Chapter 24: Neurologic System
Jarvis: Physical Examination and Health Assessment, 8th Edition
MULTIPLE CHOICE
1. What are the two parts of the nervous system?
a.
Motor and sensory
b.
Central and peripheral
c.
Peripheral and autonomic
d.
Hypothalamus and cerebral
2. The wife of a 65-year-old man tells the nurse that she is concerned because she has noticed a
change in her husband’s personality and ability to understand. He also cries very easily and
becomes angry. What part of the cerebral lobe is responsible for these behaviors?
a.
Frontal
b.
Parietal
c.
Occipital
d.
Temporal
3. Which statement concerning the areas of the brain is true?
a.
The cerebellum is the center for speech and emotions.
b.
The hypothalamus controls body temperature and regulates sleep.
c.
The basal ganglia are responsible for controlling voluntary movements.
d.
Motor pathways of the spinal cord and brainstem synapse in the thalamus.
4. The area of the nervous system that responsible for mediating reflexes?
a.
Medulla
b.
Cerebellum
c.
Spinal cord
d.
Cerebral cortex
5. While gathering equipment after an injection, a nurse accidentally received a prick from an
improperly capped needle. To interpret this sensation, which of these areas must be intact?
a.
Corticospinal tract, medulla, and basal ganglia
b.
Pyramidal tract, hypothalamus, and sensory cortex
c.
Lateral spinothalamic tract, thalamus, and sensory cortex
d.
Anterior spinothalamic tract, basal ganglia, and sensory cortex
6. A patient with a lack of oxygen to his heart will have pain in his chest and possibly in the
shoulder, arms, or jaw. The nurse knows that the best explanation why this occurs is which
one of these statements?
a.
A problem exists with the sensory cortex and its ability to discriminate the
location.
b.
The lack of oxygen in his heart has resulted in decreased amount of oxygen to the
areas experiencing the pain.
c.
The sensory cortex does not have the ability to localize pain in the heart;
consequently, the pain is felt elsewhere.
d.
A lesion has developed in the dorsal root, which is preventing the sensation from
being transmitted normally.
7. What controls humans’ ability to perform very skilled movements such as writing?
a.
Basal ganglia
b.
Corticospinal tract
c.
Spinothalamic tract
d.
Extrapyramidal tract
8. A 30-year-old woman tells the nurse that she has been very unsteady and has had difficulty in
maintaining her balance. Which area of the brain most concerns the nurse?
a.
Thalamus
b.
Brainstem
c.
Cerebellum
d.
Extrapyramidal tract
9. Which of these statements about the peripheral nervous system is correct?
a.
The CNs enter the brain through the spinal cord.
b.
Efferent fibers carry sensory input to the central nervous system through the spinal
cord.
c.
The peripheral nerves are inside the central nervous system and carry impulses
through their motor fibers.
d.
The peripheral nerves carry input to the central nervous system by afferent fibers
and away from the central nervous system by efferent fibers.
10. A patient has a severed spinal nerve as a result of trauma. Which statement is true in this
situation?
a.
Because there are 31 pairs of spinal nerves, no effect results if only one nerve is
severed.
b.
The dermatome served by this nerve will no longer experience any sensation.
c.
The adjacent spinal nerves will continue to carry sensations for the dermatome
served by the severed nerve.
d.
A severed spinal nerve will only affect motor function of the patient because spinal
nerves have no sensory component.
11. A 21-year-old patient has a head injury resulting from trauma and is unconscious. There are
no other injuries. During the assessment what would the nurse expect to find when testing the
patient’s deep tendon reflexes?
a.
Reflexes will be normal.
b.
Reflexes cannot be elicited.
c.
All reflexes will be diminished but present.
d.
Some reflexes will be present, depending on the area of injury.
12. A mother of a 1-month-old infant asks the nurse why it takes so long for infants to learn to roll
over. What is the reason for this?
a.
A demyelinating process must be occurring with her infant.
b.
Myelin is needed to conduct the impulses, and the neurons of a newborn are not
yet myelinated.
c.
The cerebral cortex is not fully developed; therefore, control over motor function
gradually occurs.
d.
The spinal cord is controlling the movement because the cerebellum is not yet fully
developed.
13. During an assessment of an 80-year-old patient, the nurse notices the following: an inability to
identify vibrations at her ankle and to identify the position of her big toe, a slower and more
deliberate gait, and a slightly impaired tactile sensation. All other neurologic findings are
normal. How should the nurse interpret these findings?
a.
CNS dysfunction
b.
Lesion in the cerebral cortex
c.
Normal changes attributable to aging
d.
Demyelination of nerves attributable to a lesion
14. A 70-year-old woman tells the nurse that every time she gets up in the morning or after she’s
been sitting for a while, she gets “really dizzy” and feels like she is going to fall over. What is
the best response by the nurse?
a.
“Have you been extremely tired lately?”
b.
“You probably just need to drink more liquids.”
c.
“I’ll refer you for a complete neurologic examination.”
d.
“You need to get up slowly when you’ve been lying down or sitting.”
15. During the taking of the health history, a patient tells the nurse that “it feels like the room is
spinning around me.” How should the nurse document this finding?
a.
Vertigo
b.
Syncope
c.
Dizziness
d.
Seizure activity
16. When taking the health history on a patient with a seizure disorder, the nurse assesses whether
the patient has an aura. Which of these would be the best question for obtaining this
information?
a.
“Does your muscle tone seem tense or limp?”
b.
“After the seizure, do you spend a lot of time sleeping?”
c.
“Do you have any warning sign before your seizure starts?”
d.
“Do you experience any color change or incontinence during the seizure?”
17. While obtaining a health history of a 3-month-old infant from the mother, the nurse asks about
the infant’s ability to suck and grasp the mother’s finger. What is the nurse assessing?
a.
Reflexes
b.
Intelligence
c.
Cranial nerves
d.
Cerebral cortex function
18. In obtaining a health history on a 74-year-old patient, the nurse notes that he drinks alcohol
daily and that he has noticed a tremor in his hands that affects his ability to hold things. With
this information, what response should the nurse make?
a.
“Does the tremor change when you drink alcohol?”
b.
“Does your family know you are drinking every day?”
c.
“We’ll do some tests to see what is causing the tremor.”
d.
“You really shouldn’t drink so much alcohol; it may be causing your tremor.”
19. A 50-year-old woman is in the clinic for weakness in her left arm and leg that she has noticed
for the past week. The nurse should perform which type of neurologic examination?
a.
Glasgow Coma Scale
b.
Neurologic recheck examination
c.
Complete neurologic examination
d.
Screening neurologic examination
20. During an assessment of the cranial nerves (CNs), the nurse finds the following: asymmetry
when the patient smiles or frowns, uneven lifting of the eyebrows, sagging of the lower
eyelids, and escape of air when the nurse presses against the right puffed cheek. These
findings indicate dysfunction of which cranial nerve(s)?
a.
Motor component of CN IV
b.
Motor component of CN VII
c.
Motor and sensory components of CN XI
d.
Motor component of CN X and sensory component of CN VII
21. The nurse is testing the function of CN XI. Which statement best describes the response the
nurse should expect if this nerve is intact?
a.
Patient demonstrates the ability to hear normal conversation.
b.
When patient sticks out tongue it is midline and without tremors or deviation.
c.
Patient follows an object with his or her eyes without nystagmus or strabismus.
d.
Patient moves the head and shoulders against resistance with equal strength.
22. During the neurologic assessment of a “healthy” 35-year-old patient, the nurse asks him to
relax his muscles completely. The nurse then moves each extremity through full range of
motion. Which of these results would the nurse expect to find?
a.
Firm, rigid resistance to movement
b.
Mild, even resistance to movement
c.
Slight pain with some directions of movement
d.
Hypotonic muscles as a result of total relaxation.
23. When the nurse asks a 68-year-old patient to stand with his feet together and arms at his side
with his eyes closed, he starts to sway and moves his feet farther apart. How should the nurse
document this finding?
a.
Ataxia
b.
Lack of coordination
c.
Negative Homan sign
d.
Positive Romberg sign
24. The nurse is performing an assessment on a 29-year-old woman who visits the clinic reporting
“always dropping things and falling down.” While testing rapid alternating movements, the
nurse notices that the woman is unable to pat both of her knees. Her response is extremely
slow and she frequently misses. What should the nurse suspect?
a.
Lesion of CN IX
b.
Vestibular disease
c.
Dysfunction of the cerebellum
d.
Inability to understand directions
25. During the taking of the health history of a 78-year-old man, his wife states that he
occasionally has problems with short-term memory loss and confusion: “He can’t even
remember how to button his shirt.” When assessing his sensory system, which action by the
nurse is most appropriate?
a.
The nurse would perform the tests, knowing that mental status does not affect
sensory ability.
b.
The nurse would proceed with an explanation of each test, making certain that the
wife understands.
c.
Before testing, the nurse would assess the patient’s mental status and ability to
follow directions.
d.
The nurse would not test the sensory system as part of the examination because the
results would not be valid.
26. The assessment of a 60-year-old patient has taken longer than anticipated. In testing his pain
perception, the nurse decides to complete the test as quickly as possible. When the nurse
applies the sharp point of the pin on his arm several times, he is only able to identify these as
one “very sharp prick.” What would be the most accurate explanation for this?
a.
The patient has hyperesthesia as a result of the aging process.
b.
This response is most likely the result of the summation effect.
c.
The nurse was probably not poking hard enough with the pin in the other areas.
d.
The patient most likely has analgesia in some areas of arm and hyperalgesia in
others.
27. The nurse is performing a neurologic assessment on a 41-year-old woman with a history of
diabetes. When testing her ability to feel the vibrations of a tuning fork, the nurse notices that
the patient is unable to feel vibrations on the great toe or ankle bilaterally, but she is able to
feel vibrations on both patellae. Given this information, what would the nurse suspect?
a.
Hyperalgesia
b.
Hyperesthesia
c.
Peripheral neuropathy
d.
Lesion of sensory cortex
28. The nurse places a key in the hand of a patient and he identifies it as a penny. What term
would the nurse use to describe this finding?
a.
Extinction
b.
Stereognosis
c.
Graphesthesia
d.
Tactile discrimination
29. The nurse is testing the deep tendon reflexes of a 30-year-old woman who is in the clinic for
an annual physical examination. When striking the Achilles heel and quadriceps muscle, the
nurse is unable to elicit a reflex. How should the nurse proceed?
a.
Ask the patient to lock her fingers and pull.
b.
Document these reflexes as 0 on a scale of 0 to 4+.
c.
Refer the patient to a specialist for further testing.
d.
Complete the examination, and then test these reflexes again.
30. In assessing a 70-year-old patient who has had a recent cerebrovascular accident, the nurse
notices right-sided weakness. What might the nurse expect to find when testing his reflexes on
the right side?
a.
Normal reflexes
b.
Lack of reflexes
c.
Diminished reflexes
d.
Hyperactive reflexes
31. When the nurse is testing the triceps reflex, what is the expected response?