Neuro PrepU

The nurse is assessing a 51-year-old morbidly obese client who is seeking care for the recent loss of sensation in his feet and toes. The client also complains of intermittent burning and tingling in his feet that radiate up his legs. For which of the following health problems should the nurse first assess?

Diabetic peripheral neuropathy

A client presents to the health care clinic with a 3-day history of fever, chills, neck pain and stiffness, and headache. The nurse observes an elevated temperature of 102.5°F and pain with rotation of the head side to the side and decreased ability to flex the head forward. The nurse recognizes these findings as most likely the onset of what infectious process?

Meningitis

How many pairs of cranial nerves exit from the brain?

12

An adult client has asked the nurse about actions that she can take to reduce her future risk of stroke. What health promotion activity should the nurse prioritize?

Smoking cessation

A client has sustained an injury to the cerebellum. Which area would be the primary area for assessment?

coordination

The nurse is assessing the neurological status of an unconscious client. The nurse should use which assessment scale?

Glasgow

The nurse performing an admission assessment on an older adult. What would be an expected finding?

Decreased vision

The nurse is preparing to perform the Romberg test on an adult male client. The nurse should instruct the client to

stand erect with arms at the sides and feet together.

A client with a diagnosis of type 1 diabetes is admitted to the hospital with acute symptomatic seizures. Given the client's underlying condition, what would be the most likely cause of this type of seizure?

hyperglycemia

A nurse is preparing to assess the cranial nerves of a client. The nurse is about to test CN I. What would the nurse do?

Ask a client to identify scents.

A client says that an object placed in the hand is a pair of scissors when the object is a paper clip. Which aspect of the client’s neurologic system should the nurse identify as being compromised?

sensory

During an admission assessment, the nurse notes that the client has diabetes with peripheral neuropathy. What finding would the nurse expect to find?

Decreased sensation in the feet

When assessing deep tendon reflexes in an elderly client what finding would the nurse anticipate?

Decreased reaction time

During the health history a client reports a decrease in his ability to smell. During the physical assessment, the nurse would make sure to assess which cranial nerve?

CN I

A nurse is preparing to assess the cranial nerves of a client. The nurse is about to test CN I. Which of the following would the nurse do?

Ask a client to identify scents.

Lifestyle can play a big part in developing risk factors for stroke. Which of the following can greatly reduce a client's risk for stroke? Select all that apply.

• Quitting smoking

• Regularly exercising

• Maintaining a healthy weight

When performing an assessment of the nervous system, it is most appropriate for a nurse to complete it in which sequence?

Mental status, cranial nerves, motor/cerebellar, sensory, reflexes

During assessment, the nurse notes the client has limited movement of his lower extremities and sways when standing with feet together. The nurse identifies that the client is at risk for what?

Falls

A client has sustained an injury to the cerebellum. Which area should be the nurse's primary focus for assessment?

Coordination

The nurse is providing teaching to a client with type 1 diabetes. When providing information about reducing the risk of diabetic neuropathy, the nurse should be sure to include which point?

"Effective blood glucose regulation can prevent this problem."

A nurse is preparing to assess a client's cerebellar function. Which of the following would the nurse expect to test?

Balance

A nurse is preparing to assess a client's cerebellar function. What aspect of neurological function should the nurse address?

Balance

A nurse is working with a client who is victim of a shooting. The client has an increased pulse rate and pupil dilation and is clearly in stress. The nurse recognizes the “fight-or-flight” response in this client and understands that this represents an activation of which of the following?

Sympathetic nervous system

A nurse is preparing to offer a community education session on anxiety. On which part of the nervous system should the nurse focus during the discussion?

sympathetic nervous system

The nurse walks into a client's room and finds that the client is disoriented to time and place but is awake and responsive. What term best describes this client?

Confused

A client has sustained an injury to the cerebellum. Which area would be the primary area for assessment?

Coordination

When evaluating a client's risk for cerebrovascular accident, which client would the nurse identify as being at highest risk?

68-year-old African American male with hypertension

The husband of a 65-year-old female tells the nurse, "My wife is having trouble navigating the steps in our home and she needs my help to step down off a curb." What part of the nervous system should the nurse assess for a potential source of the problem?

Cerebellum

After testing deep tendon reflexes, the nurse documents 2+. The nurse should evaluate further.

False

The nurse lightly strokes the sides of a client’s abdomen, above and below the umbilicus. For which reflex is the nurse testing?

Abdominal

A nurse cares for a client who suffered a cerebrovascular accident and demonstrates the inability to speak clearly. The nurse recognizes that injury has occurred to what portion of the brain?

Broca's area

Which tests are appropriate for a nurse to perform to test cranial nerve VIII?

Whisper, Rinne, and Weber tests

The husband of a 65-year-old female tells the nurse, “My wife is having trouble navigating the steps in our home and needs my help to step down off a curb.” What part of the nervous system should the nurse assess for a potential source of the problem?

Cerebellum

Upon reviewing the client's medical record, the nurse finds the client has left ptosis. The nurse would assess the client for what?

Drooping of the left eye

The brain is a network of interconnecting neurons that control and integrate the body's activities. What components make up these neurons? Select all that apply.

• Cell body

• Axon

• Dendrite

Which tests are appropriate for a nurse to perform to test the cranial nerve VIII?

Whisper test, Rinne, and Weber

Which assessment procedure should a nurse institute to test a client for stereognosis?

With eyes closed, ask the client to identify a familiar object that is placed in their hand

The nurse plans to test which cranial nerve when testing an elderly client's hearing status?

VIII

A 7-year-old boy is performing poorly in school. His teacher is frustrated because he is frequently seen “staring off into space” and not paying attention. If this is a seizure, it most likely represents which type?

Absence

Which of the following assessment techniques should the nurse use to determine a client's stereognosis?

With the client's eyes closed, place a coin or key in hand and ask him or her to identify the object.

The nurse is performing the Romberg test as part of a client's focused neurological assessment. What finding would constitute a positive Romberg test?

The client moves her feet apart to prevent herself from falling.

The nurse performs a neurological assessment and determines the Glasgow Coma Scale (GCS) score is 15. What is the nurse's best action?

Document the findings.

When the nurse is assessing a client's mental status as part of the screening neurological examination, which question would be most appropriate to ask?

"Can you tell me where you are right now?"

When explaining how the nurse would test graphesthesia, which of the following would the nurse include?

Client will close the eyes and identify what number the nurse writes in the palm of the client's hand with a blunt-ended object

The Glasgow Coma Scale measures the level of consciousness in clients who are at high risk for rapid deterioration of the nervous system. A score of 13 indicates

some impairment.

While the nurse is performing as assessment of the eyes for a client, the nurse notes that one of the client’s pupils is dilated and unresponsive to light. Which condition should the nurse suspect?

cranial nerve III (oculomotor) damage

During a routine follow up visit, an older adult client asks the nurse, “I’ve noticed that my sense of smell has decreased over the years and I’m concerned about the cause.” What is the nurse’s best response?

“Over time the sense of smell decreases in some people, and this is normal.”

A client's patellar reflex is normal for the right side but diminished on the left. Using the scale for grading reflexes, how should the nurse document this finding?

Right knee +2; Left knee +1

What is the level of the spinal cord associated with the knee (patellar) deep tendon reflex?

L2 to L4

Which of the following assessments is most likely to provide insight into the function of the client's CN VIII?

Test the client's hearing for lateralization and bone and air conduction.

What would the nurse most likely find when assessing a client diagnosed with a frontal lobe contusion following a motor vehicle accident?

Difficulty speaking

When the nurse is assessing the motor function of cranial nerve VII as part of the neurological examination, what should the nurse instruct the client to do?

Smile

When assessing cranial nerves IX and X, what would the nurse consider as a normal finding?

Uvula and soft palate rising bilaterally on phonation

Which of the following would the nurse most likely expect to find when assessing a client diagnosed with a frontal lobe contusion following a motor vehicle accident?

Difficulty speaking

A nursing instructor is describing the peripheral nervous system to a group of students. The instructor would explain that there are how many pairs of spinal nerves?

31

What should the nurse assess to test the function of the occipital lobe?

Ability to read

The nurse documents “Romberg test positive” on a client’s medical record. What did the nurse most likely assess in this client?

Swaying

The nurse is preparing to assess balance in an older adult client. Which test would the nurse plan on possibly omitting from the exam?

Hop on one foot

A nurse is assessing a client for abnormalities of gait due to a concern that the client is at increased risk for a fall. Which instruction should the nurse give the client first?

"Walk across the room and back."

While the client is sitting quietly, the thumb and index finger of the left hand are moving in a circular motion. The nurse identifies this finding as which of the following problems?

A resting tremor

What should the nurse assess to test the function of the frontal lobe?

Communication

Which of the following would lead the nurse to suspect meningeal irritation?

Pain and flexion of the hips and knees with neck flexion

On assessment of a client, the nurse finds that the client has difficulty in producing and understanding language. How should the nurse document this finding in the client's record?

Aphasia

What task should a nurse ask a client to perform to assess the function of cranial nerve XI?

shrug shoulders against resistance

A client is in the emergency room with what could be a lumbar injury. Which deep tendon reflex would be most appropriate to test?

patellar

A client who was injured by a fall at a construction site has been admitted to the hospital. He has suffered nerve damage such that his gag reflex is no longer intact, requiring him to receive intravenous total parenteral nutrition. Which nerve should the nurse suspect to be involved in this client's injury?

Glossopharyngeal (IX)

The nurse has positioned a client supine and asked her to perform the heel-to-shin test. An inability to run each heel smoothly down each shin should prompt the nurse to perform further assessment in what domain?

Balance and coordination

The cranial nerve that has sensory fibers for taste and fibers that result in the “gag reflex” is the

glossopharyngeal

Which part of the brain controls the vital functions of temperature, heart rate, blood pressure, sleep, the anterior and posterior pituitary, the autonomic nervous system, and emotions and maintains overall autonomic control?

Hypothalamus

The nurse is preparing to assess balance in an older adult client. Which test would the nurse plan on possibly omitting from the exam?

Hop on one foot

During the Romberg test, a client is unable to stand with his feet together and demonstrates a wide-based, staggering, unsteady gait. The nurse would identify this as which of the following?

Cerebellar ataxia

When testing the biceps reflex, what type of response should the nurse expect if normal?

Elbow flexes and muscle contracts

The nurse has completed a Glasgow Coma Scale assessment and assigns the client a score of three. Which is the best way for the nurse to assess pain in this client?

Assess for nonverbal signs.

During morning report the nurse learns that an assigned client needs assistance with ambulation because of spastic hemiparesis. What should the nurse expect when ambulating with this client?

A nurse is performing a focused cranial assessment on a client. The nurse observes that the client is unable to shrug their shoulders. The nurse documents this as a dysfunction of which cranial nerve?

XI

The nurse assesses the motor system as part of the full neurological examination. In order to effectively assess this system, which of the following instructions should be given to the client?

Instruct the client to flex and extend the right elbow

The nurse is caring for a client in the hospital and identifies the client to be experiencing acute confusion after cardiac surgery. The nurse recognizes this as what?

Delirium

The nurse is performing the Romberg test. Which of the following indicate a normal finding?

Client stands erect with minimal swaying

The nurse is assessing CN V (trigeminal nerve) in a newly admitted client. What instruction should the nurse provide to the client during this phase of assessment?

“Clench your teeth together tightly.”

When assessing cranial nerves IX and X, which of the following would the nurse consider as a normal finding?

Uvula and soft palate rising bilaterally

A nurse observes a client's gait and notes it to be wide based and staggering. The Romberg test results were positive. The nurse recognizes this as what type of abnormal gait?

Cerebellar ataxia

The nurse is assessing a client exhibiting dystonic movements. The nurse should review the client's medications from home to check whether he is taking which medications that may cause the dystonia?

Psychiatric medications

The diencephalon of the brain consists of the

thalamus and hypothalamus.

A 48-year-old grocery store manager comes to the clinic complaining of her head being “stuck” to one side. She says that today she was doing her normal routine when it suddenly felt like her head was being moved to her left and then it just stuck that way. She says it is somewhat painful because she cannot move it back to a normal position. She denies any recent neck trauma. Her past medical history consists of type 2 diabetes and gastroparesis (slow-moving peristalsis in the digestive tract, seen in diabetes). She is taking oral medication for each. She is married with three children. She denies tobacco, alcohol, or drug use. Her father has diabetes and her mother passed away from breast cancer. Her children are healthy. Examination reveals a slightly overweight Hispanic woman appearing her stated age. Her head is twisted grotesquely to her left; otherwise, her examination is normal. What form of involuntary movement does she have?

Dystonia

A woman experienced syncope after hearing that her son was severely injured. She became pale and collapsed to the ground without injuring herself. On waking, she states that she felt very warm. She denies any other symptoms. There are no findings on examination. What caused her loss of consciousness?

Vasovagal syncope

A nurse is reviewing a client's health record while interviewing her. The nurse sees in the client's record a score of 3+ on the biceps reflex test from her previous visit. The nurse understands that this finding indicates which of the following?

Increased or brisk, but not pathologic

The nurse working in the emergency department is assessing an intoxicated driver involved in a motor vehicle crash when the client insists on ambulating to the bathroom. The nurse escorts the client and calls for help while anticipating which abnormal gait in this client that places him at risk for falls?

Cerebellar ataxia

Sensations of temperature, pain, and crude and light touch are carried by way of the

spinothalamic tract.

A client presents to the health care facility for a routine health checkup. The nurse learns that the client has a long history of cardiovascular disease, including hypertension and carotid artery disease. When assessing this client for potential problems in the nervous system, which question by the nurse is appropriate?

“Are you having any dizziness or lightheadedness?”

The client presents at the clinic with a complaint of weakness that is made worse with repeated effort and improves with rest. The client’s complaint is consistent with what health problem?

Myasthenia gravis

A 7-year-old child comes to the clinic with her mother, who states that her daughter is doing poorly in school because she has some kind of “ADD” (attention deficit disorder). The nurse asks the mother what makes her think the child has ADD. The mother says that both at home and at school her daughter just zones out for several seconds and licks her lips. She states it happens at least four to six times an hour. She says this has been happening for about 1 year. After several seconds of lip licking, her daughter seems normal again. She states her daughter has been generally healthy with just normal childhood colds and ear infections. The client's parents are both healthy; no other family members have had these symptoms. What type of seizure disorder is most likely?

Generalized absence seizure

When testing sensory function of the trigeminal nerve (CN V), which of the following sensations would the nurse assess?

Pain and light touch

What task should a nurse ask a client to perform to assess the function of cranial nerve XII?

Move the tongue from side to side

The nurse is assessing the client's coordination and finds that her movements are clumsy, unsteady, and inappropriately varying in their speed, force, and direction. The nurse notes that client has dysmetria. What would the nurse know this client has?

Cerebellar disease

A client reports resting and skipping exercise during a holiday from work. Which part of the nervous system is controlling this client’s behavior?

parasympathetic

During the Romberg test, a client is unable to stand with the feet together and demonstrates a wide-based, staggering, unsteady gait. The nurse would identify this as which of the following?

Cerebellar ataxia

A 60-year-old retired seamstress comes to the office reporting decreased sensation in her hands and feet. She states that she began to have the problems in her feet 1 year ago but now it has started in her hands also. She also complains of some weakness in her grip. She has had no recent illnesses or injuries. Her past medical history consists of having type 2 diabetes for 20 years. She now takes insulin and oral medications for her diabetes. She has been married for 40 years. She has two healthy children. Her mother has Alzheimer's disease and coronary artery disease. Her father died of a stroke and also had diabetes. She denies any tobacco, alcohol, or drug use. On examination she has decreased deep tendon reflexes in the patellar and Achilles tendons. She has decreased sensation of fine touch, pressure, and vibration on both feet. She has decreased two-point discrimination on her hands. Her grip strength and her plantar and dorsiflexion strength are decreased. Where is the disorder of the peripheral nervous system in this client?

Peripheral polyneuropathy

The nurse is assessing an newly admitted client with a seizure disorder. The nurse would asses the client for what?

Aura

A client presents to the health care facility for a routine health checkup. The nurse learns that the client has a long history of cardiovascular disease including hypertension and carotid artery stenosis. When assessing this client for potential problems in the nervous system, which question by the nurse is appropriate?

"Are you having any dizziness or lightheadedness?"

Examination of a client's gait reveals that the client is stooped over when walking and that he slowly shuffles. As well, the client maintains a stiff posture when walking. The nurse should document what type of gait?

Parkinsonian gait