Chapter 22: Neurologic System Test Bank Seidel’s Guide to Physical Examination-8th Edition-Jane W. Ball

Chapter 22: Neurologic System Test Bank Seidel’s Guide to Physical Examination-8th Edition-Jane W. BallMULTIPLE CHOICE 1.The autonomic nervous system coordinates which of the following? a.High-level cognitive function b.Balance and affect c.Internal organs of the body d.Balance and equilibrium ANS:C The autonomic nervous system coordinates the internal environment of the body by the sympathetic and parasympathetic nervous systems. The other options are associated with the cerebral cortex; its function consists of determining intelligence, personality, and motor function. 2.The major function of the sympathetic nervous system is to: strate the stress response. inate fine motor movement. mine proprioception. ive stereognosis. ANS:A Stimulation of the sympathetic branch of the autonomic nervous system prepares the body for emergencies for fight or flight (stress response). The cerebellum plays a key role in the coordination of fine motor movements. Recognition of body parts and awareness of body position (proprioception) are dependent on the parietal lobe. Stereognosis is the ability to perceive the weight and form of solid objects by touch and is not under sympathetic control. 3.The parasympathetic nervous system maintains the day-to-day function of: tion. nse to stress. atic supply to the brain. atic drainage of the brain. ANS:A The parasympathetic division functions in a complementary and counterbalancing manner to conserve body resources and maintain day to day body functions, such as digestion and elimination. 4.Cerebrospinal fluid serves as a: impulse transmitter. blood cell conveyer. absorber. tor of voluntary skeletal movement. ANS:C Cerebrospinal fluid circulates between an interconnecting system of ventricles in the brain and around the brain and spinal cord, serving as a shock absorber. 5.Diabetic peripheral neuropathy will likely produce: active ankle reflexes. ished pain sensation. erated vibratory sense. sensitive temperature perception. TEST BANK CHAPTER 22: NEUROLOGIC SYSTEM ANS:B Peripheral neuropathy is a disorder of the peripheral nervous system that results in motor and sensory loss in the distribution of one or more nerves, usually in the hands and feet. Patients may have sensations of numbness, tingling, burning, and cramping. In moderate to severe diabetic neuropathy, there is wasting of the foot muscles, absent ankle and knee reflexes, decreased or no vibratory sensation below the knees, and/or loss of pain or sharp touch sensation to the midcalf level. 6.The thalamus is the major integration center for the perception of: h. tion. . hts. ANS:C The thalamus is the major integrating center for the perception of various sensations such as pain and temperature, serving as the relay center between the basal ganglia and cerebellum. The reception of speech and interpretation of speech are located in the Wernicke area. The olfactory sense is processed in the parietal lobe. The cerebrum holds memories, allows you to plan, and enables you to imagine and think. 7.The awareness of body position is known as: ioception. esthesia. ognosis. -point discrimination. ANS:A Recognition of body parts and awareness of body position are known as proprioception. This is dependent on the parietal lobe. The other options are assessment techniques that test for sensory impairment. 8.Which area of the brain is responsible for perceiving sounds and determining their source? a.Frontal lobe b.Occipital lobe c.Parietal lobe d.Temporal lobe ANS:D The temporal lobe is responsible for the perception and interpretation of sounds and determination of their source. The frontal lobe contains the motor cortex associated with voluntary skeletal movement. The occipital lobe contains the primary vision center. The parietal lobe is primarily responsible for processing received sensory data. 9.Peripheral nerves that arise from the brain rather than the spinal cord are called ___________ nerves. thetic ympathetic al omic ANS:C Cranial nerves are peripheral nerves that arise from the brain rather than the spinal cord. The other choices refer to the autonomic nervous system. 10.Which area of the brain maintains temperature control? a.Epithalamus b.Thalamus c.Abducens d.Hypothalamus ANS:D The hypothalamus is the major processing center of internal stimuli for the autonomic nervous system. It maintains temperature control, water metabolism, body fluid osmolarity, feeding behavior, and neuroendocrine activity. The epithalamus houses the pineal body and is responsible for sexual development and behavior. The thalamus conveys all sensory impulses, except olfaction, to and from the cerebrum before their distribution to appropriate associative sensory areas. The abducens is the sixth cranial nerve with motor function responsible for lateral eye movement. 11.If a patient cannot shrug his or her shoulders against resistance, which cranial nerve (CN) requires further evaluation? a.CN I, olfactory b.CN V, trigeminal c.CN IX, glossopharyngeal d.CN XI, spinal accessory ANS:D CN XI is responsible for the motor ability to shrug the shoulders. CN I is associated with smell reception and interpretation. CN V is associated with opening of the jaw, chewing, and sensation of the cornea, iris, conjunctiva, eyelids, forehead, nose, teeth, tongue, ear, and facial skin. CN IX is associated with swallowing function, sensation of the nasopharynx, gag reflex, taste, secretion of salivary glands, carotid reflex, and swallowing. 12.Motor maturation proceeds in an orderly progression from: heral to central. to toe. al to medial. to cephalic. ANS:B Motor maturation proceeds in a cephalocaudal direction. Motor control of the head and neck develops first, followed by the trunk and extremities. The other choices are incorrect because they relate the maturation sequence inappropriately, from outward to central. 13.Normal changes of the aging brain include: ased velocity of nerve conduction. ished perception of touch. ased total number of neurons. ished intelligence quotient. ANS:B Sensory perceptions of touch and pain are diminished by aging. The velocity of nerve impulse conduction declines, so responses to stimuli take longer. The number of cerebral neurons is thought to decrease by 1% a year, beginning at 50 years of age; however, the vast number of reserve cells inhibits the appearance of clinical signs. 14.The area of body surface innervated by a particular spinal nerve is called a: tome. pathway. l accessory area. eous zone. ANS:A The sensory and motor fibers of each spinal nerve supply and receive information to a segment of skin known as a dermatome. Nerve pathway and spinal accessory area refer to nerve routes. Cutaneous zone refers to a skin area that transmits fine mechanical information and normal exogenous thermal information at the same time. 15.A neurologic past medical history should include data about: gies. latory problems. tional level. izations. ANS:B The neurologic past medical history should include data concerning neurovascular problems such as stroke, aneurysm, and brain surgery. The other answers are not pertinent medical information for the neurologic past medical history. 16.Which of the following is the technique most often used for evaluating the neurologic system? a.Auscultation b.Inspection c.Palpation d.Percussion ANS:B The evaluation tool of inspection is used most often. Inspection of gait and response to questions can provide data concerning neurologic system function. 17.When assessing superficial pain, touch, vibration, and position perceptions, you are testing: ellar function. onal status. ry function. n reflexes. ANS:C Superficial pain, touch, vibration, and position perceptions are sensory functions. 18.You are initially evaluating the equilibrium of Ms. Q. You ask her to stand, with her feet together and arms at her sides. She loses her balance. Ms. Q has a positive: a.Kernig sign. b.Homan sign. c.McMurray test. d.Romberg sign. ANS:D The Romberg test has the patient stand with the eyes closed, feet together, and arms at the sides. A slight swaying movement of the body is expected, but not to the extent of falling. Loss of balance results in a positive Romberg test. The Kernig sign indicates meningeal irritation, the Homan sign indicates venous thrombosis, and the McMurray test is a rotation test for demonstrating a torn meniscus. 19.The finger to nose test allows assessment of: ination and fine motor function. location. ry function. ognosis. ANS:A To perform the finger to nose test, the patient closes both eyes and touches his or her nose with the index finger, alternating hands while gradually increasing the speed. This tests coordination and fine motor skills. All the other choices test sensory function without motor function. 20.You are performing a two-point discrimination test as part of a well physical examination. The area with the ability to discern two points in the shortest distance is the: . . rtips. arms. ANS:C The fingertips can discern two points with a minimal distance of 2 to 8 mm, the back, 40 to 70 mm, the palms, 8 to 12 mm, and the upper arms, 75 mm. 21.As Mr. B enters the room, you observe that his gait is wide-based and he staggers from side to side while swaying his trunk. You would document Mr. B’s pattern as: nic ataxia. ellar ataxia. age gait. ic stamping. ANS:B A cerebellar gait (cerebellar ataxia) occurs when the patient’s feet are wide-based, with a staggering gait, lurching from side to side, often accompanied by swaying of the trunk. Dystonic ataxia is jerky dancing movements that appear nondirectional. Steppage gait is noted when the hip and knee are elevated excessively high to lift the plantar-flexed foot off the ground. The foot is brought down with a slap and the patient is unable to walk on the heels. Tabetic stamping occurs when the legs are positioned far apart, lifted high, and forcibly brought down with each step; in this case, the heel stamps on the ground. 22.Deep pressure tests are used mostly for patients who are experiencing: t superficial pain sensation. and stepping disturbances. sis, osteoporosis, or arthritis. neck or torso spasms. ANS:A Deep pressure sensation is tested by squeezing the trapezius, calf, or biceps muscle, thus causing discomfort. When superficial pain sensation is not intact, further assessments of temperature and deep pressure sensation are performed. 23.Vibratory sensory testing should be routinely done for the patient with: a.Parkinson disease. tes. ral palsy. d.Guillain-Barré syndrome. ANS:B Diabetic neuropathy must be routinely assessed in all diabetic patients. In moderate to severe cases, decreased or absent vibratory sensation occurs below the knees, which should be assessed with a tuning fork. The other choices do not result in sensation deficits. 24.To assess a cremasteric reflex, the nurse strokes the: of the foot and observes whether the toes fan down and out. en and observes whether the umbilicus moves away from the stimulus. thigh and observes whether the testicle and scrotum rise on the stroked side. and observes whether the fingers attempt to grasp. ANS:C Stroking the inner thigh of a male patient (proximal to distal) will elicit the cremasteric reflex. The testicle and scrotum rise on the stroked side. Stroking the sole of the foot elicits a Babinski sign. Stroking the abdomen elicits an abdominal reflex. Stroking the palm elicits a palmar grasp. 25.When you ask a patient to close her or his eyes and identify an object placed in the hand, you are evaluating: ognosis. esthesia. tory sensation. ction phenomenon. ANS:A. Stereognosis is the ability to recognize an object through touch and manipulation. Tactile agnosia, an inability to recognize objects by touch, suggests a parietal lobe lesion. Graphesthesia tests the patient’s ability to identify the figure being drawn on the palm. The vibratory sense uses a tuning fork placed on a bony prominence, and the extinction phenomenon tests sensation by simultaneously touching bilateral sides of the body with a sterile needle. 26.The ability to recognize a number traced on the skin is called: ognosis. esthesia. extinction phenomenon. -point discrimination. ANS:B The ability to recognize a number traced on the skin is called graphesthesia. Stereognosis is the ability to recognize an object through touch and manipulation. The extinction phenomenon test and twopoint discrimination assess a person’s ability to discern the number of pinpoints and their location. 27.Which one of the following conditions is consistent with Brown-Séquard syndrome? a.Central sensory loss that is generalized b.Motor paralysis on the lesion side of the body c.Multiple peripheral neuropathy of the joints d.Spinal root paralysis below the umbilicus ANS:B Parietal spinal sensory syndrome (Brown-Séquard syndrome) is noted when pain and temperature sensation occur one to two dermatomes below the lesion on the opposite side of the body from the lesion. Proprioceptive loss and motor paralysis occur on the lesion side of the body. 28.To assess spinal levels L2, L3, and L4, which deep tendon reflex should be tested? a.Triceps b.Patellar c.Biceps d.Achilles ANS:B To assess spinal levels L2-L4, the patellar reflex should be tested. The patellar tendon is the only deep tendon that assesses the lumbar spinal level. The triceps and biceps tendon are tested to assess the cervical spine, whereas the Achilles tendon is tested to assess the sacral spine. 29.When using a monofilament to assess sensory function, the nurse: two simultaneous monofilaments on similar bilateral points and then compares results. es both a monofilament and a pin on similar bilateral points and then compares results. es pressure to the monofilament until the filament bends. es the monofilament along the skin from proximal to distal areas. ANS: C The monofilament is placed on several smooth spots of the patient’s plantar foot for seconds. Adequate pressure applied by the monofilament is measured by the bend of the monofilament. 30.Visible or palpable extension of the elbow is caused by reflex contraction of which muscle? a.Achilles b.Biceps c.Patellar d.Triceps ANS: D The triceps tendon, when directly hit with the reflex hammer just above the elbow, will cause contraction of the triceps muscle and extension of the elbow. 31.It is especially important to test for ankle clonus if: tendon reflexes are hyperactive. tendon reflexes are hypoactive. Romberg sign is positive. patient has peripheral neuropathy.