysiologicIntegrity:BasicCareandComfort 7.Theabilitythathumanshavetoperformveryskilledmovementssuchaswritingiscontrolledbythe: a.

Basalganglia.

b.

Corticospinaltract.

c.

Spinothalamictract.

d.

Extrapyramidaltract.

ANS:B Corticospinalfibersmediatevoluntarymovement,particularlyveryskilled,discrete,andpurposeful movements,suchaswriting.Thecorticospinaltract,alsoknownasthepyramidaltract,isanewer,higher motorsystemthathumanshavethatpermitsveryskilledandpurposefulmovements.Theotherresponsesare notrelatedtoskilledmovements.

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361

DIF:CognitiveLevel:Understanding(Comprehension) MSC:ClientNeeds:General 8.A30-year-oldwomantellsthenursethatshehasbeenveryunsteadyandhashaddifficultyinmaintaining herbalance.Whichareaofthebrainthatisrelatedtothesefindingswouldconcernthenurse? a.

Thalamus

b.

Brainstem

c.

Cerebellum

d.

Extrapyramidaltract

ANS:C Thecerebellarsystemcoordinatesmovement,maintainsequilibrium,andhelpsmaintainposture.Thethalamus istheprimaryrelaystationwheresensorypathwaysofthespinalcord,cerebellum,andbrainstemform synapsesontheirwaytothecerebralcortex.Thebrainstemconsistsofthemidbrain,pons,andmedullaand hasvariousfunctions,especiallyconcerningautonomiccenters.Theextrapyramidaltractmaintainsmuscle toneforgrossautomaticmovements,suchaswalking. DIF:CognitiveLevel:Understanding(Comprehension) MSC:ClientNeeds:PhysiologicIntegrity:PhysiologicAdaptation NURSINGTB.COM

9.Whichofthesestatementsabouttheperipheralnervoussystemiscorrect? a.

TheCNsenterthebrainthroughthespinalcord.

b.

Efferentfiberscarrysensoryinputtothecentralnervoussystemthroughthespinalcord.

c.

Theperipheralnervesareinsidethecentralnervoussystemandcarryimpulsesthroughtheirmotor fibers.

d.

Theperipheralnervescarryinputtothecentralnervoussystembyafferentfibersandawayfrom thecentralnervoussystembyefferentfibers.

ANS:D Anerveisabundleoffibersoutsideofthecentralnervoussystem.Theperipheralnervescarryinputtothe centralnervoussystembytheirsensoryafferentfibersanddeliveroutputfromthecentralnervoussystemby theirefferentfibers.Theotherresponsesarenotrelatedtotheperipheralnervoussystem. DIF:CognitiveLevel:Remembering(Knowledge) MSC:ClientNeeds:General 10.Apatienthasaseveredspinalnerveasaresultoftrauma.Whichstatementistrueinthissituation? a.

Becausethereare31pairsofspinalnerves,noeffectresultsifonlyonenerveissevered.

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362

b.

Thedermatomeservedbythisnervewillnolongerexperienceanysensation.

c.

Theadjacentspinalnerveswillcontinuetocarrysensationsforthedermatomeservedbythe severednerve.

d.

Aseveredspinalnervewillonlyaffectmotorfunctionofthepatientbecausespinalnerveshaveno sensorycomponent.

ANS:C Adermatomeisacircumscribedskinareathatisprimarilysuppliedfromonespinalcordsegmentthrougha particularspinalnerve.Thedermatomesoverlap,whichisaformofbiologicinsurance;thatis,ifonenerveis severed,thenmostofthesensationscanbetransmittedbythespinalnerveaboveandthespinalnervebelow theseverednerve. DIF:CognitiveLevel:Applying(Application) MSC:ClientNeeds:PhysiologicIntegrity:PhysiologicAdaptation 11.A21-year-oldpatienthasaheadinjuryresultingfromtraumaandisunconscious.Therearenoother injuries.Duringtheassessmentwhatwouldthenurseexpecttofindwhentestingthepatientsdeeptendon reflexes? a.

Reflexeswillbenormal.

b.

Reflexescannotbeelicited.

c.

Allreflexeswillbediminishedbutpresent.

d.

Somereflexeswillbepresent,dependingontheareaofinjury.

NURSINGTB.COM

ANS:A Areflexisadefensemechanismofthenervoussystem.Itoperatesbelowthelevelofconsciouscontroland permitsaquickreactiontopotentiallypainfulordamagingsituations. DIF:CognitiveLevel:Applying(Application) MSC:ClientNeeds:SafeandEffectiveCareEnvironment:ManagementofCare 12.Amotherofa1-month-oldinfantasksthenursewhyittakessolongforinfantstolearntorollover.The nurseknowsthatthereasonforthisis: a.

Ademyelinatingprocessmustbeoccurringwithherinfant.

b.

Myelinisneededtoconducttheimpulses,andtheneuronsofanewbornarenotyetmyelinated.

c.

Thecerebralcortexisnotfullydeveloped;therefore,controlovermotorfunctiongraduallyoccurs.

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d.

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Thespinalcordiscontrollingthemovementbecausethecerebellumisnotyetfullydeveloped.

ANS:B Theinfantssensoryandmotordevelopmentproceedsalongwiththegradualacquisitionofmyelin,whichis neededtoconductmostimpulses.Verylittlecorticalcontrolexists,andtheneuronsarenotyetmyelinated. Theotherresponsesarenotcorrect. DIF:CognitiveLevel:Applying(Application) MSC:ClientNeeds:HealthPromotionandMaintenance 13.Duringanassessmentofan80-year-oldpatient,thenursenoticesthefollowing:aninabilitytoidentify vibrationsatherankleandtoidentifythepositionofherbigtoe,aslowerandmoredeliberategait,anda slightlyimpairedtactilesensation.Allotherneurologicfindingsarenormal.Thenurseshouldinterpretthat thesefindingsindicate: a.

CNdysfunction.

b.

Lesioninthecerebralcortex.

c.

Normalchangesattributabletoaging.

d.

Demyelinationofnervesattributabletoalesion. NURSINGTB.COM

ANS:C

Someagingadultsshowaslowerresponsetorequests,especiallyforthosecallingforcoordinationof movements.Thefindingslistedarenormalintheabsenceofothersignificantabnormalfindings.Theother responsesareincorrect. DIF:CognitiveLevel:Analyzing(Analysis) MSC:ClientNeeds:HealthPromotionandMaintenance 14.A70-year-oldwomantellsthenursethateverytimeshegetsupinthemorningoraftershesbeensitting, shegetsreallydizzyandfeelslikesheisgoingtofallover.Thenursesbestresponsewouldbe: a.

Haveyoubeenextremelytiredlately?

b.

Youprobablyjustneedtodrinkmoreliquids.

c.

Illreferyouforacompleteneurologicexamination.

d.

Youneedtogetupslowlywhenyouvebeenlyingdownorsitting.

ANS:D Agingisaccompaniedbyaprogressivedecreaseincerebralbloodflow.Insomepeople,thisdecreasecauses dizzinessandalossofbalancewithapositionchange.Theseindividualsneedtobetaughttogetupslowly. Theotherresponsesareincorrect.

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PHYSICAL EXAMINATION AND HEALTH ASSESSMENT 8TH EDITION JARVIS TEST BANK TestBank-PhysicalExaminationandHealthAssessment8e(byJarvis)

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DIF:CognitiveLevel:Analyzing(Analysis) MSC:ClientNeeds:HealthPromotionandMaintenance 15.Duringthetakingofthehealthhistory,apatienttellsthenursethatitfeelsliketheroomisspinningaround me.Thenursewoulddocumentthisfindingas: a.

Vertigo.

b.

Syncope.

c.

Dizziness.

d.

Seizureactivity.

ANS:A Truevertigoisrotationalspinningcausedbyaneurologicdysfunctionoraprobleminthevestibularapparatus orthevestibularnucleiinthebrainstem.Syncopeisasuddenlossofstrengthoratemporarylossof consciousness.Dizzinessisalightheaded,swimmingsensation.Seizureactivityischaracterizedbyalteredor lossofconsciousness,involuntarymusclemovements,andsensorydisturbances. DIF:CognitiveLevel:Applying(Application) MSC:ClientNeeds:PhysiologicIntegrity:PhysiologicAdaptation NURSINGTB.COM 16.Whentakingthehealthhistoryonapatientwithaseizuredisorder,thenurseassesseswhetherthepatient hasanaura.Whichofthesewouldbethebestquestionforobtainingthisinformation?

a.

Doesyourmuscletoneseemtenseorlimp?

b.

Aftertheseizure,doyouspendalotoftimesleeping?

c.

Doyouhaveanywarningsignbeforeyourseizurestarts?

d.

Doyouexperienceanycolorchangeorincontinenceduringtheseizure?

ANS:C Auraisasubjectivesensationthatprecedesaseizure;itcouldbeauditory,visual,ormotor.Theother questionsdonotsolicitinformationaboutanaura. DIF:CognitiveLevel:Applying(Application) MSC:ClientNeeds:PhysiologicIntegrity:PhysiologicAdaptation 17.Whileobtainingahealthhistoryofa3-month-oldinfantfromthemother,thenurseasksabouttheinfants abilitytosuckandgraspthemothersfinger.Whatisthenurseassessing? a.

Reflexes

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PHYSICAL EXAMINATION AND HEALTH ASSESSMENT 8TH EDITION JARVIS TEST BANK TestBank-PhysicalExaminationandHealthAssessment8e(byJarvis)

b.

Intelligence

c.

CNs

d.

Cerebralcortexfunction

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ANS:A Questionsregardingreflexesincludesuchquestionsas,Whathaveyounoticedabouttheinfantsbehavior,Are theinfantssuckingandswallowingseemcoordinated,andDoestheinfantgraspyourfinger?Theother responsesareincorrect. DIF:CognitiveLevel:Understanding(Comprehension) MSC:ClientNeeds:HealthPromotionandMaintenance 18.Inobtainingahealthhistoryona74-year-oldpatient,thenursenotesthathedrinksalcoholdailyandthat hehasnoticedatremorinhishandsthataffectshisabilitytoholdthings.Withthisinformation,whatresponse shouldthenursemake? a.

Doesyourfamilyknowyouaredrinkingeveryday?

b.

Doesthetremorchangewhenyoudrinkalcohol?

c.

Welldosometeststoseewhatiscausingthetremor. NURSINGTB.COM

d.

Youreallyshouldntdrinksomuchalcohol;itmaybecausingyourtremor.

ANS:B Seniletremorisrelievedbyalcohol,althoughnotarecommendedtreatment.Thenurseshouldassesswhether thepersonisabusingalcoholinanefforttorelievethetremor. DIF:CognitiveLevel:Analyzing(Analysis) MSC:ClientNeeds:HealthPromotionandMaintenance 19.A50-year-oldwomanisintheclinicforweaknessinherleftarmandlegthatshehasnoticedforthepast week.Thenurseshouldperformwhichtypeofneurologicexamination? a.

GlasgowComaScale

b.

Neurologicrecheckexamination

c.

Screeningneurologicexamination

d.

Completeneurologicexamination

ANS:D

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PHYSICAL EXAMINATION AND HEALTH ASSESSMENT 8TH EDITION JARVIS TEST BANK TestBank-PhysicalExaminationandHealthAssessment8e(byJarvis)

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Thenurseshouldperformacompleteneurologicexaminationonanindividualwhohasneurologicconcerns (e.g.,headache,weakness,lossofcoordination)orwhoisshowingsignsofneurologicdysfunction.The GlasgowComaScaleisusedtodefineapersonslevelofconsciousness.Theneurologicrecheckexamination isappropriateforthosewhoaredemonstratingneurologicdeficits.Thescreeningneurologicexaminationis performedonseeminglywellindividualswhohavenosignificantsubjectivefindingsfromthehealthhistory. DIF:CognitiveLevel:Applying(Application) MSC:ClientNeeds:HealthPromotionandMaintenance 20.DuringanassessmentoftheCNs,thenursefindsthefollowing:asymmetrywhenthepatientsmilesor frowns,unevenliftingoftheeyebrows,saggingofthelowereyelids,andescapeofairwhenthenursepresses againsttherightpuffedcheek.ThiswouldindicatedysfunctionofwhichoftheseCNs? a.

MotorcomponentofCNIV

b.

MotorcomponentofCNVII

c.

MotorandsensorycomponentsofCNXI

d.

MotorcomponentofCNXandsensorycomponentofCNVII

ANS:B Thefindingslistedreflectadysfunctionofthemotorcomponentofthefacialnerve(CNVII). DIF:CognitiveLevel:Analyzing(Analysis) NURSINGTB.COM MSC:ClientNeeds:HealthPromotionandMaintenance 21.ThenurseistestingthefunctionofCNXI.Whichstatementbestdescribestheresponsethenurseshould expectifthisnerveisintact?Thepatient: a.

Demonstratestheabilitytohearnormalconversation.

b.

Sticksoutthetonguemidlinewithouttremorsordeviation.

c.

Followsanobjectwithhisorhereyeswithoutnystagmusorstrabismus.

d.

Movestheheadandshouldersagainstresistancewithequalstrength.

ANS:D Thefollowingnormalfindingsareexpectedwhentestingthespinalaccessoryner...