Neurological Disorders and Pathophysiology, Exams of Nursing

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MN 551 Unit 9 Chapter 13, 15, 16, 17, 18

The nurse knows that which of the following phenomena listed below is an accurate statement about axonal transport - Answer -Materials can be transported to the nerve terminal by either a fast or slow component An adult male has a new diagnosis of Guillain Barre syndrome. The nurse knows which of the following pathophysiological processes underlie the deficits that accompanied the degeneration of myelin in his peripheral nervous system - Answer -Unless re-myelination occurs the axon will eventually die 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. Immediately the patient became unresponsive. The nurse knows that based on the pathophysiologic principles the most likely cause of this unresponsiveness is - Answer -Interruption of the blood/oxygen supply to the brain When educating a patient about to undergo a pacemaker insertion the nurse explains the normal phases of cardiac muscle tissue. During the repolarization phase the nurse will stress that the membranes must be re-polarized before they can be re-excited. Within the cell the nurse understands that - Answer - Potassium channels open while sodium channels close causing repolarization to the resting state A client with a diagnosis of depression has been prescribed a medication that ultimately increases the levels of neurotransmitter serotonin between neurons. Which of the following processes will accompany

the actions of the neurotransmitter in a chemical synapse? - Answer -More neurotransmitters will cross the synaptic cleft's and bond with postsynaptic receptors The Neurotransmitter GABA Mainly functions to trigger inhibitory postsynaptic potential. Therefore when explaining this to a group of nursing students the nurse will state that - Answer -The combination of GABA with the receptor site is inhibitory since it causes the local nerve membrane to become hyper polarized and less excitable When reviewing the purpose/action of neurotransmitters as they interact with different receptors the nurse instructor gives an example using acetylcholine. When Acetylcholine is released at the SA node in the right atrium of the heart it is - Answer -Inhibitory A mail newborn infant has been diagnosed with spina bifida occulta. Which of the following pathophysiological processes has most likely contributed to the infants health problem - Answer -The neural groove failed to fuse and completely close across the top of the neural plate A child is experiencing difficulty with chewing and swallowing. The nurse knows that which of the following cells may be innervating specialize got related receptors that provide taste and smell - Answer -Special visceral afferrent cells A nursing student having trouble moving his head from side to side is likely experiencing a problem with which type of neurons? - Answer -Pharyngeal efferent neurons. Following a spinal cord injury suffered in a motor vehicle accident a 22-year-old male has lost fine motor function of his fingers 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 have likely been damaged? - Answer -The outer layer (neolayer) Not realizing that it's surface was hot a woman has quickly withdrawn her hand from the surface of a bowl that she was removing from a microwave. Which of the following phenomena has facilitated the rapid movement of her hand in response to the painful stimulus? - Answer -Her CNS has an acted a productive response received by neurons that innervate her arm muscles A taekwondo master is applying downward pressure just above the elbow joint on an attacker who immediately collapses to the ground. The taekwondo master knows the elbow joint can bend inward

toward the body but not in the opposite direction. Which of the following reflexes is applicable to this example - Answer -Inverse myotatic During a clinical assessment of a 68-year-old client who has suffered a head injury a neurologist suspects that a client has sustained damage to her Vegas nerve (CN 10). Which of the following assessment findings as most likely to lead the physician to this conclusion? - Answer -The client has difficulty swallowing and has had a recent constipation and hypo active bowel sounds A nine year old girl has a diffuse collection of symptoms that are indicative of deficits in endocrine and autonomic nervous system control. She also suffers from persistent fluid and electrolyte in balance. The nurse knows which of the following aspects of the nervous system listed below with her healthcare providers focus their diagnostic efforts on? - Answer -Impaired function of her hypothalamus A badly burn fire fighter has been in an induced coma for three weeks. When he awakens he thinks his son for singing happy birthday to him a week earlier. Which of the brain is responsible for allowing him to hear and comprehend while comatose - Answer -Thalamus Which of the following statements best conveys an aspect of the role of cerebral spinal fluid - Answer - CSF cushions the brain and provides a near water medium for diffusion of nutrients A 21-year-old male is brought to the ED following a night of partying in his fraternity. His friend found him asleep and could not get him to respond. They cannot recall how many alcoholic beverages he drink the night before. Or educating a student nurse and the roommate in the fraternity the nurse begins by explaining alcohol is - Answer -Very lipid soluble rapidly crosses the blood brain barrier A 45-year-old diabetic male is experiencing erectile dysfunction. If his erectile dysfunction is caused by the nervous system then the nurse can educate the patient that the venous blood supply to the penis is controlled by - Answer -Sacral parasympathetic fibers As you were walking in the park a huge black Labrador dog runs up to you and places his paws on your shoulders. Immediately your heart starts racing you feel palpitations and anxiety in your hands become a little shaky. The nurse knows that this response is primarily caused by - Answer -Increased levels of glucocorticoids by the adrenal glands that result in an increase in Epinephrine level

During a late night study session a pathophysiology student reaches out to turn the page of a textbook. Which of the following components of her nervous system contains the highest level of control of her arm and hand action - Answer -Frontal lobe A patient is asked to stand with feet together Eyes open and hands by the sides. Then the patient has asked to close his eyes while the nurse observes for a four minute. What assessment is the nurse performing - Answer -Proprioception A clinician is conducting an assessment of a male client suspected of having a disorder of motor function. Which of the following assessment findings would suggest a possible upper motor neuron lesion? - Answer -The client displays increased muscle tone The parents of a three-year-old boy have brought him to a pediatrician for assessment of the boys late ambulation in frequent falls. Subsequent muscle biopsy has confirmed a diagnosis of Duchenne muscular dystrophy. Which of the following teaching points shut the physician include when explaining the child's diagnosis to his parents? - Answer -Your son will be prone to heart problems and decreased lung function because of this Do unique clinical presentation of a three month old infant in the emergency department leads the care team to suspect botulism. Which of the following assessment questions posed to the parents as likely to be most useful in differential diagnosis? - Answer -Have you ever given your child any honey or honey containing products? A 22 year old female college student is shocked to receive a diagnosis of myasthenia gravis. What are the etiology and most likely treatment for her health problem - Answer -A decline in functioning acetylcholine receptors; treatment with corticosteroids and intravenous immunoglobulins A toddler is displaying signs and symptoms of weakness and muscle atrophy. The pediatric neurologist suspect it may be a lower motor neuron disease called spinal muscular atrophy. The patient's family asked how we got this. The nurse will respond - Answer -This is a degenerative disorder that tends to be inherited as an autosomal recessive trait Which of the following individuals it's likely to have the best prognosis for recovery from his or her and talk to the peripheral nervous system? An adult - Answer -Who had his forearm partially crushed by gears during industrial accident

A nurse working in a busy orthopedic clinic is asked to perform the tunnel sign on a patient having problems in his hand/wrist. In order to test tinnel sign the nurse should give the patient which of the following directions?? - Answer -I'm going to tap over the median nerve in your wrist tell me what sensation you feel while I am doing this. Does the sensation stay in the rest or go anywhere else? During a flu shot clinic one of the questions the student nurse ass relates to whether the patient has had Guillain-Barre syndrome in his medical history. The patient ask what is that? The nursing student should reply - Answer -A type of paralysis that affects movement on both sides of the body that may even involve the respiratory muscles Hey 60 year old male office worker presents to clinic complaining of a new onset of lower back pain that has been worsening over the last six weeks. The nurse knows which of the following components of his physical assessment and history is most indicative of a serious pathological process (like aortic aneurysm or quit cancer)? - Answer -His onset of pain has been gradual and he has no prior history of lower back problems A middle-age woman is brought to the emergency room for a minor auto accident. Her gait is staggering and unsteady; her speech is slurred; and she displace late in the stigmas. The police officer who brought her and says she has not been drinking. Her blood pressure is very high. Which of the following health problems most likely underlies her present state - Answer -Cerebral damage caused by a cardiovascular accident A 70 year old male has been diagnosed with a stroke that resulted in infarct to his cerebellum. Which of the following clinical findings would be most closely associated with cerebral insult? - Answer -Unsteady gait and difficulty in speaking and swallowing The geriatrician providing care for a 74 year-old man with diagnosis of Parkinson disease has recently changed the client's medication regimen. What is the most likely focus of the pharmacologic treatment of the man's health problem? - Answer -Increasing the functional ability of the underactive dopaminergic system A 47-year-old woman was diagnosed with amyotrophic Lateral sclerosis three years ago and has experienced a progressive on certain severity of complications. She has been admitted to a palliative care unit due to her poor prognosis? What assessment and intervention should the nursing staff of the unit prioritize in their care? - Answer -Assessment of swallowing ability in respiratory status

A 41-year-old woman was diagnosed with multiple sclerosis seven years ago and is sharing her story with members of an MS support group many of whom have been diagnosed recently. Which of the following aspects of her health problem show the woman warn others to expect at some point in the progression of the disease? Select all that apply - Answer -A) debilitating fatigue B) Progressive loss of visual acuity D) loss of mental acuity The nurse should anticipate she will need to teach the newly diagnosed multiple sclerosis patient how to give injections if he is prescribed which medication to modify the course of the disease by reducing exacerbations - Answer -Interferon beta After being thrown off the back of a bull The bull rider can move his arms but has lots of motor function in the lumbar and sacral segments of the spinal cord this is usually referred to as - Answer -Paraplegia Several months ago a 20-year-old male suffered a spinal cord injury brought about by a Snowboard trick gone wrong. The lasting affects of his injury include a flaccid bowel and bladder and the inability to obtain an erection. All sensation has been completely preserved in his legs and feet his motor function is significantly impaired. What type of incomplete spinal cord injury has the man most likely experienced - Answer -Conus medullaris syndrome Conus Medullaris Syndrome - Answer -Injury of the sacral cord and lumbar nerve roots resulting in LE motor and sensory loss and a reflexic bowel and bladder If the nurse suspects a spinal cord injury the patient has developed autonomic dysreflexia. Which of the following assessments would confirm this complication? - Answer -A) blood pressure 180/ C) pulse rate 49 D) complaints of a pounding headache A nurse on a neurology unit is assessing a female brain injured client. The client is unresponsive the speech and her pupils are dilated and do not react to light. She is breathing regularly but her respiratory rate is 45 breaths per minute. In response to a noxious stimuli her arms and legs extend rigidly. What is her level of impairment - Answer -Coma

Following a motor vehicle accident Three months prior a 20-year-old female who has been in a coma since her accident has now had her condition declared a persistent vegetative state. How can her care providers most accurately explain an aspect of our situation to your parents? - Answer -Does she still goes through a cycle of sleeping and waking her condition is unlikely to change Which of the following individuals would most likely experience global ischemia to his or her brain - Answer -A man who is entered cardiogenic shock following a severe myocardial infarction global ischemia - Answer -consequences of inadequate blood supply to meet the needs of the brain tissue; results in hypoxia Which of the following diagnostic findings is likely to result in the most serious brain insult - Answer - Mean arterial pressure that equals intracranial pressure 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. - Answer -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 A patient in the intensive care unit who has a brain tumor has experienced a sharp decline. The care team suspects that water and protein have crossed the blood brain barrier It has been transferred from the vascular space and the clients interstitial space. Which of the following diagnosis best captures his pathophysiology - Answer -Vasogenic edema A baseball player was hit in the head with a bat during practice. In the emergency department the physician tells the family that he has a coop injury. How will the nurse explain to his family so that they can understand - Answer -Your son has a contusion of the brain at the site where the bat hit his head Following an injury where a child hit his head from my fall the CT scan reveals a contusion that the doctor classifies as moderate brain injury. Which of the following manifestations will the nurse more

than likely assess on This child that support this diagnosis? Select all that apply - Answer -B) periods of unconsciousness C) Aphasia at times E) weakness or slight paralysis affecting one side of the body Following a collision while mountain biking the diagnostic work up I have a 22-year-old male has indicated the presence of an acute sub dural hematoma. Which of the following pathophysiological process is most likely underlies his diagnosis? - Answer -Blood has accumulated between the man's Dura in subarachnoid space A 20 year old has been admitted to a rehabilitation center after hospital treatment for an ischemic stroke. Which of the following aspects of the clients history would be considered to have contributed to a stroke? Select all that apply. The client - Answer -A) Is an African-American male C)Blood pressure has historically been in the range of 150s over 90s D) Was diagnosed with type two diabetes eight years A nurse at a long-term care facility provides care for an 85-year-old man who has had recent transient ischemic attacks. Which of the following statements best identifies future complications associated with TIAs? TIAs - Answer -Resolve rapidly but may place the client at an increased risk of stroke Which of the following clients' signs and symptoms would allow a clinician to be most justified and ruling out stroke as a cause? An adult - Answer -Has had a gradual onset of weakness headache and visual disturbances over the last two days The nurse knows that which of the following treatment plans listed below is most likely to be prescribed after a CT scan of the head reveals a new answer aneurysmal sub arachnoid hemorrhage - Answer - Craniotomy and clipping of the Affected vessel A college student has been experiencing frequent headaches that he describes is throbbing and complaining of difficulty concentrating while studying. Upon cerebral angiography he is found to have an arterial venous malformation. Which of the following pathophysiological concepts is likely responsible for his symptoms - Answer -High pressure and local hemorrhage of the venous system

A nine year old boy has been brought to the emergency department by his father who is concerned by his son's recent fever stiff neck pain and nausea examination reveals a particular rash. Which of the following assessment questions by the emergency room physician is most appropriate? - Answer -How's your son had any sinus or ear infections in the last Little while A teenager exposed to west now virus a few weeks ago while camping with his friends admitted with headache fever and nuchal rigidity. The teenagers also displaying some lethargy and disorientation the nurse knows which of the following medical diagnoses listed below may be associated with these clinical manifestations - Answer -Encephalitis A 20-year-old has been diagnosed with an astrocytic brain tumor located in the brain stem. Which of the following statements by the oncologist treating the client is most accurate? - Answer -Your prognosis will depend on whether we can surgically resect your tumor A brain tumor causing clinical manifestations of headache nausea projectile vomiting in mental changes is likely located in which parts of the brain? Select all that apply. - Answer -A) Intra-axially B) Extra-axially E) Frontal lobe Which of the following clients may be experiencing a sensory focal seizure that has sent an abnormal cortical discharge to the autonomic nervous system - Answer -A 56-year-old complaining of tingling sensations and has both an elevated pulse and blood pressure A 26-year-old female is resting after a one minute episode during which she lost consciousness while her muscles contracted and extremities extended. This was followed by a rhythmic contraction and relaxationOf her extremities. On regaining consciousness she found herself to have been in continent of urine. What was the woman most likely experiencing - Answer -Tonic clonic seizure Which of the following statements most accurately characterizes an aspect of the neurobiology of sleep? - Answer -The reticular formation thalamus and cerebral cortex interact to integrate the sleep wake cycle A client with a diagnosis of insomnia surprised when his Physician explained to him that his brain is still highly active during normal sleep. Which of the following statements best captures the character brain

activity during sleep - Answer -Fewer neurons in your brain are firing when you're asleep but they're more synchronized than when you're awake Which of the following characteristics describes stage to non-REM sleep? Select all that apply. - Answer - B) During this stage theta waves are primarily seen on EEG Which of the following observations of a female client in a sleep lab would indicate the clinicians that she is in rim sleep? - Answer -Her motor movements are suppressed and muscle tone is flacid The nurse knows that which of the following observations of a client during a sleep study but most likely considered a pathological finding? - Answer -The client spends the majority of his sleeping hours and deep REM sleep Which of the following statements about over the counter melatonin is accurate? - Answer -It produces phase shifting changes in the circadian rhythm When explaining an upcoming test a polysomnography the nurse should include which of the following education related to equipment placement the patient will have placed on his or her person during the sleep study? Select all that apply - Answer -A) an ECG with lots of chest leads will monitor the heart rate and rhythm B) A pulse ox amateur placed on a finger is used to determine the arterial oxygen saturation C) An EOG will be placed on the skin near the eye to record a movement D) In the MG patch will be placed under the chin to record muscle movement The parents of a 15-year-old boy are frustrated at his persistent inability to fall asleep at a reasonable hour at night as well as the extreme difficulty that they have rousing him in the morning. While sleeping after waking the sun claims not to feel drowsy after lunch in the evening. What is most likely classification of the boys sleep disorder? - Answer -Delayed sleep faze syndrome A business traveler just arrived in Japan from the United States. During a meeting with his customer he begins to experience yawning and stretching with an ability to stay focused on the meeting. He also has some I rotation and has developed a headache. Based on the clinical manifestations what diagnosis would most likely be causing the symptoms - Answer -Time zone change syndrome

Nurses regularly rotate between dayshift hours and overnight work hours. Following an overnight shift nurses frequently exhibit which of the following manifestations? Select all that apply - Answer -A) unable to sleep for a long period of time during the day B) falling asleep while sitting in front of a computer charting during the night C) finding it difficult to sleep when they have a night off And adult client is experiencing chronic insomnia related to a divorce and child custody proceedings. The client is requesting a renewable prescription for sleeping pills. The nurse knows that which of the following interventions listed below will provide the most beneficial treatment for this client? - Answer - Behavioral therapy is an education regarding sleep hygiene will provide assistance for the client A 17-year-old female as suspected of having narcolepsy. Which of the following aspects of her medical history and sleep analysis would contribute to a confirmation of the diagnosis? Select all that apply. - Answer -C) She is frequently awake and unable to move or speak D) she believes that she experiences auditory hallucinations when she awakens While working for a neurologist who is assessing a patient experiencing restless leg syndrome. 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 - Answer -Many patience with RLS also have an iron deficiency anemia as well A 57-year-old female has presented to a clinic exasperated by the effect that restless leg 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? - Answer -This could be something that I'm simply prone to genetically Which of the following individuals would be expected to have the highest risk of developing sleep apnea? - Answer -A man with poorly controlled diabetes and hypertension Which of the following motor disorders of sleep can be life-threatening - Answer -obstructive apnea A 77-year-old woman is concerned because she occasionally found her husband sleepwalking in the last several weeks. What is her care providers most appropriate response to her concerns - Answer -There may be something else going on with your husband such as delirium or problem with his medications

The nurses educating the new mother about the sleep patterns of a newborn. Which of the following statement should she include in her education? - Answer -Newborns usually sleep approximately 16 to 20 hours per day If I've-year-old boy has starting 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? - Answer -Assess the boy and settling down with her awakening him after an episode He geriatrician is assessing an 84-year-old male recently admitted to a sub acute medical unit of a hospital for rehabilitation following a recent fall resulting in hip contusion. Which of the following aspects of the client sleep history with the physician want to follow up with education? Select all that apply. - Answer -A) I make sure that I take a long nap each afternoon to compensate for my frequent waking at night. B) i've got a bottle of diazepam at home but I only take them once or twice a month Which of the following statements best captures the current understanding of the ideology of mental illness? - Answer -Mental illness exists from the interplay of biologic factors in psychosocial influences As a part of a diagnostic work up of a 22-year-old male with recently diagnosed schizophrenia and neurologist wants to examine the levels of metabolic activity in particular areas of the client spraying. Which of the following diagnostic procedures is efficient most likely to order? - Answer -Positron emission tomography (PET) An adult who are sexually abused as a child has been displaying some stress. She seems to complain of increasing medical problems when she is under more stress. The nurse would classify this as an example of - Answer -The stress diathesis theory A toddler brought up in a chaotic non-nurturing environment may suffer from neurological consequences if the parent does not achieve attachment with the child. The nurse knows that which of the following nervous system is listed below is the first to respond to the safety needs of the child - Answer -Sympathetic nervous system

A student notices that the certain times during his studying for final exams he is more awake and has a ability to think at a higher level is happening easier. The nurse knows that the this experience may attribute to which of the following neurological functions? - Answer -Release of excitatory neurotransmitter such as glutamate Parents of a 16-year-old male who has been behaving in increasingly bizarre ways in recent months or distraught that he has been diagnosed with schizophrenia. Which of the mothers following statements about her sons diagnosis demonstrates an accurate understanding of the disease? - Answer -This makes us even more worried about his younger brother and whether he might develop schizophrenia Which of the following is a negative symptoms of schizophrenia? - Answer -Affective flattening Negative symptoms of schizophrenia - Answer -the absence of appropriate behaviors (expressionless faces, rigid bodies) positive symptoms of schizophrenia - Answer -delusions and hallucinations During an acute phase of schizophrenia when the patient is experiencing hallucinations and delusions the nurse should anticipate that the physician will prescribe which of the following medication categories listed below? - Answer -An antipsychotic like a risperidone Which of the following clinical manifestations with the nurse assess in the patient with bipolar disorder who is experiencing mania? Select all that apply - Answer -A) labile mood B) highly distractible C) inflated self-esteem A 44-year-old female has been diagnosed with major depression. Which of the following Nuro imaging findings as most congruent with the woman's diagnosis? - Answer -Reduce activity with gray matter volume in the prefrontal cortex 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 with 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? - Answer -The components of the clients limbic system A 20-year-old college student has presented to his campus medical clinic because of his unshakable despondency in recent months. He has been diagnosed with depression based on his sound symptoms and history. The nurse knows it which of the following treatments will likely be prescribed for the student? - Answer -Medication that inhibits the reuptake of serotonin in his presynaptic space A psychiatrist is providing care for 68 year old female who's anxiety disorder is significantly decreasing her quality of life. The nurse knows that The client will likely benefit from which of the following pharmacologic therapies listed below? - Answer -A drug that influences gamma amnio butyric acid (GABA) levels A woman has a long running compulsion to repeatedly check if the doors of her home are locked and has received a diagnosis of OCD. Her husband is at a loss to understand her irrational behavior and has sought help from a therapist himself to deal with the effect of his wife's OCD is having on their daily lives. Which of the husbands following statements would require correction? - Answer -I'm glad that this is some thing that's a result of life stressors and is not associated with any dysfunction in her brain A 50-year-old woman has experience devastating consequences and her family and work life as a result of our long-standing alcohol addiction. The levels of pathways which of the following neurotransmitters and her body are likely to differ from an individual without addiction - Answer -Dopamine The nurse knows that The patient admitted for opioid addiction may benefit from which of the following treatment modalities? Select All that apply - Answer -A) Prescription of Dolphine (methadone) C) involvement in a self-help group like opioid anonymous Which of the following statements on the final diagnostic report regarding a CT of the head with contrast would lead the healthcare providers to diagnose a patient with Alzheimer's disease? - Answer - Too numerous to count beta-amyloid deposits noted A geriatrician and social worker facilitating a family meeting for the children and wife of a 79-year-old man who has been diagnosed with Alzheimer's disease. What goal of treatment will the conditions most likely prioritize in their interactions with family? - Answer -The use of medication such as donepezil and rivastigmine to slow the progression of the disease

A 70 year old woman has been brought to the emergency department by her daughter who noticed that the woman is weak and confused and forgetful in recent months along with uncoordinated movement and visual disturbances at times. Which of the following questions by the physician are most likely to the address for probable diagnosis? Select all that apply - Answer -A) what medication does your mother currently taking B) does your mother drink alcohol Which of the following is the most likely course of Warnicke syndrome - Answer -If the symptoms are correctly diagnosed most of the effects of the disease can be reversed they're better nutrition and supplemental thiamine