MN 551 Unit 9 Quiz [2021]

MN 551 Unit 9 Quiz [2021] 1 Question 1. A clinician is conducting an assessment of a male patient suspected of having a disorder of motor function. Which of the following assessment findings would suggest a possible u ...

MN 551 Unit 9 Quiz [2021] 1 Question 1. A clinician is conducting an assessment of a male patient suspected of having a disorder of motor function. Which of the following assessment findings would suggest a possible upper motor neuron (UMN) lesion? (Points : 0.4) The patient has decreased deep tendon reflexes. The patient displays increased muscle tone. The patient's muscles appear atrophied. The patient displays weakness in the distal portions of his limbs. Rationale: UMNs typically produce increased muscle tone, while hyporeflexia, muscle atrophy, and weakness in the distal portion of the limbs are more commonly indicative of lower motor neuron (LMN) lesions Question 2. A 51-year-old has been admitted to a rehabilitation center after hospital treatment for an ischemic stroke. Which of the following aspects of the patient's history would not be considered to have contributed to his stroke? (Points : 0.4) He was diagnosed with type 2 diabetes eight years ago Elevated cholesterol Blood pressure that is normally 120/80 The patient is an African American Male History of sickle cell anemia Question 3. Following a spinal cord injury suffered in a motor vehicle accident, a 22-yearold male has lost fine motor function of his finger and thumb, but is still able to perform gross motor movements of his hand and arm. Which of the following components of his white matter has most likely been damaged? (Points : 0.4) The inner layer (archilayer) The middle layer (paleolayer) The outer layer (neolayer) The reticular formation Rationale: Fine manipulation skills are the domain of the outer layer, or neolayer, of tract systems. The inner and middle layers and the reticular formation are not noted to be responsible for these functions. Question 4. A 44-year-old female has been diagnosed with major depression. Which of the following neuroimaging findings is most congruent with the woman's diagnosis? (Points : 0.4) Decreased brain activity in the pons and brain stem Reduced activity and gray matter volume in the prefrontal cortex Atrophy and decreased blood flow in the amygdala Enlargement of the lateral and third ventricles and reduction in frontal and temporal volumes Rationale: In some cases of familial major depressive disorder and bipolar disorder, PET and MRI studies have 2 Question 26. When reviewing the purpose/action of neurotransmitters as they interact with different receptors, the nursing instructor gives an example using acetylcholine. When acetylcholine is released at the sinoatrial node in the right atrium of the heart, it is: positively charged inhibitory overstimulated dormant Rationale: The action of a transmitter is determined by the type of receptor to which it binds. Acetylcholine is excitatory when it is released at a myoneural junction, and it is inhibitory when it is released at the sinoatrial node in the heart. Question 27. A toddler is displaying signs and symptoms of weakness and muscle atrophy. The pediatric neurologist suspects it may be a lower motor neuron disease called spinal muscular atrophy (SMA). The patient's family asks how he got this. The nurse will respond: This could result from playing in soil and then ingesting bacteria that are now attacking his motor neurons. No one really knows how this disease is formed. We just know that in time, he may grow out of it. This is a degenerative disorder that tends to be inherited as an autosomal recessive trait. This is a segmental demyelination disorder that affects all nerve roots and eventually all muscle groups as well. Question 28. A child is experiencing difficulty with chewing and swallowing. The nurse knows that which of the following cells may be innervating specialized gut-related receptors that provide taste and smell? Special somatic afferent fibers General somatic afferents Special visceral afferent cells General visceral afferent neurons Question 29. While assessing a critically ill patient in the emergency department, the nurse notes on the cardiac monitor an R-on-T premature ventricular beat that develops into ventricular tachycardia (VT). Immediately, the patient became unresponsive. The nurse knows that based on pathophysiologic principles, the most likely cause of the unresponsiveness is: metabolic acidosis that occurs spontaneously following any dysrhythmias. interruption of the blood/oxygen supply to the brain. massive cerebrovascular accident (CVA) resulting from increased perfusion. a blood clot coming from the heart and occluding the carotid arteries. Question 30. The parents of a 3-year-old boy have brought him to a pediatrician for assessment of the boy's late ambulation and frequent falls. Subsequent muscle biopsy has confirmed a diagnosis of Duchenne muscular dystrophy. Which of the following teaching points should the physician include when explaining the child's diagnosis to his parents? Your son's muscular dystrophy is a result of faulty connections between muscles and the nerves that normally control them. He'll require intensive physical therapy as he grows up, and there's a good chance that he will outgrow this problem as he develops. Your son will be prone to heart problems and decreased lung function because of this. 3 His muscles will weaken and will visibly decrease in size relative to his body size throughout his childhood. Question 31. Following a car accident of a male teenager who did not have his seatbelt on, he arrived in the emergency department with a traumatic brain injury. He has severe cerebral edema following emergent craniotomy. Throughout the night, the nurse has been monitoring and reporting changes in his assessment. Which of the following assessments correspond to a supratentorial herniation that has progressed to include midbrain involvement? Select all that apply. A) Clouding of consciousness B) Decorticate posturing with painful stimulation C) Pupils fixed at approximately 5 mm in diameter D) Respiration rate of 40 breaths/minute E) Decerebrate posturing following painful stimulation of the sternum Question 32. A patient with a diagnosis of depression has been prescribed a medication that ultimately increases the levels of the neurotransmitter serotonin between neurons. Which of the following processes will accompany the actions of the neurotransmitter in her chemical synapses? Two-way communication between neurons is permitted, in contrast to the one-way communication in electrical synapses. Communication between a neuron and the single neuron it is connected with will be facilitated. The neurotransmitter will cross gap junctions more readily. More serotonin molecules will cross the synaptic cleft and bond with postsynaptic receptors. Rationale: In chemical synapses, neurotransmitters cross the synaptic cleft and bond with postsynaptic receptors to facilitate communication between neurons. This communication is one way, not two way, and each neuron has synaptic connections with thousands of other neurons. Gap junctions are associated with electrical synapses, not chemical synapses. Question 33. Which of the following statements most accurately characterizes an aspect of the neurobiology of sleep? The hypothalamus stimulates the anterior and posterior pituitary to modulate sleeping–waking cycles. The pituitary releases melatonin at predictable points in the circadian rhythm in order to facilitate sleep. The reticular formation, thalamus, and cerebral cortex interact to integrate the sleep–wake cycle. Input from the retinas is interpreted by the cerebellum and contributes to maintenance of the circadian rhythm. Rationale: The sleep-wake cycle is rooted anatomically in the reticular formation and the interaction between the thalamus and cerebral cortex. Melatonin is produced by the pineal gland, and the hypothalamus and cerebellum are not central contributors to the sleep-wake cycle. Question 34. After surviving an ischemic stroke, a 79-year-old male has demonstrated significant changes in his emotional behavior, with his family noting that he now experiences wide mood swings and exaggerated responses of empathy, anger, and sadness to situations. His care team would most likely attribute these responses to ischemic changes in which of the following brain structures? The man's occipital lobe The patient's temporal lobe in general and Wernicke area in particular The man's parietal lobe The components of the patient's limbic system Question 35. A nurse practitioner is providing care for a 40-year-old male who is experiencing chronic insomnia in recent months while going through a divorce and child custody proceedings. The man is requesting a 4 prescription for “sleeping pills” to help him through this time. Which of the following statements forms a valid basis for the nurse practitioner's plan for treatment? Sedative and hypnotic drugs will not provide safe relief of the man's health problem. The man is suffering from primary insomnia. Melatonin supplements will be the safest and most effective long-term pharmacological treatment. Behavioral therapies, counseling, and education may be of some use to the patient. Question 36. The parents of a 15-year-old boy are frustrated by his persistent inability to fall asleep at a reasonable hour at night, as well as the extreme difficulty that they have in rousing him in the morning. While sleepy after waking, the son claims not to feel drowsy after lunch or in the evening. What is the most likely classification of the boy's sleep disorder? Delayed sleep phase syndrome (DSPS) Non–24-hour sleep–wake syndrome Advanced sleep phase syndrome (ASPS) Chronic insomnia Rationale: The teen's sleep patterns are characteristic of DSPS. Non-24-hour sleep-wake syndrome is characterized by a sleep cycle that greatly exceeds 24 hours, and ASPS is the opposite of DSPS. Chronic insomnia would likely include afternoon and evening drowsiness Question 37. Which of the following characteristics describe stage 2 non-REM sleep? Select all that apply. It occurs at the onset of sleep and lasts approximately 7 minutes. During this stage, theta waves are primarily seen on EEG. This stage is known as deep sleep where heart rate and BP are decreased. This stage has interruptions of spindle activity that helps with integration of new memories. Muscles of the body are relaxed. Rationale: Stage 2 non-REM sleep lasts approximately 10 to 25 minutes, where on EEG activity includes predominantly theta waves that are interrupted by sleep spindles consisting of bursts of high-frequency (12 to 14 Hz) waves. Answer choice A relates to stage 1 sleep that occurs at the onset of sleep and lasts approximately 7 minutes. Answer choices C and E relate to stages 3 and 4 of non-REM sleep, known as deep sleep where heart rate and BP are decreased and the muscles of the body are relaxed. Question 38. Which of the following observations of a female client in a sleep lab would indicate the clinicians that she is in REM sleep? Rolling eye movements are observed, and she has moderate muscle activity. Her motor movements are suppressed, and muscle tone is flaccid. Delta waves are evident on her EEG, and the heart and respiration rates are slowed. She has a low level of cerebral activity, and her EEG indicates low voltage and mixed frequencies. Rationale: REM sleep is accompanied by low levels of muscle movement and loss of muscle tone. Rolling eye movements, delta waves, and low levels of cerebral activity are associated with stages 1 through 4 of sleep. Question 39. The nurse knows that which of the following observations of a client during a sleep study would be most likely considered a pathological finding? 5 The client experiences periods of apnea of 5 to 15 seconds in duration. The client's intrinsic clock involves a sleep–wake cycle that is consistently 2 hours longer than the actual length of a day. The client's PCO2 level is increased, and his PO2 level decreased during deep sleep. The client spends the majority of his sleeping hours in deep REM sleep. Rationale: While vital, REM sleep does not normally occupy the majority of sleeping hours. The brain is highly active during REM sleep, and it accounts for 20% to 25% of normal sleep. Brief apneic spells are not uncommon, and the circadian rhythm often does not match the 24-hour length of day. It is normal for PCO2 to increase and PO2 to decrease during deep sleep. Question 40. Which of the following statements about over-the-counter (OTC) melatonin is accurate? It has received the FDA approval for effectiveness as a sleep aid. Long-term studies of melatonin conclude that it is non-addicting. It produces phase-shifting changes in the circadian rhythm. Under strict clinical testing, potency and purity of melatonin have been shown to be consistent. Rationale: Administration of melatonin produces phase-shifting changes in the circadian rhythm similar to those caused by light. Synthetic forms of melatonin are available without prescription in health food stores and pharmacies. However, synthetic forms of melatonin are not regulated by the FDA; therefore, their potency, purity, safety, and effectiveness cannot be ensured. There is a lack of clinical trial evidence about dosage, adverse effects, and drug interactions with over-the-counter forms of melatonin. Question 41. When explaining an upcoming test, a polysomnography, the nurse should include which of the following education related to equipment placements the patient will have placed on his or her person during the sleep study? Select all that apply. An ECG with lots of chest leads will monitor heart rate and rhythm. A pulse oximeter placed on a finger is used to determine arterial oxygen saturation. An EOG will be placed on the skin near the eye to record eye movements. An EMG patch will be placed under the chin to record muscle movement. An actigraph device will be placed on the wrists and ankles to measure body motion. Rationale: The ECG, which measures heart rate, is used to detect cardiac rhythm disorders, and the pulse oximeter is used to determine arterial oxygen saturation, which indicates adequacy of ventilation. The EOG, which records eye movements, and the EMG, which records muscle movement, will also be attached. During REM sleep, the eyes move rapidly, but the muscles are paralyzed. Periods during which the EOG recorded lots of movement, and the EMG recorded very little, would indicate REM sleep. An actigraph device will be placed on the wrists and ankles to measure body motion for obtaining objective measurements of sleep duration. Question 42. A business traveler has just arrived in Japan from the United States. During a meeting with his customer, he begins to experience yawning and stretching with an inability to stay focused on the meeting. He also has some eye irritation and has developed a headache. Based on these clinical manifestations, what diagnosis would most likely be causing these symptoms? Advanced sleep phase syndrome Delayed sleep phase syndrome Free-running sleep disorder Time zone change syndrome 6 Rationale: All of the symptoms are manifestations of jet lag syndrome. Answer choice A relates to early sleep onset and early arising, where people have trouble staying awake in the evening. Answer choice B relates to difficulty in falling asleep at a conventional hour of night and awakening on time in the morning. Answer choice C relates to a lack of synchronization between the internal sleep–wake rhythm and the external 24-hour day, seen commonly in blind people. Question 43. Nurses regularly rotate between day shift hours and overnight work hours. Following an overnight shift, nurses frequently exhibit which of the following manifestations? Select all that apply. Unable to sleep for a long period of time during the day Falling asleep while sitting in front of a computer charting during the night Finding it difficult to sleep when they have a night off Heightened alertness and reflexes on their drive home after work Increased hunger and thirst in the middle of the night Rationale: Manifestations of sleep disorders of night shift workers include shortened and interrupted daytime sleep after the night shift, somnolence and napping at work, sleepiness while commuting home, and insomnia on the nights off from work. Question 44. While working for a neurologist who is assessing a patient experiencing restless legs syndrome (RLS), the nurse should be prepared to answer the question about why the patient needs to have his iron level drawn? The nurse response should include, “Many of the drugs we give for RLS can cause drastic decreases in your iron level.” “Many patients with RLS also have an iron deficiency anemia as well.” “You just look a little pale, and so we want to make sure you have normal blood levels.” “People with low iron levels do not have enough oxygen circulating to their legs.” Rationale: RLS may be a symptom of iron deficiency, so the patient should undergo testing for serum ferritin and iron saturation levels. Iron deficiency is frequently present in the absence of anemia. Answer choice A is incorrect since one of the ways RLS is treated is by administering medication to correct the iron deficiency. Answer choice C is a common sign of anemia. Answer choice D is incorrect since the number of RBCs will decrease the oxygen carrying capacity to the body, not iron levels. Low iron levels can be caused by infection, cancer, chronic blood loss, or dietary deficiencies to name a few. Question 45. A 57-year-old female has presented to a clinic exasperated by the effect that restless legs syndrome is having on her sleep. The clinician has performed client teaching prior to choosing a treatment plan. Which of the following responses by the client demonstrates a sound understanding of her condition? “Increasing my calcium intake is something simple that might help.” “Transcutaneous electrical nerve stimulation might be a treatment that can help me avoid needing drugs for this.” “This could be something that I'm simply prone to genetically.” “I'll try to get more exercise, since there aren't really any effective medications for restless legs syndrome.” Rationale: There is a strong suggestion of a genetic component to RLS. Calcium intake is not noted to influence RLS, and TENS is not a noted treatment modality. Pharmacologic treatments exist for the problem. Question 46. Which of the following individuals would be expected to have the highest risk of developing sleep apnea? 7 A woman with restless legs syndrome and chronic obstructive pulmonary disease A male client with a diagnosis of unstable angina and peripheral arterial disease A man with poorly controlled diabetes and hypertension A female with chronic insomnia and atrial fibrillation that is treated with warfarin Rationale: Male gender, diabetes, and hypertension are all associated with sleep apnea. COPD, angina, PAD, and atrial fibrillation are not noted to be strongly associated with sleep apnea. Question 47. Which of the following motor disorders of sleep can be life-threatening? Narcolepsy Periodic limb movement disorder Obstructive apnea Restless legs syndrome Rationale: Obstructive apnea causes poor ventilation, poor-quality sleep, and daytime sleepiness, at best. At worst, it can contribute to depression, auto- and work-related accidents, cardiac dysrhythmias, and hypertension. Severe apnea can lead to pulmonary hypertension, polycythemia, or cor pulmonale. Periodic limb movement disorder and restless legs syndrome, although distressing and possibly indicative of a disease, are not of themselves lifethreatening. Narcolepsy is not a motor disorder of sleep. Question 48. A 77-year-old woman is concerned because she has occasionally found her husband sleepwalking in the last several weeks. What is her care provider's most appropriate response to her concerns? “This is not an uncommon event that often accompanies older age.” “I'll likely prescribe a benzodiazepine for this when I next see your husband.” “This is understandably upsetting for you, but as long as the environment is safe, it's likely not significant.” “There may be something else going on with your husband such as delirium or a problem with his medications.” Rationale: New-onset sleepwalking in the elderly is usually a manifestation of another problem such as delirium, drug toxicity, or a seizure disorder. It is not a normal age-related change, and a benzodiazepine is not a prudent initial treatment. Question 49. The nurse is educating the new mother about the sleep patterns of a newborn. Which of the following statements should she include in her education? “Newborns usually sleep approximately 16 to 20 hours/day.” “Newborns generally sleep 6 to 8 hours/day and then are awake for 2 to 4 hours.” “Don't worry about them sleeping too long; they will wake up when they are hungry.” “Most newborns will have their days and nights mixed up.” Rationale: Newborns usually sleep approximately 16 to 20 hours/day. Equally distributed over night and daytime, sleep periods generally last for 1 to 4 hours interspersed with 1- to 2-hour periods of wakefulness. Initially, sleep– wake patterns are based on hunger. Question 50. A 5-year-old boy has started sitting up in bed displaying signs of extreme anxiety. In the morning, when the parents ask the boy about this, he has no recollection. What should the nurse convey to the parents if this happens again? 8 Assist the boy in settling down without awakening him after an episode. Watch him closely to see if he has any twitching or thrashing about. Bring him back to the clinic if this keeps happening, so we can prescribe some sleep medicine. Shake him to wake him up, and then comfort him and put him back in bed. Rationale: Treatment for sleep terrors in children consists primarily of educating and reassuring the family. The child should be assisted in settling down without awakening. The child must be protected if he gets up and walks during these episodes. Question 51. A geriatrician is assessing an 84-year-old male recently admitted to a subacute medical unit of a hospital for rehabilitation following a recent fall resulting in a hip contusion. Which of the following aspects of the client's sleep history would the physician want to follow up with education? Select all that apply. “I make sure that I take a long nap each afternoon to compensate for my frequent waking at night.” “I've got a bottle of diazepam at home, but I only take them once or twice a month.” “I try my best to get out for a walk after breakfast or after supper.” “I make it a rule not to drink any alcohol in the evening.” “Once my head hits the pillow, I am fast asleep.” Rationale: Daytime sleeping can interfere with the normal sleep–wake cycle. Diazepam is a long-acting benzodiazepine, and occasional use is acceptable. However, excessive use could lead to falls. Moderate exercise not performed before bedtime can help with insomnia. Alcohol can inhibit sleep in the elderly. 9