Chapter 24 - Neurological

Which test would help screen the gross and fine motor coordination skills of a child?

A) Weber

B) Denver II

C) Romberg

D) Heel-to-shin

B) Denver II (helps determine age-specific developmental achievements)

*Weber = assess the hearing ability

*Romberg = assess the upright postural control

*heel-to-shin = check lower extremity coordination

Which lobe of the brain would be associated with personality and intellectual functioning?

A) frontal

B) parietal

C) occipital

D) temporal

A) frontal (personality, behavior, emotions, and intellectual functioning)

*parietal = processing of sensory information such as pressure, touch, and pain

*occipital = primary visual receptor center

*temporal = functions of hearing, taste, and smell

Which aspect would be the major function of the glossopharyngeal nerve?

A) tasting of food

B) swallowing and gagging

C) lateral movement of the eye

D) muscular movement of the tongue

B) swallowing and gagging (glossopharyngeal nerve = cranial nerve IX (nine)

*tasting of food = cranial nerve X (ten) vagus nerve

*lateral movement of eye = cranial nerve VI (six) abducens nerve

*movement of tongue = cranial nerve XII (twelve) hypoglossal nerve

Which lobe of the brain would be associated with language comprehension?

A) frontal

B) parietal

C) occipital

D) temporal

D) temporal (Wernicke area associated with language comprehension)

*frontal = emotions and behaviors

*parietal = postcentral gyrus contains primary center for sensation

*occipital = center that is responsible for vision

Which reflex would help the nurse assess the functioning of cranial nerve VIII (vestibulocochlear nerve) in an infant?

A) gag

B) sucking

C) optical

D) acoustic blink

D) acoustic blink (cranial nerve VIII (eight) aids in transmission of impulses from inner ear to brain)

*gag = cranial nerve X (pharyngeal muscle)

*sucking = cranial nerve V (muscles of jaw)

*optical = cranial nerves I, III, IV, and VI (one, three, four, and six)

Which component of the central nervous system would carry the sensations of pain and temperature?

A) extrapyramidal

B) anterolateral tract

C) corticospinal

D) posterior columns

B) anterolateral tract (sensory fibers enter dorsal root of spinal cord and synapse with second sensory neuron)

*extrapyramidal = all motor nerve fibers originating in the motor cortex; these subcortical motor fibers maintain muscle tone and control body movements

*corticospinal = motor neurons originate in motor cortex and travel to brainstem; permits skilled and purposeful movements

*posterior columns = conduct position and vibration sensations and finely localized touch

In which location would the nurse test a patient's superficial reflex?

A) calf muscle

B) quadriceps

C) elbow

D) sole of the foot

D) sole of the foot (aka cutaneous reflex instigated by stroking the sole of the foot)

*calf muscle = assessed for clonus

*quadriceps and elbow = deep tendon reflexes

In which manner would an adult patient normally responds to the plantar reflex?

A) flexing the toes

B) extending the great toe

C) extending the lower leg

D) flexing the elbow

A) flexing the toes (flexion of toes and inversion and flexion of forefoot)

*extension of the big toe = fanning of all toes in abnormal response is abnormal in adults but normal in infants

*extending lower leg = stretched tendons of flexed knee that are struck below tendon

*flexing the elbow = brachioradialis reflex; relaxed forearm is stroked 2-3 cm above radial styloid process respond with flexion and supination of forearm

In which patient would the nurse expect a palmar grasp reflex and a positive Babinski reflex?

A) infant

B) child

C) adolescent

D) adult

A) infant (palmar grasp; aka Babinski reflex, is a primitive reflex originating in CNS exhibited by healthy infants)

*child = after 4 months is due to frontal robe lesions

*adolescent/adult = should exhibit normal reflexes but not Babinski reflex

Which type of tremor would be common in a patient with cerebral palsy?

A) chorea

B) athetosis

C) intention

D) familial

B) athetosis (characterized by slow, twisting, writhing, continuous movements resembling a snake or worm)

*chorea = sudden rapid, jerking movements of limbs, trunks or face (huntington's disease)

*intention = involuntary contractions of muscles that worsen during voluntary movements and common in cerebellar disease of multiple sclerosis

*familial = intentional tremor common in older patients

Injury to which cranial nerve would result in anosmia?

A) cranial nerve I (olfactory)

B) cranial nerve II (optic nerve)

C) cranial nerve III (oculomotor nerve)

D) cranial nerve IV (trochlear nerve)

A) cranial nerve I (olfactory innervates olfactory bulb and mediates sense of smell; amnosia = loss of sense of smell

*cranial nerve II (optic nerve) = innervates eye and mediates sense of vision; damaged results in vision loss

*cranial nerve III and IV (oculomotor and trochlear nerve) = innervates muscles that aid i movement of the eyeball; if damaged results in ptosis, or drooping eyelids

The nurse would suspect damage to which cranial nerve in a patient with an asymmetric smile who is unable to wrinkle the forehead?

A) cranial nerve II (optic nerve)

B) cranial nerve III (oculomotor nerve)

C) cranial nerve VII (facial nerve)

D) cranial nerve VIII (auditory nerve)

C) cranial nerve VII (facial nerve damage indicates Bell palsy and asymmetric facial facial movements and inability to wrinkle forehead)

*II = eye and mediates sense of vision; damage leads to loss of vision

*III = muscle of eyeball; damage leads to ptosis or eyelid drooping

*VIII = innervates ear and mediates sense of hearing; damage results in hearing impairment

Which muscle tone abnormality would the nurse anticipate with Guillain-Barre syndrome?

A) rigidity

B) flaccidity

C) spasticity

D) cogwheel rigidity

B) flaccidity (polyneuropathy that affects lower motor neurons; resulting decrease in muscle tone and leads to flaccidity)

*rigidity = a constant state of resistance; i.e. Parkinson's disease

*spasticity = upper motor neuron injury; muscle tone is increased

*cogwheel rigidity = increased tone is released intermittently with passive motion; patient with parkinsonism

The patient with difficulty swallowing with regurgitation of ingested fluids through the nose would have a lesion on which cranial nerve?

A) cranial nerve III

B) cranial nerve V

C) cranial nerve X

D) cranial nerve XII

C) cranial nerve X (vagus nerve innervates heart and digestive tract; bilateral lesions on vagus nerve has difficulty swallowing and fluids can be regurgitated through nose)

*III = oculomotor nerve; innervates muscles of eyeball, paralysis may dilate pupils, ptosis, or drooping eyelids

*V = trigeminal nerve; innervates muscles of jaw, lesions may cause weakness to jaw muscles

*XII = hypoglossal nerve; innervates tongue and controls its movement; damage results in slow rate of movement of tongue

The patient with receptive aphasia would have lost which ability?

A) taste

B) smell

C) walk or stand

D) understand language

D) understand language (receptive aphasia caused by dysfunction of Werknicke area in temporal lobe)

*taste = ageusia, unable to detect sweetness, sourness, bitterness, or saltiness

*smell = anosmia, inability to perceive odor or functioning olfaction

*walk or stand = astasis, lack of motor coordination without assistance

If the patient's deep tendon reflexes are very brisk and hyperactive with clonus, which grade would the nurse document?

A) 1+

B) 2+

C) 3+

D) 4+

D) 4+ (documents very brisk and hyperactive responses with clonus; possible indication of an upper motor neuron lesion)

reflex responses are graded on a 4-point scale

*1+ = diminished reflex

*2+ = average and normal responses

*3+ = brisker than average response

Which finding would the nurse observe in a patient with flaccid quadriplegia? (select all that apply)

A) hyperextension of the back

B) prolonged arching of the back

C) complete loss of muscle tone

D) paralysis of all four extremities

E) prolonged adduction of the arm

C, D (neurological disease or trauma; complete loss of muscle tone and paralysis of all four extremities caused by completely nonfunctional brainstem)

*hyperextended back = decerebrate rigidity

*prolonged arching of back = caused by meningeal irritation

*prolonged adduction of arm = decorticate rigidity

Degeneration of which structure would the nurse aspect in the patient with resting tremors, abnormally slow movement, flat expression, reduced eye blinking, and slouched posture?

A) cerebral cortex

B) corticospinal tract

C) upper motor neurons

D) dopamine-producing neurons

D) dopamine-producing neurons (parkinsonism occurs because of the degeneration of the dopaminergic neurons in substantia nigra of brain)

*cerebral cortex = cerebral palsy; may have seizures

*corticospinal and upper motor neurons = results in hemiplegia; contralateral paralysis of upper and lower limbs i.e. adducted shoulder, flexed elbow, pronated wrist, extended leg

If a patient reports a loss of pain and temperature sensation in the right lumbar region and has also lost the sensation of vibration and position discrimination on the left side of the lumbar region, which diagnosis would the nurse anticipate?

A) chorea

B) flaccid quadriplegia

C) peripheral neuropathy

D) Brown-Sequard syndrome

D) Brown-Sequard syndrome (loss of the sense of pain and temperature)

*chorea = abnormal rapid, jerky, purposeless movement of limbs, trunks, or face; decreased sensory perception

*flaccid quadriplegia = paralysis of all four extremities and complete loss of muscle tone

*peripheral neuropathy = loss of sensation in upper and lower limbs

The patient diagnosed with cerebellar damage would likely experience a change in which characteristic?

A) memory

B) libido

C) thermoregulation

D) voluntary movements

D) Voluntary movements (cerebellum controls motor coordination of voluntary movements, equilibrium, and muscle tone)

*memory = cerebral cortex

*libido/thermoregulation = hypothalamus

With the eyes closed if the patient is unable to identify a key placed in their hand by touching it, which term would the nurse use to document this finding?

A) clonus

B) torticollis

C) asterognosis

D) hyperreflexia

C) astereognosis (inability to identify an object by touch)

*clonus = rapid and rhythmic contractions of the same muscles

*torticollis = abnormal, asymmetrical head or neck position

*hyperreflexia = overactive or overresponsive reflexes

The nurse asks the patient to stand straight with the eyes closed and to stretch out both arms with the palms facing up and to hold that position. If the patient's left palm starts turning downward within 10 seconds, though the patient can hold the right hand steady, which condition would the nurse suspect?

A) athetosis

B) dysarthria

C) pronator drift

D) astereognosis

C) Pronator drift (downward unilateral drift that occurs with mild hemiparesis)

*athetosis = slow, twisting, writhing, continuous movement of muscles, resembling a snake or worm

*dysarthria = difficulty forming words

*astereognosis = inability to identify objects by active touching with hands

The reflex arc would consist of which structures? (select all that apply)

A) nucleus

B) sensory nerve

C) motor nerve

D) cranial nerve

E) neuromuscular junction

B, C, E (five components; sensory nerve as afferent neuron, efferent neuron by motor nerve fiber, efferent pathway ends at neuromuscular junction, functional synapse in cord, and competent muscle)

*nucleus = a brain structure

*cranial nerve = originates in brain, not component of reflex arc

Which disorder would the nurse suspect in the patient who cannot touch the tip of the nose with the forefinger and loses balance when the eyes are closed?

A) bell palsy

B) hypoesthesia

C) meningeal irritation

D) cerebellar dysfunction

D) cerebellar dysfunction (concerned with motor coordination of voluntary movements, equilibrium, and muscle tone)

*bell palsy = lower motor neuron lesion causes paralysis of one half of face

*hypoesthesia = touch sensation is decreased

*meningeal irritation = lead to abnormal posture

If the nurse flashes light into the eyes of a 5 year old child and observes ocular misalignment and a deviated gaze, which tern would the nurse use to document this finding?

A) nystagmus

B) strabismus

C) Horner's syndrome

D) myasthenia gravis

B) strabismus (eyes are not aligned caused by extraocular muscle incoordination

*nystagmus = involuntary back and forth movement of eye

*Horner's syndrome = disruption of sympathetic nerves that supply eyes (ptosis)

*Myasthenia gravis = chronic condition that weakens muscle of body; including eye muscles leading to drooping eyelids

Patients with which condition would be at an increased risk of hemorrhagic stroke?

A) hemophilia

B) endocarditis

C) atrial fibrillation

D) atherosclerosis

A) hemophilia (defect is coagulation cascade leading to hemorrhagic strokes)

*endocarditis/atrial fibrillation = formation of moving clot or embolus in blood vessels

*atherosclerosis = formation of thrombus in blood vessels

C, D, E = leads to ischemic stroke

Which condition would be characteristic of a lower motor neuron lesion? (select all that apply)

A) spasticity

B) hyperreflexia

C) fasciculation

D) muscular atrophy

E) loss of superficial abdominal reflexes

C, D

*spasticity = hypertonicity of the muscles; lower motor neurons lesions lead to hypotonia

*hyperreflexia = lower motor neuron lesion results in hyporeflexia or areflexia

*lower motor neurons don't control superficial reflexes like abdominal reflex

Which instruction would the nurse offer the patient when performing the Romberg test?

A) "walk heel to toe across the room"

B) "pronate and supinate the hands rapidly"

C) "run the heel of the foot down the opposite shin"

D) "stand with your feet together and eyes closed"

D) "stand with your feet together and eyes closed" (patient should be able to hold for 20 seconds without losing balance)

*heel to toe = gait evaluation

*pronate to supinate = diadochokinesia; upper extremity test

*heel to foot down shin = cerebellar coordination and fine motor movement

Which assessment would be included in the Glasgow Coma Scale? (select all that apply)

A) eye opening

B) pulse rate

C) verbal response

D) blood pressure

E) motor response

A, C, E (measure level of consciousness by a numeric scale)

*pulse rate and blood pressure = unreliable parameters of central nervous system deficits

Which medication would be prescribed for an older adult patient experiencing tremors that occur with voluntary movement and that cease upon rest?

A) Diazepam (Valium)

B) Levodopa (Sinemet)

C) Ibuprofen (Ultraprin)

D) Chlorpromazine (Largactil)

A) diazepam (tremors can cause emotional stress and are relieved by sedatives)

*levodopa = increases dopamine levels; used for Parkinsons

*ibuprofen = anti-inflammatory reduces pain in musculoskeletal

*chlorpromazine = reduces psychotic symptoms

Which factor would result in the absence of corneal, abdominal, and cremasteric reflexes on the right side of the patient's body with spastic paralysis on the left side of the body?

A) defect in cranial nerve IX

B) demyelination of neurons

C) lower motor neuron damage

D) damage to corticospinal tract

D) damage to corticospinal tract (primary motor activity for somatic motor system from neck to feet; spinal pathways involved in voluntary movement)

*cranial nerve IX = difficulty swallowing

*demyelination = multiple sclerosis

*lower motor neurons = flaccid paralysis, not spastic

The patient reports a sudden and severe throbbing headache and right arm weakness, and the nurse notes facial drooping and stuttered speech. When magnetic resonance imaging (MRI) reveals the developments of an atherosclerotic plaque in the middle cerebral artery, the nurse would anticipate the diagnosis of which type of stroke?

A) silent

B) embolic

C) thrombotic

D) hemorrahgic

C) thrombotic (atherosclerosis forms plaque along inner walls of vessels which break off to form a thrombus blocking vessels of brain)

*silent = may not experience any symptoms of stroke

*embolic = presence of embolus, moveable clot

*hemorrhagic = bleeding from weakened artery of brain

For which condition would the nurse assess in the patient who is unable to recognize the smell of coffee? (select all that apply)

A) sinusitis

B) allergic rhinitis

C) brainstem tumor

D) fracture of the cribriform plate

E) increase in intracranial pressure

A, B, D (sinusitis and allergic rhinitis = inflammation of sinuses; fracture of cribriform = leads to leakage of cerebrospinal fluid into nose; results in decreased sense of smell)

*brainstem tumor = not able to move eyeball properly

*increased intracranial pressure = throbbing headache with dilated, nonreactive pupil

Patients with which condition would be at risk of peripheral neuropathy? (select all that apply)

A) meningioma

B) diabetes mellitus

C) cervical spondylosis

D) shoulder dislocation

E) nutritional deficiency

B, E (loss of sensory perception and numbness due to damaged nerves)

*meningioma = complete or partial loss of sensation on contralateral side below level of lesion

*cervical spondylosis = loss of all sensory modalities below the affected region

*shoulder dislocation = injury to individual nerves, not partial loss of sensation in hands and feet

Which clinical manifestation would point to a diagnosis of Alzheimer disease? (select all that apply)

A) diplopia

B) bradykinesia

C) mood swings

D) disorientation

E) loss of initiative

C, D, E (neurodegenerative disorder causes memory loss due to death of neurons in cerebral cortex and subcortical regions; mood swings = death of nerve cells, disorientation = neuron damage in cerebrum, loss of initiative = passive symptom due to loss of initiative)

*diplopia = demyelination of optic nerve from multiple sclerosis

*bradykinesia = characteristic of Parkinson's

The patient with multiple sclerosis would experience sequelae because of demyelination of which cranial nerve? (select all that apply)

A) I

B) II

C) III

D) VI

E) VII

B, C (CN II = optic nerve, CN III = oculomotor; multiple sclerosis is demyelination and degeneration of nerves, frequently CN II and CN III causing nystagmus and diplopia)

*CN I = fracture of cribriform plate, a lesion in frontal lobe, or tumor of olfactory bulb

*CN VI = tumor in brainstem damages abducens

*CN VII = facial nerve associated with Bell palsy, not MS

Which statement would describe decerebrate rigidity?

A) arms are flexed, and legs are extended

B) back is hyperextended, palms are pronated

C) muscle tone is lost, all four extremeities are paralyzed

D) back is arched, head and heels are bent backward

B) back is hyperextended, and palms are pronated (decerebrate rigidity; indicates lesion on brainstem at midbrain or upper pons)

*decorticate rigidity = arms flexed and legs extended; hemispheric lesion of cerebral cortex

*flaccid quadriplegia = complete loss of muscle tone and paralysis of all 4 extremities; complete nonfunctional brainstem

*meningeal irritation = prolonged back arch with head and heels bent backward; opisthotonos

Damage to which cranial nerve would cause drooping of the upper eyelids in the patient diagnosed with myasthenia gravis?

A) acoustic

B) olfactory

C) oculomotor

D) hypoglossal

C) oculomotor (myasthenia gravis may have ptosis, drooping eyelids; CN III innervates eye orbits and controls movement of eyes and eyelids)

*acoustic = CN VIII innervates ear and mediates sense of hearing; causing impairment

*olfactory = CN I innervates the nose and helps in sense of smell; causing anosmia, loss of smell

*hypoglossal = CN XII innervates tongue and controls its movement, damage causes difficulty swallowing and speech

Which statement would describe the efferent fibers?

A) sensory neurons carry impulses from receptors

B) motor neurons influencing or modifying lower motor neurons

C) motor neurons carrying impulses to the muscles, organs, and glands

D) motor neurons originating in motor cortex and traveling to the brainstem

C) motor neurons carrying impulses to muscles, organs and glands (efferent fibers are peripheral motor nerves that deliver output from CNS to target organs)

*sensory afferent fibers = input to CNS from receptors (A)

*descending motor fibers = upper motor neurons that influence lower motor neurons (B)

*pyramidal tracts = nerve fibers that originate in motor cortex and travel to brainstem (D)

Which assessment would indicate the patient is in a tonic phase of a generalized seizure? (select all that apply)

A) bites the tongue

B) tachycardia

C) facial grimacing

D) persistent confusion

E) opening of the mouth of the eyes

A, E (tonic phase will have muscle rigidity, bite tongue, open eyes and mouth, and high-pitched cry)

*clonic phase = tachycardia, facial grimacing, and violent muscular contractions

*postictal phases = final phase; deep sleep, disorientation, and confusion

Which reflex, if present in a 6 month old, would prompt the nurse to immediately refer the patient to the provider?

A) Moro

B) Sucking

C) Babinski

D) Tonic neck

A) Moro (startle reflex; present at birth and disappears by 4 months)

*Sucking = disappears at age 10-12 months

*Babinski = disappears by 24 months

*tonic neck = disappears 4-6 months

Which action by the nurse assessing a patient's pain perception would require correction?

A) using a sharp edge of a tongue blade to test pain

B) discarding the tongue blade after the assessment

C) maintaining a 2 second gap between each pain stimulus

D) applying the tongue blade on the patient's body in a systematic order

D) applying the tongue blade on the patient's body in a systematic order (must have 2 types of sensation; sharp and dull, to assess pain)

The nurse asks the patient to close their eyes and then traces the number 5 on the patient's palm. If the patient is unable to identify the number even after repeated attempts, this finding would indicate damage to which part of the patient's brain?

A) cerebellum

B) sensory cortex

C) cranial nerve XII

D) dorsal spinothalamic tract

B) sensory cortex (graphesthesia; lesions of sensory cortex has impaired sensory perception and will not be able to identify number or letter traced on palm)

*cerebellum = controls voluntary movement of body; damage results in impaired voluntary functions but not decreased sensory perception

*Cranial nerve XII = hypoglossal nerve innervates tongue and mediates speech, swallowing, and chewing processes

*dorsal spinothalamic tract lesion = decreased sense of pain and temperature

The nurse anticipates the patient with a Glasgow Coma Scale (GCS) score of 3 would be in which condition?

A) fully alert

B) comatose

C) obtunded

D) able to perform commands

B) comatose (a score of less than 7 = comatose)

*fully alert = GSC score of 15

*obtunded = not comatose but not fully alert

*able to perform commands = GSC score of greater than 6

Which test would involve placing a paper clip in the palm of a patient whose eyes are closed and asking them to recognize the object?

A) extinction

B) stereognosis

C) graphesthesia

D) discrimination

B) stereognosis (determines ability to recognize familiar objects by feeling their forms, sizes, and weights without seeing them)

*extinction = simultaneous touches along both sides of patient's body at same point

*graphesthesia = inability to read number/letter traced on skin

*discrimination = discrimination ability of the sensory cortex

Which complication would be present in a patient with crossed knees, fatigue, nystagmus, and diplopia, and who is unable to maintain balance with the eyes closed?

A) athetosis

B) myoclonus

C) meningitis

D) multiple sclerosis

D) multiple sclerosis (inflammation of axons resulting in demyelination of neurons in brain and spinal cord, affects cerebellar system resulting in impaired voluntary movements leading to crossed knees and scissor gait)

*athetosis = slow, involuntary, convoluted and writhing movements of body resembling a snake

*myoclonus = rapid, sudden jerking movements, or short series of jerks at regular intervals; caused by spinal cord or brain injury

*meningitis = opisthotonos posture but not crossed knees

The nurse observes a palmar grasp reflex in an 8 month old infant and would anticipate which diagnosis?

A) normal neurodevelopment

B) frontal lobe lesion

C) nerve injury

D) occipital lobe damage

B) frontal lobe lesion (persistence of palmar grasp after 4 months old)

*nerve injury = leads to loss of palmar grasp reflex

*occipital lobe damage = results in vision problems

Which cranial nerve would the nurse assess by touching a cotton wisp to the patient's forehead, cheeks, and chin?

A) IV

B) V

C) VI

D) VII

B) V (Cranial Nerve V = trigeminal nerve; sensory functions related to nose, eyes, tongue, and teeth, ophthalmic, maxillary, and mandibular branches)

*CN IV = trochlear nerve; connected to midbrain and controls eye muscles and turning of eye

*CN VI = abducens nerve; lateral movement of eyes

*CN VII = facial nerve; various facial expressions

Which condition in the 3 year old child would prompt the nurse to suspect pyramidal tract disease?

A) extension of the limbs

B) positive Babinski reflex

C) presence of a Moro reflex

D) asymmetry in upper limb movement

B) positive Babinski reflex (present at brith and disappears by the age of 24 months)

*extension of the limbs = intracranial hemorrhage

*Moro reflex = after 5 months indicates severe CNS injury; does not lead to pyramidal tract disease

*asymmetry of upper limbs = brachial plexus palsy

Which response by the infant to having the nose pinched would indicate a normally functioning cranial nerve XII?

A) wrinkles the forehead

B) blinks the eyes with rapid closure

C) opens the mouth and raises the tongue

D) cries with a symmetrical facial movement

C) opens the mouth and raises the tongue (CN XII controls tongue and mouth)

*wrinkles forehead = CN VII Facial nerve; aids in facial movements

*blinks eyes with rapid closure = CN IV Trochlear nerve; aids in movement of eye muscles

*cries with symmetrical facial movement = CN VII Facial nerve; facial movement while crying and smiling

Which type of medication prescribed for long-term therapy for seizures would result in a staggering gain and positive Romberg sign?

A) barbiturate

B) anticonvulsant

C) antipsychotic

D) dopaminergic

A) barbiturate (sedative medications act on cerebellum and decrease its activity; side-effects include staggering gait, impaired balance, or positive Romberg sign)

*anticonvulsant = anti-seizure medications that help treat epilepsy or seizure disorder; side-effects include inability to sleep, weight loss, decreased appetite

*antipsychotic = possible prescription for seizures

*dopaminergic = increase dopamine levels but don't depress cerebellum but does not cause staggering gait or impaired balance

The nerve fibers present in the posterior column of the spinal cord would carry information about which sensation?

A) pain

B) crude touch

C) temperature

D) position and vibration

D) position and vibration (posterior column of spinal cord)

*anterolateral tract = pain, crude touch, and temperature

Which test would be used to assess for a sensory cortex lesion?

A) Weber

B) Point location

C) Finger-to-nose

D) Finger-to-finger

B) point location (assess the sense of touch and ability to localize sense of touch; lesion in sensory cortex)

*Weber = testing CN VIII (vestibulocochlear nerve) transmits hearing impulses from eat to brain

*Finger-to-nose/Finger-to-finger = assess muscle coordination; indicates cerebellar dysfunction

Which response to the brachioradialis reflex test would be documented as normal?

A) extension of lower leg

B) extension of forearm

C) dorsiflexion of toes

D) flexion and supination of forearm

D) flexion and supination of forearm (brachioradialis reflex originates at cervical vertebrae 5 and 6; normal response shows flexion and supination of forearm)

*quadricep reflex (hit patella) = extension of lower leg

*triceps reflex = extension of forearm

*dorsiflexion of toes in an abnormal reaction

Which percentage of the population would have a dominant left hemisphere, including those who are left-handed?

A) 70%

B) 75%

C) 87%

D) 95%

D) 95% (left hemisphere is dominant in about 95% of people; including left-handed)

Which type of basic reflex would include pupillary response to light and accommodation?

A) visceral

B) superficial

C) pathologic

D) deep tendon

A) visceral (pupillary response to light and constricts immediately)

*superficial = corneal reflex and abdominal reflex

*pathologic = abnormal and indicates disease; Babinski and Kernig reflex

*deep tendon = knee jerk reflex

Which condition would cause stiff extension of the upper and lower extremities, clenching of the teeth, and hyperextension?

A) meningeal irritation

B) lesion in the upper pons

C) lesion in cerebral cortex

D) injury to extrapyramidal motor tracts

B) lesion in upper pons (decerebrate rigidity)

*meningeal irritation = opisthotonos posture prolonged arching of back with head and heels bent backward

*lesion in cerebral cortex = decorticate rigidity

*extrapyramidal motor tract = constant state of resistance to passive movement

If a patient presents with prolonged arching of the back with the head and heels bend backward, which condition would the nurse suspect?

A) meningeal irritation

B) brachial plexus palsy

C) lesions in the brainstem

D) lesions in cerebral cortex

A) meningeal irritation (opisthotonos posture; inflammation leading to decreased range of motion of spine; nuchal rigidity)

*brachial plexus palsy = asymmetry of upper limb movement

*lesions in brainstem = extension of BOTH upper and lower limbs

*lesions in cerebral cortex = flexion of upper limbs and extension of lower limbs

The presence of which pathologic reflex would prompt the nurse to suspect meningeal irritation? (select all that apply)

A) Kernig

B) Gordon

C) Babinski

D) Brudzinski

E) Oppenheim

A, D (Kernig = resistance to straightening the leg in supine position; Brudzinski = resistance and pain in neck with flexion of hips and knees; both indicate meningeal irritation)

*Gorgon, Babinski, and Oppenheim = patient with pryamidal tract disease

Which test would assess cerebellar function? (select all that apply)

A) Romberg

B) Extinction

C) Stereognosis

D) point location

E) finger-to-nose

A, E (Romberg = balance test; Finger-to-nose = upper limb coordination; both tests asses cerebellar function)

*Extinction = determines perceived sensation upon touch both sides simultaneously

*Stereognosis = recognize objects by feeling their form

*Point location = determines locates area where they are touched

**extinction, stereognosis, point location test for sensory cortex function

If a patient is experiencing a generalized seizure with tachycardia and violent muscular contractions, which subsequent clinical manifestations would the nurse expect following the seizure? (select all that apply)

A) confusion

B) disorientation

C) muscular rigidity

D) high-pitched cry

E) loss of consciousness

A, B (postictal phase, ending of seizure)

*tonic phase = muscular rigidity, high-pitched cry

*initial phase = loss of consciousness

*clonic phase = increased heart rate and violent muscular contractions

A lesion in which part of the brain would be suspected in the patient displaying decorticate posturing?

A) cerebrum

B) midbrain

C) upper pons

D) cerebral hemispheres

D) cerebral hemispheres (flexion on arms, extension of lower extremities, and plantar flexion)

*cerebrum damage = difficulties associated with memory and thinking

*midbrain and pons = decerebrate posture

Infant Reflexes...when do they go away?

Rooting, suckling, palmer, plantar, babinski, tonic neck, and moro

A) 24 months

B) 3 - 4 months

C) 10 - 12 months

D) 8 - 10 months

E) 4 - 6 months

rooting = B (3 - 4 months)

suckling = C (10 - 12 months)

palmar = B (3 - 4 months)

plantar = D (8 - 10 months)

Babinski = A (24 months)

tonic neck = E (4 - 6 months)

moro = B (3 - 4 months)

Cranial Nerves

1. CN 1 A. Trigeminal

2. CN 2 B. Facial

3. CN 3 C. Olfactory

4. CN 4 D. Vestibulocochlear

5. CN 5 E. Vagus

6. CN 6 F. Optic

7. CN 7 G. Hypoglossal

8. CN 8 H. Oculomotor

9. CN 9 I. Trochlear

10. CN 10 J. Accessory

11. CN 11 K. Glossopharyngeal

12. CN 12 L. Abducens

CN 1 = C (Olfactory)

CN 2 = F (Optic)

CN 3 = H (Oculomotor)

CN 4 = I (Trochlear)

CN 5 = A (Trigeminal)

CN 6 = L (Abducens)

CN 7 = B (Facial)

CN 8 = D (Vestibulocochlear)

CN 9 = K (Glossopharyngeal)

CN 10 = E (Vagus)

CN 11 = J (Accessory)

CN 12 = G (Hypoglossal)

Which cranial nerves innervate what?

1. Olfactory A. side to side eye movement

2. Optic B. Digestion and heart rate

3. Oculomotor. C. up, down, back, forth (eye)

4. Trochlear D. sense of smell

5. Trigeminal. E. facial expressions and taste

6. Abducens. F. ability to see

7. Facial. G. face, cheeks, taste, and jaw

8. Vestibulocochlear. H. move the tongue

9. Glossopharyngeal. I. taste and swallow

10. Vagus J. move and blink eyes

11. Accessory. K. sense of taste

12. Hypoglossal. L. shoulder/neck movement

Olfactory = D (sense of smell)

Optic = F (ability to see)

Oculomotor = J (move and blink)

Trochlear = C (up, down, back, forth (eyes)