NR 509 APEA (updated) – Chamberlain College of Nursing | NR 509 APEA (updated) – Answers and Explanations

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NR 509 APEA (updated) – Chamberlain College of Nursing Question: A transient ischemic attack is: a transient episode of neurologic dysfunction by focal brain, spinal cord, or retinal ischemi... a, 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.  Infocal or asymmetric weaknesses caused by central and peripheral nerve damage. Explanation: 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 asked to visually follow a finger through the cardinal fields of gaze. Which cranial nerves are being assessed? III, IVIII, IV, VI  V, VI, VII Explanation: 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: Uncontrolled electrical activity in the brain, which may produce minor physical signs, thought disturbances, or disturbed motor activity is: dystonia.bradykinesia.tremor.seizure.   Explanation: 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: When evaluating the sensory system, testing the posterior columns tract would include assessing sensations of: position and vibration.  pain and temperature.deep touch.  Indiscriminative sensations. Explanation: When evaluating the sensory system, testing the spinothalamic tracts would include assessing sensations of pain and temperature. Assessing position and vibration evaluate the posterior columns. Light touch assesses both the spinothalamic and posterior column tracts. To assess discriminative sensation, both the spinothalamic and posterior columns tracts as well as the cortex would be assessed. Question: 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.  Inhirsutism.Arnold -Chiari malformation. spina bifida occulta.   Explanation: There are four types of spina bifida: occulta, closed neural tube defects, meningocele, and myelomeningocele. Occulta is the mildest and most common form in which one or more vertebrae are malformed. The name “occulta,” which means “hidden,” indicates that a layer of skin covers the malformation, or opening in the vertebrae. This form of spina bifida, present in 10-20 percent of the general population, rarely causes disability or symptoms. Closed neural tube defects are often recognized early in life due to an abnormal tuft or clump of hair or a small dimple or birthmark on the skin at the site of the spinal malformation. Meningocele and myelomeningocele generally involve a fluid-filled sac—visible on the back—protruding from the spinal canal. In meningocele, the sac may be covered by a thin layer of skin. In most cases of myelomeningocele, there is no layer of skin covering the sac and an area of abnormally developed spinal cord tissue is usually exposed. Hirsutism is an excessive amount of hair on the body usually caused by a hormonal imbalance. An Arnold-Chiari malformation is a cyst-like formation in the fourth ventricle, cerebellum or brainstem. Question: 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  InSymmetricAsymmetric Explanation: 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: What geriatric condition is characterized by normal alertness but progressive global deterioration of cognition in multiple domains? DeliriumCognitive impairmentParkinson's diseaseAlzheimer's disease   Explanation: Alzheimer's disease is a geriatric condition in which normal alertness is present but progressive global deterioration of cognition occurs in multiple domains, including short-term memory, but with sparing of memory for remote events, subtle language errors, visuospatial perceptual difficulties, and changes in executive function, or the ability to perform sequential tasks such as instrumental activities of daily living (IADLs). Delirium is a serious disturbance in a person's mental abilities that results in a decreased awareness of one's environment and confused thinking. Cognitive impairment is an intermediate stage between the expected cognitive decline of normal aging and the more serious decline of dementia. Parkinson's disease is a progressive disorder of the nervous system that affects movement. Question: 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 systemCerebellar systemVestibular system  InSensory system   Explanation: Coordination of muscle movement requires that four areas of the nervous system function in an integrated way: motor system for muscle strength, cerebellar system for rhythmic movements and steady posture, vestibular system for balance and coordinating eye, head, and body movements, and sensory system for position sense. Question: A band of skin innervated by the sensory root of a single spinal nerve is termed a: peripheral nerve field.dermatome.  synapseasterixis. Explanation: 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 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. Explanation: A baby typically should be able to control the neck muscles by around 4 months of age, so that when pulling from a lying to a sitting position the head should remain in line with the torso and not flop back. Delays in reaching this developmental milestone have been observed in premature babies and in those with cerebral palsy; all others should be referred to a pediatric neurologist for further evaluation. The other choices do not address the issue or the cause. Early interventions result in better outcomes. Question: Hyperalgesia refers to: decreased sensitivity to pain.increased sensitivity to pain.  absence of pain sensation.absence of touch sensation. Explanation: Analgesia refers to absence of pain sensation; hypalgesia to decreased sensitivity to pain; hyperalgesia to increased sensitivity; and anesthesia to absence of touch sensation. Question: Brief, repetitive, stereotyped, coordinated movements occurring at irregular intervals are consistent with: facial tics.  dystonic movements.athetoid movements.oral-facial dyskinesias.  In Explanation: Facial tics are brief, repetitive, stereotyped, coordinated movements occurring at irregular intervals. Examples include repetitive winking, grimacing, and shoulder shrugging. Dystonic movements are similar to athetoid movements, but often involve larger portions of the body, including the trunk. Grotesque, twisted postures may result. Athetoid movements are slower and more twisting and writhing than choreiform movements, and have a larger amplitude. They most commonly involve the face and the distal extremities. Oral–facial dyskinesias are rhythmic, repetitive, bizarre movements that chiefly involve the face, mouth, jaw, and tongue: grimacing, pursing of the lips, protrusions of the tongue, opening and closing of the mouth, and deviations of the jaw. These are involuntary movements. Question: 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.  Inan abscess. Explanation: 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: 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)  InCranial Nerve V (CN V)  Cranial Nerve X (CN X) Explanation: Touching the cornea and assessing for a reflex assesses cranial nerve V. 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.  Inpoint localization.   Explanation: Graphesthesia, or number identification is the ability to identify a number when drawn in the hand of a patient whose eyes are closed. A discriminative sensation, stereognosis, is the ability to identify an object by feeling. The ability to identify an object touching 2 areas simultaneously is termed two-point discrimination. Point localization refers to the ability of the patient to identify the area of the body that was touched when his eyes were closed. Question: 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)   Explanation: 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: 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. Explanation: 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: Having the patient shrug his shoulders and elicit neck movements would be testing Cranial Nerve: VI.VII.IX.XI.   Explanation: 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: The Glasgow coma scale assesses: cranial nerve response.pupillary response.motor response.  auditory response. Explanation: 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: Discriminative sensations include all of the following except: astereognosis.stereognosis.graphesthesia.deep tendon reflexes   Explanation: 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: Symmetric weakness of the distal muscles of the legs suggests a: polyneuropathy.  myopathy.sensory neuropathy.cerebellar disease.  In Explanation: Polyneuropathy would present as symmetric weakness in the distal muscles. Symmetric weakness of the proximal muscles of the legs suggests a myopathy. Nystagmus, dysarthria, hypotonia, and ataxia would be characteristic of cerebellar disease. Sensory neuropathy usually presents as numbness, tingling, and pain. Question: The thalamus and the basal ganglion are located in the: spinal cord.peripheral nervous system.white matter.gray matter.   Explanation: 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: The most common cause of viral encephalitis in children is: Herpes simplex virus Type IIPicornavirusEnteroviruses  InHerpes simplex virus Type I   Explanation: Herpes simplex Type I is the most common cause of viral encephalitis in children. The other choices are in. 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.  In Explanation: By placing the patient in the supine position, the nurse practitioner raises the patient's relaxed and straightened leg while flexing the leg at the hip, then dorsiflexes the foot. This maneuver is known as the straight leg raise and is used to evaluate sciatica. It is positive if there is pain down the back of the leg below the knee. Ipsilateral calf wasting and weak ankle dorsiflexion may be present. Question: 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. Explanation: 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: 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. Explanation: 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: A term used to describe muscle wasting or loss of muscle bulk is: hypertrophy.muscular atrophy.  pseudohypertrophy.muscle weakness. Explanation: 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: Which one of the following senses is most often affected in patients on long-term antibiotic therapy? TouchTasteSmellHearing   Explanation: Many antibiotics can produce varying degrees of ototoxicity. The other senses are rarely, if ever, affected by long - term antibiotic use. Question: Common physical findings in a young child with cerebral palsy include which one of the following? Walks by placing the heels of the feet down firstMoves about by crawling on the abdomen or all four extremitiesGenerally meets motor developmental milestones on schedulePresence of crossed or touching knees   Explanation: Cerebral palsy (CP) is a group of disorders that can involve the brain and nervous system functions, such as movement, learning, hearing, seeing, and thinking. There are several different types of cerebral palsy, including spastic, dyskinetic, ataxic, hypotonic, and mixed. Symptoms usually depend on the type and can be seen before a child is 2 years old, and sometimes as early as 3 months. Symptoms may include delays in reaching and in developmental stages such as sitting, rolling, crawling, or walking, or abnormal gait. Arms may be tucked in toward the sides, knees may be crossed or touching, legs may make "scissor" movements, and child may walk on toes. Additionally, newborn reflexes may persist beyond the expected time frame for their disappearance. Question: 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)  InCranial nerve XII (CN XII) Explanation: The muscles responsible for closing the mouth are innervated by Cranial nerve V (trigeminal nerve). Cranial nerve V innervates the masseter, the temporalis, and the internal pterygoids. Question: The term used to describe involuntary muscle spasms and twisting of the limbs is: dystonia.  bradykinesia.akinesia.  Indyskinesia. Explanation: Dystonia is a neurological disorder that causes involuntary muscle spasms and twisting of the limbs. Bradykinesia is the term used to describe the impaired ability to adjust to one's body position. This symptom is noted in patients who have Parkinson's disease. The absence or loss of control of voluntary muscle movements is akinesia. Dyskinesia is defined as the presence of involuntary muscle movements such as tics or chorea. These movements can be seen in children who have rheumatic fever. Question: Postural tremors appear when the affected part is: at rest.moving voluntarily. is actively maintaining a posture.  getting closer to its target. Explanation: Tremors are rhythmic oscillatory movements. Postural tremors appear when the affected part is actively maintaining a posture. Examples include the fine rapid tremor of hyperthyroidism, the tremors of anxiety and fatigue, and benign essential tremor. The other choices are not consistent with postural tremors. Question: A patient presents with sweating, tremors, palpitations, hunger, and confusion. This patient is most likely experiencing: a syncopic event.hypoglycemia.  postural hypotension.hypocapnia. Explanation: 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: 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. Explanation: 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: 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.   Explanation: 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: 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 10Thoracic 10, 11, and 12Lumbar 5 and Sacral 1  Sacral 2, 3, and 4 Explanation: Superficial (cutaneous) reflexes and their corresponding spinal segments include the following: Abdominal reflexes: upper thoracic 8, 9, 10 and lower thoracic 10, 11, 12; Plantar: lumbar 5 and sacral 1; and Anal: sacral 2, 3, 4. Question: 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. Explanation: A patient is instructed to stand, close both eyes, and extend both arms forward with the palms facing upward for 20-30 seconds. If the forearm drifts downward, this would indicate a corticospinal lesion originating in the contralateral hemisphere. An upward drift would be indicative of a lesion in the cerebellum. This test is called the Test for Pronator Drift and is used to test for upper motor neuron disease. Question: 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.  In Explanation: Bilateral predominantly distal weakness suggests a polyneuropathy, as in diabetes. Proximal limb weakness, usually symmetric and without sensory loss, occurs in myopathies from alcohol, glucocorticoids, and inflammatory muscle disorders like myositis and dermatomyositis. In the neuromuscular junction disorder myasthenia gravis, there is proximal, typically asymmetric weakness that gets worse with effort. Question: 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) Explanation: Ptosis of the left eye would be suggestive of 3rd nerve palsy (CN III)-Oculomotor nerve. 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)  In Explanation: 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: 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.   Explanation: To elicit Babinski sign, stroke the lateral aspect of the sole from the heel to the ball of the foot with the end of an applicator stick. Plantar flexion is normal. Dorsiflexion of the big toe is a positive Babinski's sign. To elicit Brudzinski's sign, flex the neck. Flexion of both the hips and knees is positive for Brudzinski's. To test for Kernig's sign, flex the patient's leg at both the hip and the knee and then straighten the knee. Pain and increased resistance to extending the knee are positive for a Kernig's sign. With the patient lying supine, the nurse practitioner places her hands behind the patient's head while flexing his neck forward until his chin touches his chest. Neck stiffness with resistance to flexion is noted. This is positive nuchal rigidity and suggestive of meningeal inflammation from meningitis or subarachnoid hemorrhage. Question: An ambulatory child with spastic cerebral palsy needs a diet: high in potassium.low in fiber.low in sodium.high in calories.   Explanation: 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: 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.  Incerebellum.diencephalon.   Explanation: 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: 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.   Explanation: Dysarthria refers to a defect in the muscular control of the speech apparatus (lips, tongue, palate, or pharynx). Dysphonia refers to less severe impairment in the volume, quality, or pitch of the voice. Aphonia refers to a loss of voice that accompanies disease affecting the larynx or its nerve supply. Aphasia refers to a disorder in producing or understanding language. Question: The inability to hop in place on each foot, could be suggestive of a: cerebellar dysfunction.  corticospinal tract weakness.  Inproximal tract weakness.weakness of the quadriceps. Explanation: 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: Hyperesthesia refers to: absence of touch sensation.decreased sensitivity to touch.increased sensitivity to touch.   absence of pain sensation. Explanation: Anesthesia is absence of touch sensation; hypesthesia is decreased sensitivity to touch; hyperesthesia is increased sensitivity to touch; and analgesia refers to absence of pain sensation. Question: The part of the brain that maintains homeostasis is the: basal ganglion.thalamus.hypothalamus.  cerebellum.  In Explanation: The hypothalamus maintains homeostasis and regulates temperature, heart rate, and blood pressure. The hypothalamus affects the endocrine system and governs emotional behaviors such as anger and sexual drive. Hormones secreted in the hypothalamus act directly on the pituitary gland. Question: 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.  In Explanation: 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: 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. Explanation: Athetoid movements are slower and more twisting and writhing than choreiform movements, and have a larger amplitude. They most commonly involve the face and the distal extremities. Facial tics are brief, repetitive, stereotyped, coordinated movements occurring at irregular intervals. Examples include repetitive winking, grimacing, and shoulder shrugging. Dystonic movements are similar to athetoid movements, but often involve larger portions of the body, including the trunk. Grotesque, twisted postures may result. Oral–facial dyskinesias are rhythmic, repetitive, bizarre movements that chiefly involve the face, mouth, jaw, and tongue: grimacing, pursing of the lips, protrusions of the tongue, opening and closing of the mouth, and deviations of the jaw. These are involuntary movements. Question: Which of the following procedures should NOT be performed in a comatose patient? Check corneal responseCheck pupillary responseDilate the pupils  Inspect the posterior pharynx  In Explanation: When assessing a comatose patient, the nurse practitioner should not dilate the eyes because pupillary reaction is the single most important clue to the underlying cause of the coma: structural or metabolic. The other procedures can be performed on a comatose patient. Question: A form of aphasia in which the person has word-finding difficulties for speaking and writing is known as: Broca's aphasia.  Inanomic aphasia.  Wernicke's aphasia.global aphasia. Explanation: With anomic aphasia, the person has word-finding difficulties and because of the difficulties, the person struggles to find the right words for speaking and writing. In Broca's aphasia, speech is confluent, slow, with few words and laborious effort. Inflection and articulation are impaired but words are meaningful, with nouns, transitive verbs, and important adjectives. Small grammatical words are often dropped. With Wernicke's aphasia, speech is fluent, often rapid, voluble, and effortless. Inflection and articulation are good, but sentences lack meaning and words are malformed (paraphasias) or invented (neologisms). Speech may be totally incomprehensible. With global aphasia, the person has difficulty speaking and understanding words and is unable to read or write. Question: A neurological assessment to evaluate neurologic input to the cerebellum is: Glasgow coma scale.  Inabdominal reflex.babinski test.romberg test.   Explanation: 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: 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?.  In Explanation: 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: Which developmental area is predominantly affected by lead poisoning? NutritionCommunicationCognition  Mobility Explanation: Lead is a naturally-occurring element that can be harmful to humans when ingested or inhaled, particularly to children under the age of 6 years. Lead poisoning can cause a number of adverse human health effects, but is particularly detrimental to the neurological development of children. Question: A term used to describe an increase in muscular bulk with diminished strength is: hypertrophy.muscular atrophy.pseudohypertrophy.  muscle weakness. Explanation: 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: 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. Explanation: Evidence of flexed posture, tremor, rigidity, bradykinesia, micrographia, shuffling gait, and difficulty rising from a chair are symptoms consistent with Parkinson's disease. Question: A form of aphasia where articulation is good but sentences lack meaning is referred to as: Broca's aphasia.  Inanomic aphasia.Wernicke's aphasia.  global aphasia. Explanation: 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: 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.  Ina peripheral lesion. Explanation: When comparing two sides of the body for symmetric sensation a symmetrical distal sensory loss would be suggestive of polyneuropathy. A hemisensory loss pattern would suggest a lesion in the opposite cerebral hemisphere. Spinal cord lesions would present with sensory loss from tract damage below the level of the lesion. A peripheral lesion with sensory loss would present with a stocking - glove distribution. Question: When eliciting deep tendon reflexes in the knee, the nurse practitioner notes an abnormal reflex in the right knee. This abnormality is probably consistent with a pathological lesion in which segmented level of the spine? Cervical 5 and 6Cervical 6 and 7 Lumbar 2, 3, and 4  Sacral 1 Explanation: The segmented levels of the deep tendon reflexes are: Ankle: sacral 1; knee: lumbar 2,3, & 4; Supinator and biceps: cervical 5 & 6; and triceps: cervical 6 & 7. Question: Persistent blinking after glabellar tap and difficulty walking heel-to- toe are common in: Alzheimer's disease.Muscular Dystrophy.Parkinson’s disease.  Multiple Sclerosis. Explanation: Glabellar tap is a primitive reflex that is characterized by blinking eyes when a patient is lightly tapped between the eyebrows. In less that 5 taps, a normal individual will stop blinking. In Parkinson's disease, persistent blinking will occur until the examiner stops tapping. Difficulty walking heel-to-toe are common in Parkinson's disease. Question: 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. Explanation: 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 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. Explanation: Graphesthesia or number identification is the ability to identify a number when drawn in the hand of a patient whose eyes are closed. A discriminative sensation. stereognosis, is the ability to identify an object by feeling 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: 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.  In Explanation: When assessing the patient's sense of position, instruct the patient to first stand with his feet together and eyes open, then instruct him to close both eyes for 30-60 seconds. If he loses his balance with his eyes closed, this is a positive Romberg test and suggestive of ataxia related to a dorsal column disease. In cerebellar ataxia, the patient has difficulty standing with feet together whether the eyes are open or closed. With corticospinal tract damage, the gait is affected and the patient is unable to heel-walk. Question: A female patient complaints of weakness in both arms when transferring the wet clothes from the washer and placing them in the dryer. This finding could be suggestive of which type of weakness pattern? ProximalDistalSymmetric  Asymmetric Explanation: To identify symmetric weakness, ask about experiencing weakness in the same area on both sides of the body. 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. Explanation: With the patient lying supine, the nurse practitioner places her hands behind the patient's head while flexing his neck forward until his chin touches his chest. Neck stiffness with resistance to flexion is positive for nuchal rigidity and suggestive of meningeal inflammation from meningitis or subarachnoid hemorrhage. To elicit Brudzinski's sign, flex the neck. Flexion of both the hips and knees is a positive for Brudzinski's sign. To test for Kernig's sign, flex the patient's leg at both the hip and the knee and then straighten the knee. Pain and increased resistance to extending the knee are positive for Kernig's sign. To elicit the Babinski response, stroke the lateral aspect of the sole from the heel to the ball of the foot with the end of an applicator stick, plantar flexion is normal. Dorsiflexion of the big toe is a positive Babinski's sign. Question: 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.  Inremains unarousable with eyes closed. Explanation: A lethargic patient appears drowsy but opens his eyes, looks at the examiners, answers the questions, and then falls asleep. An obtunded patient opens the eyes and looks at the examiner, but responds slowly and is somewhat confused. A stuporous patient arouses from sleep after exposure to painful stimuli, exhibits slow verbal responses, and easily lapses into an unresponsive state. A comatose patient remains unarousable with eyes closed. There is no evident response to inner need or external stimuli. Question: 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. Explanation: 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: A patient is unable to identify the smell of an orange. This inability could reflect an abnormality in cranial nerves: I.  II.III.VIII. Explanation: Cranial Nerve I is the olfactory nerve responsible for the sense of smell. To test the sense of smell, the examiner presents the patient with familiar and nonirritating odors. A person should normally perceive odor on each side and ly identify the source. Cranial Nerves II and III assess vision and pupillary reaction. Cranial Nerve VIII tests the hearing and balance. Question: When assessing the 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)   Explanation: 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: 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. Explanation: 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 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. Explanation: A sudden brief lapse of consciousness, with momentary blinking, staring, or movements of the lips and hands but no falling is consistent with an absent seizure. A patient experiencing a myoclonic seizure manifests sudden, brief, rapid jerks, involving the trunk or limbs. During a myoclonic atonic seizure, the patient experiences a sudden loss of consciousness with falling but no movements. Injury may occur. Focal seizures with impairment of consciousness the person appears confused. Automatisms include automatic motor behaviors such as chewing, smacking the lips, walking about, and unbuttoning clothes. Question: Symptoms of a subdural hematoma include: noticeable bleeding between the dura and the skull on X-ray.   Inappropriate responses to questions.noticeable bleeding between the dura and the cerebrum on X-ray.  absent retinal hemorrhages. Explanation: Classic symptoms of subdural hemorrhages include: bleeding between the dura and the cerebrum, retinal hemorrhages, confusion, drowsiness, headaches, and possible seizures. Because this is a slow bleed, symptoms may develop slowly over several days or weeks. Bleeding between the dura and the skull are consistent with epidural bleeds. Question: Analgesia refers to: decreased sensitivity to pain.increased sensitivity to pain.  Inabsence of pain sensation.  absence of touch sensation. Explanation: Analgesia refers to absence of pain sensation; hypalgesia to decreased sensitivity to pain; hyperalgesia to increased sensitivity; and anesthesia to absence of touch sensation. Question: 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.  Incranial nerve disorder.  brainstem lesion. Explanation: While assessing the trigeminal nerve, cranial nerve V (CN V) for sensory function, the patient reports a pain sensation on the right cheek. This finding could be consistent with a cranial nerve disorder, such as trigeminal neuralgia. Question: When 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.   Explanation: A comatose patient remains unarousable with eyes closed. There is no evident response to inner need or external stimuli. A lethargic patient appears drowsy but opens the eyes, looks at the examiners, answers the questions, and then falls asleep. An obtunded patient opens the eyes and looks at the examiner, but responds slowly and is somewhat confused. A stuporous patient arouses from sleep after exposure to painful stimuli, verbal responses are slow, and lapses into an unresponsive state. Question: Disorders of speech fall into three groups that affect all of the following except the: voice.articulation of speech.written language.  comprehension of language. Explanation: Disorders of speech fall into three groups affecting: (1) the voice, (2) the articulation of words, and (3) the production and comprehension of language. The written language is not included in the disorders of speech. Question: What is an example of a disease or condition that appears in a dermatomal pattern? Fibromyalgia Shingles  Diabetic neuropathyReferred pain Explanation: 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: 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. Explanation: High-risk older adults, namely those with a single fall in the past 12 months with abnormal gait and balance and those with two or more falls in the prior 12 months, an acute fall, and/or difficulties with gait and balance, require further assessment to determine the reasons for the falls. Obtaining relevant medical history, physical exam, cognitive and functional assessment and determining multifactorial fall risks are essential to the preventing future falls. Question: When conducting a neurologic exam, which one of the following assessments is not considered part of the mental status assessment? Level of alertnessCranial Nerve II (CNII)  Appropriateness of responsesOrientation to time Explanation: When conducting a neurologic exam, mental status assessment should include evaluation of the level of alertness, appropriateness of responses, and orientation to person, place, and time. Assessing cranial nerve II would be part of the cranial nerve assessment. Question: 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.  In Explanation: 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: An ischemic stroke is: a transient episode of neurologic dysfunction by focal brain, spinal cord, or retinal ischemia, without acute infarction.   Inan 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. Explanation: Ischemic stroke is “an infarction of central nervous system tissue” that may be symptomatic or silent. TIA is now defined as “a transient episode of neurological dysfunction caused by focal brain, spinal cord, or retinal ischemia, without acute infarction.” The other terms are not related to the new definitions. Question: 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.  Infocal seizure that becomes generalized.   grand mal seizure. Explanation: 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: When assessing abdominal cutaneous reflexes, the nurse practitioner strokes the lower abdomen, the localized twitch is absent. This finding could be suggestive of a pathologic lesion in which segmented level of the spine? Thoracic 8, 9, and 10Thoracic 10, 11, and 12  Lumbar 5 and Sacral 1Sacral 2, 3, and 4 Explanation: Superficial (cutaneous) reflexes and their corresponding spinal segments include the following: Abdominal reflexes: upper thoracic 8, 9, 10 and lower thoracic 10, 11, 12; Plantar: lumbar 5 and sacral 1; and Anal: sacral 2, 3, 4. Question: An example of symmetric weakness is: the right shoulder. the right hand.both arms.  one the right side of the face. Explanation: There are 4 different patterns of weakness: Proximal, distal, symmetric, and asymmetric. An example of proximal weakness is weakness in the shoulder or hip girdle. Distal weakness occurs in the hands or feet. Symmetric weakness occurs in the same areas on both sides of the body. An asymmetric weakness occurs in a portion of the face or extremity - a form of focal weakness. Question: 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. Explanation: 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: 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).  In Explanation: Confusion Assessment Method (CAM), a screening tool specifically designed to detect delirium, is the most recommended because it provides the best supportive data for bedside use and takes 5 minutes to complete. The Delirium Rating Scale (DRS) covers a range of symptoms relating to delirium, and is useful for diagnostic purposes and for assessing severity and distinguishing delirium from other disorders. It is very complex and requires advanced training to administer. The MMSE is the most widely used instrument to test cognitive function. The Delirium Superimposed on Dementia Algorithm recommends a process to assess for delirium for people with a pre-existing dementia. [Show More]

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